Final Exam Comprehensive Review PDF

Small Group 1
AMEDD CAPTAINS CAREER COURSE 18-181

AC111 Analyze Cultural Variables
AC121 Cross-Cultural Skill Building L120 Leader Development Doctrine
AC131 Cultural Considerations of Negotiations L130 Think Critically and Creatively
L141 Examine the Army Ethic
AO220.1 Army Medicine L151 Examine Key Concepts of the Army Profession
AO220.2 Army Medicine Campaign Plan L160 Write Effectively
AO221.1 MEDCOM L161 Staff Communications
AO221.4 MHS Funding L162 Engage the Media
AO221.3 High Reliability Organizations (HRO) L170 Lead in Organizations
L171 Establish and Exert Influence
AS210.1 Introduction to Army Health System (AHS) L172 Counseling
Support
Medical Functional Areas (MFAs) LE110 Military Justice for Leaders
● Medical Mission Command LE130 Resiliency for Mid-Grade Leaders
● Medical Treatment LE150 Property Management in the COE
● Medical Evacuation LE160 Unit Maintenance Operations
● Hospitalization LE170 Commander’s Programs
● Dental Services
● Preventative Medical Services M111 Brigade Combat Team (BCT)
● Combat Operational Stress Control M112 Fundamentals of MIssion Command
● Veterinary Services Philosophy
● Medical Logistics M113 Mission Command: Warfighting Functions
● Medical Lab Services M114 Mission Command Staff Tasks
AS210.2 Military Terms and Symbology M116 Troop Leading Procedures (TLPs)
AS211.1 BCT AHS Support M117 Framing the Operational Environment
AS211.2 BCT Medical Readiness and Training
AS212.1 Echelons Above Brigade (EAB) AHS O501 Doctrine Foundations
Support O502 Stability Operations
AS212.2 EAB Medical Evacuation O503 Tactical Logistics
AS213.1 AHS Support to Stability O504 Fundamentals of Offensive Operations
AS213.2 Joint Medical Capabilities O505 Defensive Operations
AS213.3 Preservation of Remains O506 Homeland Defense and DSCA
AS214.1 AHS Planning O507 Joint Operations
AS215.1 AHS Support to DSCA
AS215.2 HICS OP111 Operations Process
OP112 The Command Post Organization &
CO230.1 HELOS Operations
CO230.2 HRP Clinical Operations OP121.1 Intro to Military Decision Making Process
CO231.1 Healthcare Education & Regulation (MDMP)
CO232.1 Clinical Quality Management OP121.2 Mission Analysis & Casualty Estimation
OP121.3 Course of Action (CoA) Development
HA241.2 IDES OP121.4 CoA Analysis, Comparison, Decision
HA250.2 TAP OP121.5 Orders Production
HA250.1 Business of Healthcare OP131 Rehearsals and FRAGORDS
HA250.3 Healthcare Quality & Cost Control OP141 RDSP
HA251.1 MED INFO SYS
HA252.1 HRP MEDLOG S100 Space Impacts on Army Operations
HA253.1 Intro to Health Law
T111 Unit Training Management 1
HR240.1 OERs T112 Unit Training Management 2
HR240.2 NCOERs T113 Unit Training Management 3
HR240.3 Awards
HR242.1 Civilian Human Resource Management U510 Law of Armed Conflict
HR242.2 PROFIS
⇱Clinical Business Module (external document)
In Order of Class Coverage* 2
L170 LEAD IN ORGANIZATIONS

❖ Assigned Readings
FM 6-22 (2015) paragraphs 1-3 to 1-9, 1-25 to 1-26, 2-1 to 2-10, 3-4 to 3-10.
FM 6-22 (2015) Read “Providing Feedback on Developmental Needs” on page 3-15; “Overcoming
Resistance to Feedback, Going the Extra Step” on page 3-16 and “Be an Advocate for Yourself-Take a
Career-view” on page 3-32.
Discuss:
1. How leaders function as change agents and encourage subordinates to exercise initiative.
2. How company grade officers can support the concept of life-long learning.
3. How to shape learning in the three domains.
4. How do leaders apply the fundamentals of leadership regardless of gender?
❖ Army 2020
➢ To address integration risk factors in near/mid/far term - Army leaders must mitigate the risk of
each factor with prioritization on Standards & Policy (near-term), Leadership (mid-term), Time
(far-term).
▪ Factors: Physical standards (MOS-specific developments), pregnancy, SH/SA, Combat Arms
culture, Field Environment, Stereotypes on women & men, Differences in leadership style,
Reclassification; Spousal concerns; “Tokenism”; Role Models; Physical Proximity;
Professional Standards of Conduct
▪ Barriers to successful integration: Inconsistent enforcement of standards/perceptions of
double-standards; Incidents of unprofessional behavior, indiscipline; Fear of sexual
harassment/assault; Cultural stereotypes; Ignorance of Army policy
❖ Lead in Organizations
➢ Lead change in organizations
▪ Function as a change agent
● Facilitate, welcome change
▪ Encourage subordinates to exercise initiative
● Engage, allow subordinates to make decisions
➢ Develop learning organizations
▪ Support the concept of life-long learning
▪ Develop self-awareness
▪ Learn from mistakes
➢ Develop subordinate leaders
▪ Shape learning in 3 domains:
● Institutional, operational, and self-development
▪ Individual development plan (guides subordinates toward their career goals)
▪ Mentor – guidance, impart wisdom; typically outside chain of command or organization
▪ Coach – teaching a skill
▪ Counsel – comes from a supervisor; performance evaluation (can be positive or negative)
L130 THINK CRITICALLY AND CREATIVELY

ATP 2-33.4 (2014) (For Foreign Disclosure), Intelligence Analysis, Chapter 2 para 2-13 thru 2-43 (9
pages)
The Applied Critical Thinking Handbook (Formerly the Red Team Handbook), (2015), pgs 43-55, 106-107
(15 pages).
ADRP 6-0 (2012 w/ Change 2 2016), para 2-27 thru 2-49 (4 pages).
ADRP 6-22 (2017), para 5-1 thru 5-10 (2 page).
www.Criticalthinking.org
Discuss:
1) What is the mental processes of critical thinking, and how is it used.
⇱RETURN to Table of Contents

2) How to use practical tools to enhance creative thinking.

3) What are the common pitfalls in thinking, and how to avoid them.
❖ Critical thinking
➢ Examines a problem in depth
➢ Thought process that aims to find facts, to think through issues, and solve problems
➢ Enables understanding of changing situations, arriving at justifiable conclusions, making good
judgments, and learning from experience
➢ Develop knowledge that conforms to reality to make better choices
❖ Creative thinking
➢ Thinking in innovative ways
➢ An outgrowth of critical thinking
❖ Leaders should quickly isolate a problem and ID solutions to generate initiative; instill agility and
initiative within subordinates
❖ Critical + creative thinking = Army Design Methodology to understand, visualize, and describe
❖ Paul-Elder Critical Thinking Model
➢ The Standards must be applied to The Elements to develop Intellectual Traits
➢ Disciplined thinking = standards + elements
➢ Standards of Thinking
▪ Clarity - elaborate further
▪ Accuracy – able to verify
▪ Precision – be more specific
▪ Relevance - how does that relate to the problem?
▪ Fairness - any vested interest in issue?
▪ Depth - complexities
▪ Breadth – look from another perspective
▪ Logic - makes sense together
▪ Significance - central focus, what’s most important
➢ Elements
▪ Point of view
▪ Question
▪ Purpose
▪ Assumptions
▪ Inferences
▪ Information
▪ Concepts
▪ Implications
➢ Intellectual Traits
▪ Courage – true to our own thinking regardless of consequences
▪ Humility – don’t claim more than you know; open to consider other/new input
▪ Autonomy – thinking for oneself while adhering to standards of rationality
▪ Fair-mindedness – treat all viewpoints equally
▪ Faith in reason – confidence that one’s own higher interests and those of society will be best
served
▪ Perseverance – having a consciousness of the need to use intellectual insights and truths in
spite of difficulties, obstacles, and frustrations
▪ Integrity – be consistent in the intellectual standards one applies to oneself
▪ Empathy – put yourself in another’s shoes
❖ Thinking and Mission Command
➢ “Art of command is creative and skillful exercise of authority through timely decision making and
leadership" (ADP 6-0).
➢ Data (Processed) → Information (Analyzed) → Knowledge (Judgement Applied) →
Understanding
➢ Creativity – an outgrowth of critical thinking (original ideas)
➢ Innovation – creativity made practical; value

➢ Tools for creativity and innovation

▪ Brainstorm - generate unconstrained ideas
▪ Outside-in thinking: “think outside the box”
▪ Red-teaming: role-play an opponent, competitor, or adversary and bring another perspective
to the problem
▪ What-if?
▪ Post-mortem analysis: assuming failure and how it could happen, used to check course of
action is doable
➢ Intuition
▪ Not magic, very situation-specific
▪ Province of experts
▪ Based on experience, mental stimulation, and pattern recognition
▪ Guidelines:
● Not trustworthy in unfamiliar situations
● Reliable in genuine experts
● USe analytics to check, time permitting
➢ Pitfalls in Thinking
▪ Heuristic-Related (describes an approach to problem solving and learning based on trial and
error, experience or experimentation)
● Availability - assign great weight to an idea because it comes to mind readily
● Representative - assign great weight to an idea because it comes to mind readily
● Anchoring - overreliance to what’s worked in the past
▪ Logical Fallacies
● Attacking the person rather than the idea
● False dichotomy - few problems are solely black and white; more than 2 alternatives
● False cause - correlation doesn't equal causation
● Appeal to the masses - popular opinion doesn’t equal fact
▪ Other Biases
● Confirmation bias - tend to look for evidence that supports the conclusion we’ve made
prematurely, not realizing that evidence can often support several hypotheses
● Sunk cost bias - persist in deciding and acting illogically, based upon decisions they
made previously; “Failure to cut bait”
● Cultural bias
● Gambler’s fallacy - “our luck is bound to change”
● Overthink
L120 LEADER DEVELOPMENT DOCTRINE

ADRP 6-22 (2012), Army Leadership
Introduction (1 page) introduces the publication.
Chapter 1 (7 pages), provides the foundation for the class regarding leadership doctrine and
identifies an approach to the Army leadership requirements model.
Chapter 7, paras 7-1 through 7-9,7-37 through 7-64. (3 pages) addresses the core leader
competency Develops; by preparing self and developing others.
TP 525-8-2 (April 2017), The US Army Learning Concept. Appendix C (21st Century Competencies),
pages 42-44.

Discuss:
1. What is the Army framework for leader development and how is it executed?
2. What are the key concepts discussed in Army leader development doctrine?
3. How to execute the self-development process and capitalize on development opportunities.
4. What are some common Leader development challenges and ways to overcome them.
❖ The Army leadership requirements model (ADRP 6-22)

➢ Leadership Attributes – what a leader is
▪ Character – Army values, empathy, Warrior Ethos, Discipline
▪ Presence – Military & professional bearing, Fitness, Confidence, Resilience
▪ Intellect – Mental agility, Sound judgment, Innovation, Interpersonal tact, Expertise
➢ Leadership Competencies – what a leader does
▪ Leads – Leads others, Builds trust, Extend influence beyond chain of command, Leads by
example, Communicates
▪ Develops – Prepares self, Develops others, Fosters esprit de corps/Create a positive
environment, Stewards the profession
▪ Achieves – Gets results
● Integrates tasks, roles, resources, and priorities.
● Improves performance.
● Gives feedback
● Executes
● Adjusts
❖ The leader’s character, presence, and intellect enable the leader to master the core leader
competencies (Leads, Develops, Achieves). The Army leaders is responsible to lead others; to
develop the environment, themselves, others, and the profession as a whole; and to achieve
organizational goals. ADRP 6-22, para 1-28, page 1-5, Aug 2012.
❖ Leader development is deliberate, continuous, sequential, and progressive process… (AR 600-100)
❖ Key components of the definition of leadership are:
➢ Influencing others
➢ Operating to accomplish the mission
➢ Improving the organization
❖ Leader Development Model
➢ Institutional (Schools)
▪ Professional Military Education (PME)
● A progressive education system that prepares leaders for increased responsibilities and
successful performance at the next higher level by developing the key knowledge, skills,
and attributes they require to operate successfully at that level in any environment.
● Linked to promotions, future assignments, career management models, and applies to all
officers.
♦ Train leaders in critical tasks
♦ Develop total Army
♦ Produce high quality product
♦ Select quality instructors
♦ Provide proper mix of resident, non-resident, distance
➢ Operational (Unit) – “on-the-job” training
▪ Provide leader development assignments
▪ Provide adequate training opportunities
▪ Assign based on leader development priorities
➢ Self-development (Soldier) – individual responsibility
▪ Supports life-long learning in the institutional and operational assignments and bridges the
gaps
▪ Identify, specify, and refine self-development requirements
▪ To develop self, individuals need:
● Capability (training)
● Opportunity (duties, resources, stretch assignments)
● Motivation (attitude, rewards [intrinsic, extrinsic, equitable], needs satisfaction, perceived
value)

▪ To improve overall organizational performance, the leader must provide the environment that
empowers and motivates individuals
M112 FUNDAMENTALS OF MISSION COMMAND PHILOSOPHY

ADP 6-0, Mission Command, 12 March 2014, para 22 thru 39
ADRP 6-0, Mission Command, 28 Mar 2014, Preface, Introduction, and Chapter 1 and 2
ADRP 3-0, Operations, 11 November 2016, para 3-41 thru para 3-46
ADRP 6-22, Army Leadership, 10 September 2012, para 5-3 thru 5-5
Discuss:
1. How does Army define the philosophy of mission command?
2. What are the six principles of mission command?
3. Analyze how critical thinking and mental agility support the philosophy of mission command.
❖ The Warfighting Functions

➢ Warfighting function: staff-guided; group of tasks and systems (people, organizations,
information, and processes) united by a common purpose that commanders use to accomplish
missions and training objectives.
➢ 4 Primary Staff Tasks
▪ conduct the operations process (plan, prepare, execute, and assess)
▪ conduct knowledge management and information management
▪ conduct information and influence activities
▪ conduct cyber electromagnetic activities
❖ Mission Command Philosophy: exercise of authority and direction by the commander using mission
orders to enable disciplined initiative within the commander's intent to empower agile and adaptive
leaders in the conduct of Unified Land Operations (ULO)
❖ Mission Command Warfighting Function
➢ Mission command is the related tasks and systems that develop and integrate those activities
enabling a commander to balance the art of command and the science of control in order to
integrate the other warfighting functions
➢ Emphasizes centralized intent and dispersed execution through disciplined initiative.
➢ Disciplined initiative fosters agile and adaptive forces
➢ 6 Mission Command Principles:
● Build cohesive teams through mutual trust
● Create shared understanding
● Provide a clear commander’s intent
● Exercise disciplined initiative
● Use mission orders
● Accept prudent risk
❖ Mission Command System: the arrangement of personnel, networks, information systems,
processes, procedures, facilities and equipment that enable commanders to conduct operations
❖ Critical Thinking and Mental Agility support mission command:

➢
➢ ADRP 6-22, para 5-3 to 5-5:
▪ 5-3. Mental agility is a flexibility of mind, an ability to anticipate or adapt to uncertain or
changing situations.
▪ 5-4. Mental agility relies upon inquisitiveness and the ability to reason critically. Inquisitive
leaders are eager to understand a broad range of topics and keep an open mind to multiple
possibilities before reaching an optimal solution. Critical thinking is a thought process that
aims to find facts, to think through issues, and solve problems…. Critical and creative thinking
are the basis for the Army Design Methodology to understand, visualize, and describe
complex, ill-structured problems and develop approaches to solve them. Critical thinking
captures the reflection and continuous learning essential to applying Army Design
Methodology concepts. Creative thinking involves thinking in innovative ways while
capitalizing on imagination, insight, and novel ideas.
▪ 5-5. Critical thinking examines a problem in depth from multiple points of view. This is an
important skill for Army leaders—it allows them to influence others and shape organizations.
M116 TROOP LEADING PROCEDURES (TLPS)

❖ TLP – the process a leader goes through to prepare the unit to accomplish a mission
➢ Process a company level or smaller unit leader goes through to prepare the unit to accomplish a
mission
▪ Begins when WARNO received
▪ May be accomplished concurrently
▪ How to think vs. what to think
❖ (8) Steps of TLP
➢ Receive the mission
▪ Analyze mission using METT-TC
● Mission, Enemy, Terrain/Weather, Troops, Time, Civilians
➢ Issue the warning order
➢ Make a tentative plan
➢ Initiate movement
➢ Conduct Reconnaissance
▪ At a minimum, the leader must make a map reconnaissance
➢ Complete plan
➢ Issue the complete plan
▪ Have terrain model or sketch prepared if unable to overlook objective
▪ Ensure all soldiers understand mission - Use brief backs and quiz junior troops
➢ Supervise and Refine
▪ conduct inspections and rehearsals
❖ 1/3-2/3 Rule
➢ Leader uses no more than 1/3 of available time for planning and issuing OPORD
➢ Subordinates get 2/3 of available time to plan and prepare

➢ Use backwards planning to schedule

❖ Compare TLP to MDMP
➢ “Parallel planning”
TLP MDMP
Receive the mission → Receive the mission
Issue the WARNO
Make a tentative plan → Mission analysis
Initiate movement COA development
Reconnoiter COA analysis
COA comparison
COA approval
Complete the Plan
Issue the complete plan → Orders production
Supervise
L160 WRITE EFFECTIVELY

ST 22-2 (March 2016) Writing and Speaking Skills for Army Leaders.
· Chapter 1, (5 pages) Read to gain an understanding of the army writing style
· Chapter 2, (24 pages) Read to gain an understanding of writing expectations
· Appendix A (5 pages) Read to gain an understanding of style, academic writing, and reference
citation
AR 25-50 (May 2013), Preparing and Managing Correspondence
· Ch 1, Section IV, (1 page) Read to gain an understanding of standards for Army writing
TR 1-11 (26 Aug 2015) Staff Procedures
· Ch 3-5/3-9, (8 pages)Read to gain an understanding of standards for Point Paper, Executive
Summary, Information Papers, and Position Paper.
Hints and Helpful Guidance for the Army Writer (Dec. 19, 2013)
· Writing Guide #1-3 (3 pages) U.S. Army Warrant Officer Career College
http://usacac.army.mil/cac2/wocc/WritingGuide.asp
Effective Writing for Army Leaders article from the Military Review. Click the hyperlink or access .pdf on
SP site : Military Review Article
Discuss:
1. How would you use the writing process to prepare Army products?
2. Why is it important to understand the Army writing style and standards?
3. What are the strengths and weaknesses of the Army writing style?
4. How would you use L130 Thinking Critically and creatively in your writing? (Military Review article)
❖ Clear, concise, and effective

❖ 5 Steps of the Writing Process
➢ Research and pre-writing
▪ Choose a topic
▪ Brainstorm – eg. mind-mapping
▪ Focus on central ideas
▪ Clarify the requirement (purpose, assumptions, audience, data)
➢ Planning and organizing
▪ Outline
➢ Drafting
➢ Revising and editing
▪ Revise = content and organization
▪ Edit = spelling, grammar, punctuation, etc.
▪ Paul Elder Critical Thinking Model
● Intellectually standards (accuracy, clarity, etc.) must be applied to elements of reason
(purpose, assumptions, etc.) to develop intellectual traits (humility, autonomy, etc.).
➢ Proofreading and final product

▪ Read paper backwards

▪ Use spell check
▪ Perform grammar check
❖ Common knowledge – information is undocumented in at least 5 credible sources
L161 STAFF COMMUNICATIONS

ST 22-2 (March 2016), Writing and Speaking Skills for Army Leaders.
Chapter 4, (11 pages) [18 minutes] Read to gain an understanding of military briefings.
FM 6-0 (May 2014), Commander and Staff Organization and Operations
Chapter 7, Military Briefings, (5 pages) [8 minutes to read] Read to gain an understanding of
Army regulations and expectations of military briefings
ADRP 6.0 (May 2012), Mission Command, Paragraphs 2-75, 2-82, 2-87, and 2-92
Discuss:
1. The concepts and requirements of oral communication.
2. The research requirements of oral presentations.
3. Army guidance on briefing.
4. Effective oral communication.
❖ Types of Briefs
➢ Information
➢ Decision – you are requesting a decision
➢ Mission – issue or enforce an order/OPORD
➢ Staff – inform commander; facilitate information exchange, announce decisions, issue directives,
or provide guidance
❖ Briefing Steps
➢ Plan – analyze the situation and prepare an outline
➢ Prepare – collect information, construct brief
➢ Execute – deliver brief
➢ Assess - follow up as required
❖ Why complete an outline?
➢ Relationships
➢ Balance
➢ Support
❖ Building a briefing outline
➢ Introduction
▪ Greeting
▪ Type of briefing
▪ Purpose/scope
▪ Summarize key points
➢ Main body
➢ Closing
▪ Ask for questions
▪ Recap main ideas
➢ Feedback
▪ Commanders use feedback to compare, decide, and direct
▪ Takes many forms
▪ Comes from many sources
Appendix A
Briefing Format Examples
Figure 1. Information briefing format example

Introduction
Greeting. Address the audience. Identify yourself and your organization.
Type and Classification of Briefing. Identify the type and classification of the briefing. For
example, “This is an information briefing. It is unclassified.”
Purpose and Scope. Describe complex subjects from general to specific.
Outline or Procedure. Briefly summarize the key points and general approach. Explain any
special procedures (such as demonstrations, displays, or tours). For example, “During my
briefing, I will discuss the six phases of our plan. I will refer toaps of our area of operations.
Then my assistant will bring out a sand table to show you the expected flow of battle.” The key
points may be placed on a chart that remains visible throughout the briefing.
Main Body
Arrange the main ideas in a logical sequence.
Use visual aids to emphasize main points.
Plan effective transitions from one main point to the
next. Be prepared to answer questions at any time.
Closing
Ask for questions.
Briefly recap main ideas and make a concluding statement.
Figure 2. Decision briefing format example
1. Introduction
Greeting. Address the decisionmaker. Identify yourself and your organization. “This is a
decision briefing.”
Type and Classification of Briefing. Identify the type and classification of the briefing. For
example, “This is a decision briefing. It is unclassified.”
Problem Statement. State the problem.
Recommendation. State the recommendation.
2. Main Body
Facts. Provide an objective presentation of both positive and negative facts bearing upon the
problem.
Assumptions. Identify necessary assumptions made to bridge any gaps in factual data.
Solutions. Discuss the various options that can solve the problem.
Analysis. List the screening and evaluation criteria by which the briefer will evaluate how to
solve the problem. Discuss relative advantages and disadvantages for each course of action.
Comparison. Show how the courses of action compare against each other.
Conclusion. Describe why the recommended solution is best.
3. Closing
Ask for questions.
Briefly recap main ideas and restate the recommendation.
If no decision is provided upon conclusion of the decision briefing, request a decision.
“Sir/Ma’am, what is your decision?” The briefer ensures all participants clearly understand the
decision and asks for clarification if necessary.
L162 ENGAGE THE MEDIA

Public Affairs Toolbox (electronic file) (12 pgs) Read to gain an understanding of Army Public Affairs
Guidance
Media Guidance for Students, Mr. John McWhethy (electronic file) (7 pgs) Read to gain an understanding
of how to handle a press conference
Media Interview Guide (electronic file) (2 pgs) Read to gain an understanding of Army guidance on talking
to reporters for interviews
FM 3-61 (2014) Preface, paragraphs 1-1, 1-5, 1-6, 1-9 to 1-13.
ALARACT 014/2017 (3 pages) Read to gain an understanding of Professionalization of Online Conduct.

The United States Army Social Media Handbook (2016) (electronic file) (16 pgs) Read to gain an
understanding of how social media influences perception and public opinion. Focus primarily on
Facebook
Air Force Meeting the Media, U.S. Air Force Public Affairs Center of Excellence
Discuss
1. What is 3x3? 3 talking points, 3 points to avoid
2. What is 5x5? 5 themes you want to get across and 5 topics you would like to avoid (worst-case)
❖ Concepts and requirements of media engagement

➢ Understand the TTP’s and doctrine
➢ Every instance is unique
➢ Have a plan
➢ Audience-centered communications (determine what the audience knows and construct an
argument for them)
➢ Use “bridging phases” (eg. the key point is that…)
❖ How does the media shapes general perceptions of the military?
❖ Army guidance concerning media engagement
❖ Your responsibility in media engagement
➢ PAO can assist in preparation for interview or feedback
❖ Ways to ensure successful media engagement
➢ Answer, respond, and explain
➢ Stay on topic and in your lane
➢ Talk through the media to the public
➢ Use messages as guideposts
➢ Be yourself
➢ Respond to issues
➢ Treat reporters with respect
➢ Make proactive statements
➢ If you don’t know – say so! But explain what you do know
LE170 COMMANDER’S PROGRAMS

***LE170 Advance Sheet***
Discussion Questions:
❖ What is a program?
➢ (obsolete) a series of actions proposed in order to achieve a certain result
➢ A plan of action aimed at accomplishing a clear business objective, with details on what work is to
be done, by whom, when, and what means or resources will be used.
▪ Programs require the uniform application of standardized practices and procedures
❖ How does a program differ from a policy or plan?
➢ Policy applies Army-wide, it involves all of the functional branches and all units and operating
agencies.
➢ Plans are implemented on the commander level
❖ What are the components or elements of an Army Program?
➢ Clear description of the benefits to be gained by standardizing
➢ Clear objectives to be achieved
➢ The procedures or actions to be standardized spelled out in an authoritative publication
➢ Specific plan for implementation and sustainment
➢ Effective procedure for enforcement
➢ Clearly delineated responsibilities
❖ What is an example of an authoritative publication?
➢ AR 34-4
❖ What is an Organizational Inspection Program (OIP)?

➢ Inspection: An evaluation that measures performance against a standard and that should identify
the cause of any deviation.
▪ All inspections start with compliance against a standard.
▪ Commanders tailor inspections to their needs
➢ The commander’s/TAG’s program to manage all inspections within the command. It is a
comprehensive, written plan that addresses all inspections and audits conducted by the
command and its subordinate elements as well as those inspections and audits scheduled by
outside agencies.
▪ Commander is responsible for establishing and enforcing OIP
▪ OIPs are developed at the Battalion level and higher to meet objectives defined in AR 1-201
▪ Task Force OIPs must be flexible and support the mission
▪ OIPs are not strictly garrison-oriented, deployed programs may be developed to meet the
needs of units conducting Unified Land Operations
➢ Coordinates inspections and audits into a single, cohesive program focused on command
objectives
▪ Inspector General (IG) is the proponent for inspection policy
▪ Reviews and approves DA guidance for inspections
▪ Advise Commanders and staff on inspection policy
▪ Conducts inspections per AR 20-1
● Inspection governed by AR 1-201 (Army Inspection Policy)
➢ Principles of inspections
▪ Purposeful
▪ Coordinated
▪ Focused on feedback
▪ Instructive
▪ Follow-up
➢ Elements of inspections
▪ Measure performance against a standard
▪ Determine the magnitude of the problem(s)
▪ Seek root cause(s) of the problem(s)
▪ Determine a solution
▪ Assign responsibility to the appropriate individual or agency
➢ The Inspection Cycle
▪
❖ What sources do leaders have for preparing and conducting inspections?
➢ External sources (eg. DOD, IG, operation readiness exercises)
➢ Internal sources (eg. personal observations, USR’s, logistics evals.)
❖ What benefits are gained by implementing standardized programs to address Sexual Harassment
and Equal Opportunity violations within the Army?
➢ Sexual assault has had, and will continue to have, a devastating effect on our capability to
achieve our mission, if we are not successful in our efforts to eliminate sexual assault in the
Army.
➢ Standardized programs will hopefully lead to increased knowledge of how/when/where to report
and increased comfort in reporting.

❖ What are the objectives of the SHARP and EO programs?

➢ EO Objective: formulate, direct, and sustain a comprehensive effort to maximize human potential
to ensure fair treatment for military personnel, family members, and civilians without regard to
race, color, gender, religion, or natural origin, and provide an environment free of unlawful
discrimination and offensive behavior.
➢ The Army’s goal is to eradicate sexual harassment and sexual assault by creating a climate that
respects the dignity of every Soldier, civilian, and Army Family member, inside and outside the
military community
❖ Five Imperatives of SHARP
➢ Prevent
➢ Investigate
➢ Create Positive Climate
➢ Enforce Accountability
➢ Fully Engaged Chain of Command
❖ What are the categories of sexual Harassment?
➢ Physical
➢ Verbal
➢ Non-verbal
❖ What are some warning signs of Sexual Harassment or Assault?
➢ Making inappropriate or uncomfortable comments or suggestive remarks, intrusive touching, and
initiating conversation that is more intimate than the level of relationship warrants.
❖ What reporting options are available to victims?
➢ Unrestricted – formal investigation
➢ Restricted – only report to a few select personnel
❖ Equal Opportunity Program
➢ Define Equal Opportunity, Discrimination and Offensive Behavior.
▪ EO – right of all persons to participate in and benefit from programs and activities for which
they are qualified
▪ Discrimination – unfair treatment on basis of age, gender, race, religion, ethnicity
▪ Offensive behavior – unwanted/unkind actions
➢ Program Elements
▪ Leader Commitment
▪ Sequential and progressive training
▪ Effective and responsive complaint system
▪ EO Action Plan
▪ EO Advisor
▪ EO Leader
▪ Feedback Mechanisms
➢ List the 3 points of fair treatment and 5 areas of unlawful discrimination.
▪ Fair treatment is equal treatment based on:
● Merit – you did the work to earn the reward
● Fitness – you proved yourself competent
● Capability - in support of readiness, means you are capable of accomplishing the mission
▪ Areas of Unlawful discrimination
● Race - identified by the possession of traits transmissible by descent and that is sufficient
to characterize persons possessing these traits as a distinctive human genotype
● Color
● Gender
● Religion - personal set or institutionalized system of attitudes, moral or ethical beliefs and
practices held with the strength of traditional views, characterized by ardor and faith and
generally evidenced
● National origin - An individual’s country of origin or that of an individual’s ancestors
● Sexual orientation
● Offensive Behavior: The Army defines offensive as whatever a reasonable person
experiences as offensive, regardless of the intent of the person performing the behavior.
➢ Violations of EO Policy
▪ Racism

▪ Sexism
▪ Prejudice
▪ Discrimination
➢ EO Complaint Process
▪ Confront the Offender
▪ Inform the appropriate officials
▪ Advise the chain of command
▪ Submit only legitimate complaints
● File 60 calendar days
● Act 3 calendar days
● Investigate 14 calendar days
● Appeal 7 calendar days
● Follow-up Assessment 30-45 calendar days
❖ How are hazing and bullying defined?
➢ Hazing - Any conduct whereby a Servicemember or members regardless of service, rank, or
position, and without proper authority, recklessly or intentionally causes a Servicemember to
suffer or be exposed to any activity that is cruel, abusive, humiliating, oppressive, demeaning, or
harmful
▪ Sometimes results in initiation and acceptance into the organization (“Rite of passage”)
➢ Bullying - Bullying is any conduct whereby a Servicemember or members, regardless of service,
rank, or position, intends to exclude or reject another Servicemember through cruel, abusive,
humiliating, oppressive, demeaning, or harmful behavior, which results in diminishing the other
Servicemember’s dignity, position, or status.
❖ Why is it important to treat everyone with dignity and respect?
➢ The Army is a values-based organization where everyone is expected to do what is right by
treating all persons as they should be treated – with dignity and respect
➢ Conduct selves in accordance with AR 600-20 and treat all persons with dignity and respect.
❖ How have Soldier 2020 and Gender Integration changed the Army culture?
➢ Soldier 2020 = standards-based Army
▪ Match the right Soldiers - regardless of whether they are men or women - to jobs that best
correspond to their abilities.
▪ Stronger Army and allows all Soldiers to best reach their full potential.
➢ End State
▪ All Army occupations and AOCs are opened to all qualified Soldiers, improved screening
tools are used to place the right Soldier into the right job, clearly defined and uniformly
enforced standards are in place for MOS/AOC assignment, enlisted attrition from initial
accession through first term of service is significantly reduced and these conditions have
yielded improved Army readiness
❖ What is considered appropriate online conduct?
➢ Online Conduct as the use of electronic communications in an official or personal capacity that is
consistent with Army Values and Standards of Conduct
➢ Online misconduct is the use of electronic communication to inflict harm.
▪ Include, but are not limited to: harassment, bullying, hazing, stalking, discrimination,
retaliation, or any other types of misconduct that undermine dignity and respect.
Transgender
❖ Recommended Readings:
DoD Directive-type Memorandum (DTM) 16-005
DoD Instruction 1300.28 In-Service Transition from Transgender Service Members
U.S. Army Directive 2016-30 Army Policy on Military Service of Transgender Soldiers)
Glossary: Trans, Genderqueer, and Queer Terms Glossary
https://lgbt.wisc.edu/documents/Trans_and_queer_glossary.pdf
GLAAD Tip Sheet for Allies of Transgender People http://www.glaad.org/transgender/allies
View (to be developed)Transgender transition video “Maintaining Army Readiness while Transitioning”
Transgender Service in the US Military: An Implementation Handbook (30 September 2016)

LE130 RESILIENCY FOR MID-GRADE LEADERS

❖ Assigned Readings:
AR 600-85 – The Army Substance Abuse Program – Chapters 1, 2 and Chapter 9 Section III
AR 600-63 – Army Health Promotion - Chapter 1 paragraph 1-25 and 27, Chapter 4 paragraph 4-4
AR 350-53- Comprehensive Soldier and Family Fitness- Chapter 1 paragraph 1-1, 1-4, 1-5, and 2-1
Discuss:
1. Leader responsibilities within the Army Substance Abuse Program.
2. Leaders role in minimizing the risk of suicidal behavior among Soldiers, DA Civilians, and Family
Members
❖ Performance Triad – part of Army’s Ready and Resilient Campaign [Activity, Nutrition and Sleep]
❖ Unit Behavior Health Needs Assessment Survey (UBHNAS) - assess the behavioral health needs of
a unit
➢ Consult with behavioral health provider to request a UBHNAS
➢ Key capabilities include estimates of Soldiers meeting screening criteria for behavioral health
problems (i.e., depression, post-traumatic stress disorder, and suicidal ideation), stigma and
barriers-to-care concerns, and a variety of unit climate characteristics (e.g., leadership, cohesion,
mission readiness)
➢ Make an up-front commitment to visible action
➢ Develop an action plan to address any problems indicated by UBHNAS results
➢ Communicate progress on the action plan at regular intervals to keep your Soldiers informed
❖ ASAP – Army Substance Abuse Program
➢ A commander’s retention readiness program
➢ AR 600-85, para. 1-5: Prevent alcohol and drug abuse in the Army
➢ Alcohol is the most abused drug by soldiers
➢ Roles
▪ Installation
▪ Unit
● Battalion
● Company
➢ Acronyms
▪ ADCO- Alcohol and Drug Control Officer
▪ UPP- Unit Prevention Plan
▪ UPL- Unit Prevention Leader
▪ URI- Unit Risk Inventory
▪ MRO- Medical Review Officer
▪ USAP- Unit Substance Abuse Program
➢ Biochemical testing commander requirements
▪ Appoint UPL’s (2 officers or NCOs E-5 and above)
▪ Maintain and publish a biochemical testing SOP as part of the USAP SOP
▪ Select observers
▪ Maintain biochemical testing program while deployed
▪ Establish procedures to identify soldiers impaired by alcohol on duty
▪ Random, unpredictable unit urinalysis
▪ Quarterly education/training
▪ Smart testing
● Before and after deployment
● After weekends and holidays
➢ Commander’s actions after receiving a drug positive report
▪ Consult with law enforcement
▪ If no law enforcement, investigation and advise soldier of UCMJ Article 31 rights
● If soldier remains silent or request a lawyer, STOP. Conduct commander’s inquiry without
questioning soldier.
● If soldier waives rights then:
♦ Show evidence to soldier
♦ Explain limited use policy

♦ Request contraband
♦ Request statement
♦ Complete commander’s inquiry
● Initiate flag
● Refer to ASAP
● Consider UCMJ or other adverse action
● Initiate separation, AR 635-200
❖ Suicide Prevention
➢ Seen in garrison, deployment, and training environments
▪ 10th leading manner of death in US
▪ 3rd among 14-25 year olds
▪ 4th among warriors
➢ Most common factors
● Relationship problems
● Occupational problems
▪ Warning signs:
● Previous attempts or thoughts of suicide
● Alcohol/substance abuse
● Statements revealing or hinting at a desire to die
● Sudden changes in behavior or sudden uncharacteristic changes; reckless behavior
● Prolonged depression, withdrawal, listlessness
➢ “ACE” Intervention
▪ ask – care – escort
➢ Suicide Prevention Program
▪ A commander’s responsibility
▪ Annual training requirement
▪ Pre-/post-deployment
▪ Goal: increase positive command climate
❖ What is “real time resilience?”
➢ An internal skill used to shut down counterproductive thinking and build motivation to focus on the
task at hand
L171 ESTABLISH AND EXERT INFLUENCE

ADRP 6-22 (2017), paragraphs 1-5 to 1-16, 1-30 to 1-33, 5-27, 6-1 to 6-18, 6-23 to 6-32, 6-53 to 6-65, 10-
7, and 10-10 to 10-12 (approx 9 pages). *This reading is based on Feb 2017 ADRP 6-22 Final Draft with
the anticipated publication date of October 2017.
ADRP Table 6-3 (one page).
FM 6-22 (June 30, 2015) para 7-19 to 22.
Discuss:
1. How do leaders effectively use influence techniques to accomplish the task (Dr. Maxwell’s ideas
about leadership and influence)?
2. How can leaders build trust and influence beyond the chain of command?
3. What are ways to use rewards and punishments as tools to maintain motivation?
4. How does empowering your subordinates serve your interests?
❖ Leadership:
➢ FM 6-22 - “the process of influencing people by providing purpose, direction, and motivation while
operating to accomplish the mission and improve the organization.”
❖ Influence Company-level units
➢ Influence - getting people to do what is required; accomplished through words and personal
example
▪ Compliance vs. Commitment
➢ Communicate purpose, direction, and motivation
▪ Purpose – gives people a reason to accomplish the mission
▪ Direction – gives a clear mission; prioritize tasks

▪ Motivations – supplies the will and initiative to do what is necessary to accomplish a mission
➢ Formal and informal leadership
➢ Influence techniques
▪ Pressure – explicit demands
▪ Legitimating – leader establishes authority as a basis for a request
▪ Exchange – quid pro quo (“if this, then that”)
▪ Personal appeal – leaders asks the follower to comply with a request based on friendship or
loyalty
▪ Collaboration – leader cooperates in providing assistance or resources to carry out a directive
or request
▪ Rational persuasion – logical explanations
▪ Apprising – helping someone understand why a request will benefit a follower
▪ Inspiration – motivate
▪ Participation – feeling included and part of the team
➢ Provide motivation
➢ Employ rewards and punishments
❖ Negotiate to extend influence within and beyond the chain of command
➢ Gain compliance and commitment
▪ Compliance – focused influence primarily based on leader’s authority
● Appropriate for short-term, immediate requirements where little risk can be tolerated
▪ Commitment – belief something is the right thing to do and is best for the organization
● Changing attitudes and beliefs; longer lasting and broader effects
➢ Provide purpose – provide a vision, provide subordinates reason to achieve desired outcome
▪ Commander’s intent – used to convey purpose
➢ Build trust outside lines of authority – be present with your soldiers
▪ Understanding the sphere, means, and limits of influence
▪ Negotiating, consensus, conflict resolution
● establish trust – identify areas of common interests and goals; keeping others informed
➢ Build consensus, resolve conflicts
▪ Trust, understanding, and knowing the right influence technique for the situation are the
determining factors in negotiating, consensus building and conflict resolution
L141 EXAMINE THE ARMY ETHIC

ADRP 1 (June 2015) The Army Profession, Ch. 2, page 2-1 thru 2-19
ADRP 6-22 (2017), Army Leadership, Ch. 3, page 3-1 thru 3-7. *This reading is based on Feb 2017
ADRP 6-22 Final Draft with the anticipated publication date of October 2017. There are no changes from
version 2012 to 2017 for Ch. 3 page 3-1 thru 3-7.
Discuss:
1. Why is the character of a Soldier essential to successful leadership?
2. What role(s) does Army Values play in shaping Army Leadership and all Army professionals?
3. The Army Ethic – Who we are, why and how we serve.
❖ Moral dilemma = available courses of action represent conflicting values

➢ Black and white moral challenges
➢ Gray moral challenges
➢ Unseen moral challenges
❖ The Army Ethic
➢ Army Expert (Competence)
➢ Steward of the Profession (Commitment)
➢ Honorable Servant (Character)
➢ Trust – foundation/center of living and upholding the Army Ethic
❖ The Rest Model
➢ Moral Recognition
➢ Moral Evaluation
➢ Moral Intentions

➢ Moral Action
▪ “Ethical Reasoning” Model
● Recognize the Conflict
♦ Moral recognition – acknowledge that a moral dilemma exists, define it, and ID the
conflicting values
● Evaluate the Options
♦ Moral evaluation – process the information
♦ Virtue, Rules, Outcome
● Commit to a Decision
♦ Moral intentions - choose the best course of action
● Act
♦ Moral action – act on your decision
❖ Tactical Ethics – the dynamic ethical factors that influence thoughts and behaviors
➢ Professional ethics & ethos
➢ Army culture & values
➢ Laws, regulations, and ROE
➢ Human spirit
➢ Personal virtues, ethics, and morals
➢ Physical and psychological state
➢ Operating environment
➢ Unit leadership, culture, and norms
❖ Moral Development Process
▪ Moral recognition and moral evaluation relate to thinking
▪ Moral intentions and moral actions concerned with behavior
▪ Recognize the conflict-evaluate the options-commit to a decision-act
● Feedback grows moral strength and moral maternity
➢ Moral maturity – an individual’s capacity to make meaning of morally relevant information →
Reflection
▪ Identity
▪ Judgment
▪ Ownership
➢ Moral strength – state of ownership over the moral aspects of one’s life
▪ Confidence
▪ Courage
▪ Self Discipline
❖ Moral self-identity – formed from moral maturity; awareness that comes from interactions with the
environment, one’s own beliefs/values/attributes/and links between them, and their effect on behavior
AC111 ANALYZE CULTURAL VARIABLES

● Recommended Readings:
Analyze Cultural Variables: Terms and Definitions, July 2017
Discuss:
Define culture in your own words in consideration of the Army definition of culture and for use in military
planning and operations.
2. Define Values, Beliefs, Behaviors, and Norms.
3. Define worldview, perspective, bias, and prejudice in relation to analyzing cultural variables for military
planning and operations.
4. Give a brief description of the PMESII-PT operational variables.
5. Describe a seminal event and provide examples at the personal, family, community, city, state, region,
nation, and world levels.
6. How do you think seminal event analysis supports the Commander’s Task of Understanding?
❖ Culture = values, beliefs, and norms that drive action and behavior (VBBN)
➢ Values – what individuals hold as important in life
➢ Beliefs – what individuals hold to be true

➢ Behavior – the way in which someone conducts himself

➢ Norms – something that is usual, typical, or standards
❖ Values and beliefs are not visible to the naked eye, but expressed through behaviors
❖ Norms (formally written laws or unwritten rules) guide behaviors and are informed by values and
beliefs
❖ Seminal event = historical moment that marks a significant turning point for a given society and
carries the seeds for future developments for that group
➢ Seminal event analysis uses PMESII-PT as a starting point to analyze a given society based on
conditions before and after a seminal event. This approach allows Soldiers to identify potential
changes, to predict the influences of these changes on the operational environment (and society),
and to anticipate probably impact for military missions. Because seminal event analysis is a
method of processing data to develop meaning, it supports the Commander’s task of
Understanding as defined in ADRP 6-0 Mission Command.
❖ Worldview – the framework composed of the knowledge, beliefs, and point of view of an individual or
society that is used to interpret and interact with the world; a comprehensive outlook on life
❖ Perspective – the context or reference from which individual’s sense, measure, or codify an
experience, resulting in some belief; “point of view”
❖ Bias – an inclination of temperament or outlook; especially: a personal and sometimes unreasoned
judgment
❖ Prejudice – “Halo or Horns effect” describes a person’s assessment of a cultural Value, Belief,
Behavior, or Norms as totally good or totally bad, completely righteous or evil; it validates self by
diminishing others
❖ PMESII-PT:
➢ Political – describes the distribution of responsibility and power at all levels of governance –
formally constituted authorities, as well as informal or covert political powers
➢ Military-Security – explores the military and/or paramilitary capabilities of all relevant actors
➢ Economic – encompasses individual and group behaviors related to producing, distributing, and
consuming resources
➢ Social – describes the cultural, religious, and ethnic makeup within an OE and the beliefs,
values, customs, and behaviors of society members
➢ Infrastructure – Details the composition of the basic facilities, services, and installations needed
for the functioning of a community or society in the OE
➢ Information – Explains the nature, scope, characteristics, and effects of individuals,
organizations, and systems that collect, process, disseminate, or act on information
➢ Physical Terrain– Depicts the geography and man-made structures as well as the climate and
weather in the OE
➢ Time – Describes the timing and duration of activities, events, or conditions within an OE, as well
as how the timing and duration are perceived by various actors in the OE
❖ Seminal Event Analysis
➢ Seminal Event
▪ historical moment
▪ significant turning point for a given society
▪ carries seeds for future developments
➢ Seminal Event Analysis
▪ Uses PMESII-PT (or another framework)
▪ analyze before and after a seminal event
▪ identify potential changes
▪ predict the influences of changes
● operational environment
● society
▪ anticipate probable impact for military missions

Raw Data Information

Cultural/
(Observations (PMESII-PT or Cultural
Situational
, research, other Knowledge
Understanding
etc) framework)
AC121 CROSS-CULTURAL SKILL BUILDING

● Recommended Readings:
Cross-Cultural Skill Building Concepts, July 2017
Discuss:
❖ Describe the communication process and how culture affects it.

➢ The sender communicates a message to the receiver. The receiver then communicates feedback
to the sender.
▪ External “noise” can alter how the messages are delivered and received.
▪ Both parties also have filters that may alter how each other send and receive messages.
● May be affected by cultural beliefs, norms, and values.
❖ Culture Collisions
➢ Reasons
▪ Poor communication
▪ Misunderstanding
▪ Cultural differences
➢ Clues
▪ Contextual
▪ Verbal
▪ Non-verbal
➢ Responses
▪ Research and plan
▪ Use respect as a tool
▪ Build rapport
❖ Norms of Interaction
➢ Time
➢ Space
➢ Face (honor)
➢ Emotions
➢ Fate (Faith)
➢ Social roles (gender, age, kinship, status, class, ethnicity)
❖ Communication Styles
➢ Linear vs circular
➢ Direct vs indirect
➢ Low context vs high context
➢ Attached vs detached
➢ Ideas vs people
➢ Tasks vs relationships
❖ Why is an awareness of these factors important to Leaders and how can one adjust for these factors?
AC131 CULTURAL CONSIDERATIONS OF NEGOTIATIONS
❖ Conflict - a sharp disagreement or opposition, as of interests, ideas, etc., and includes the perceived
divergence of interest, or a belief that the parties’ current aspirations cannot be achieved
simultaneously.

❖ Conflict results from the interaction of interdependent people who perceived incompatible goals and
interference from each other in achieve those goals.
❖ 4 Levels of Conflict
➢ intrapersonal – within yourself
➢ Interpersonal – between two people
➢ Intragroup – within a group
➢ Intergroup – between groups
❖ Identify and describe the Negotiation Phases
▪ Plan – Positions, interests, strengths, weakness, 5W’s
▪ Discuss – Intros, small talk, transition
▪ Propose – Listen & observe your counterpart; discuss positions and interests
▪ Bargain – mutual gains, possibilities, agreements; who will do what and when?
▪ Evaluate – before, during, and after
♦ Prepare – VBBN considerations; build a rapport; build a plan to include reservation
point (lowest acceptable level), zone of possible agreements, and aspiration point
(ideal outcome)
♦ Implement – put into action your plan
♦ Evaluate
❖ How would you choose a Negotiation Approach?
➢ Consider the desired outcome (both sides), situation, the context, and the cultural considerations
➢ Negotiation approaches include:
▪ Distributive – “win-lose” or “fixed pie”
● Decide issues based on positions
● Power-based, relationships not as important
● conflict inevitable; competition rather than collaboration
▪ Integrative – “win-win” or “expands pie”
● Mutual gains
● Trust-building, nurtures relationships
● Interest-based negotiation
➢ Conflict Management and Negotiation Styles:
❖ Discuss Interest-Based Negotiation (IBN)

➢ An integrative approach focusing on relationships
➢ Five Principles of IBN:
▪ Separate the people from the problem (focus on issues)
▪ Focus on the interests not the position
▪ Determine Best Alternative to a Negotiated Agreement (BATNA)
▪ Create options for mutual gain
▪ Define objective criteria to measure fairness or reasonableness of the agreement
➢ Best Alternative to a Negotiated Agreement (BATNA) = what you currently have or what you will
do if you do not reach agreement; an alternative

➢ Zone of Possible Agreement (ZOPA) = range between the RP and the AP.
▪ Reservation Point (RP) = the bottom line; the least you will accept
▪ Aspiration Point (AP) = the ideal outcome
● How can I determine my counterpart’s RP and AP?
♦ Consider the counterpart’s interests, priorities, and BATNA.
➢ Determined before implementation or the meeting
❖ Negotiation styles:
➢ Measured by level of assertiveness (satisfy self) vs. cooperativeness (satisfy others)
➢ Competing/Insisting (Competitor): power-oriented, push your position and win
➢ Collaborating/Cooperating (Problem solver); relationship-oriented mode, seeking “win-win”
solutions
➢ Compromising/Settling (Haggler): relationship-oriented mode, losing some to win others
➢ Avoiding/Evading (Dodger): delay-oriented mode, not pursuing either parties’ issues
➢ Accommodating/Complying (Dreamer): good-will oriented mode, giving to foster good will
❖ Assess Cultural Considerations of Negotiation
➢ High/low context
▪ High context: societies or groups where people have close connections over long periods of
time; cultural behavior is understood
▪ Low context: societies where people tend to have many connections but of shorter duration;
cultural behavior must be taught to new members
➢ Language
➢ Status
➢ Gender
➢ Emotions
▪ Genuine emotions: acknowledge and recognize emotions
▪ Strategic emotions: if counterpart’s current mood is helpful to the negotiation, reinforce (it not,
vice versa)
❖ 10 Ways in which Cultures Differ in Negotiation
➢ Definition of Negotiation - Contract ↔ Relationship: this determines what is actually negotiable,
what is expected to occur during negotiation, and the focus of the negotiation
➢ Negotiation Opportunity – Distributive ↔ Integrative: how negotiators perceive an opportunity as
distributive vs integrative
➢ Selection of Negotiators – Experts ↔ Trusted Associates: determines who participates based on
SME vs relationship/age/gender/etc.
➢ Protocol – Informal ↔ Formal: degree of importance of formality
➢ Communication – Direct ↔ Indirect: be alert to other cultures use or interpretation of non-verbals
➢ Time Sensitivity – High ↔ Low
➢ Risk Propensity – High ↔ Low
➢ Groups vs. Individuals – Collectivism ↔ Individualism: a reflection of values and beliefs
➢ Nature of Agreements – Specific ↔ General: what signifies an agreement and completion may be
different (e.g. contract vs a handshake)
➢ Emotionalism – High ↔ Low: culture often informs the extent to which negotiators display
emotions, as well as individual personality
LE110 - MILITARY JUSTICE FOR LEADERS

Commanders Legal Handbook 2015
AR 27-10 11 MAY 2016
Manual for Courts Martial (MCM)
Discuss:
❖ Purpose of military law - promote justice, assist in maintaining good order and disipline in the armed
forces
❖ Why a separate system?
➢ Uniformity
➢ World-wide jurisdiction
➢ Disciplinary needs unique

➢ Efficient system in disparate, diverse environment

❖ What documents are the sources of authority for military Justice?
➢ UCMJ
➢ Manual for Courts-Martial (MCM)
➢ Army Regulations (AR 27-10)
❖ Who is allowed to administer punishment under the UCMJ?
➢ Commanders at all levels
❖ What are the three types of Court-Martial?
➢ Summary – composed of one officer; handles minor crimes
▪ Convening authority - Company Commander
➢ Special – tries all soldiers and consists of a military judge, at least 3 court members, a trial
counsel, and a defense counsel
▪ Convening authority - Brigade Commander (COL)
➢ General - tries cases for most serious offenses; requires Article 32
▪ Convening authority - Special Court-Martial Convening Authority (GCMCA); Division
commander
❖ Trial courts
➢ Summary
➢ Special
➢ General courts-martial
❖ Appellate courts
➢ court of criminal appeals
❖ Jurisdiction
➢ over the person
➢ over the offense
❖ Preliminary inquiries
➢ concentrate on:
▪ misconduct actually did occur
▪ misconduct is punishable under UCMJ
▪ Soldier was involved
▪ Soldier’s character and military record
➢ More serious investigations referred to MPI/CID
➢ All SA allegations referred to CID
❖ Categories of flags
➢ Transferrable
➢ Non-transferrable
❖ Article 15-6 investigations
➢ Formal (seldom) - i.e. show cause, administrative separation boards
➢ “Informal”
❖ Article 31(b) UCMJ - “know the trigger” (Rights warning)
➢ Official law enforcement/discipline
➢ Questioning
➢ Suspect
➢ exceptions:
▪ spontaneous statements
▪ medical purposes
❖ Search and seizure - 4th amendment protections
➢ Constitutional Amendment prohibits unlawful search and seizure
➢ “Competent authority” can authorize with probable cause
▪ Reasonable belief that the person, property or evidence sought is located in the place or on
the person to be searched
▪ ompetent authorities:
● Civilian authority (judge)
● Military judges
● Military magistrates
● Commander/acting commander
➢ Can only authorize searches in unit area

▪ Commanders should NOT conduct searches

➢ exceptions to authorization requirement:
▪ consent searches
▪ lawful arrest
▪ exigent circumstances
▪ health & welfare searches (inspections, inventories, UAs)
▪ plain view doctrine
❖ What are 4 key rights soldiers have when facing UCMJ?
➢ Presumption of innocence
➢ Legal counsel
➢ Search and seizure
➢ Prompt action
❖ When is Pretrial Confinement a prudent action?
➢ You must have reasonable ground that the person committed an offense that is triable by court-
martial to order someone into pretrial confinement
➢ Confinement is necessary because the accused is a flight risk OR will commit serious future
misconduct and lesser forms of restraint are inadequate
❖ List Framework that would constitute Unlawful Command Influence (UCI)
➢ Accusatory (process of bringing charges) vs adjudicative (the actual trial)
▪ Accusatory UCI happens when someone that is responsible for bringing charges or
processing charges takes a certain action because someone else pressured him or her to
take that action. Adjudicative UCI is UCI that taints the trial process itself – the military judge,
the defense counsel, the members, or a witness is pressured to do or not do something.
➢ Apparent vs. actual
▪ UCI does not have to actually occur for there to be a problem. If the situation just looks bad –
as in, members of the public would think that the system is unfair – then that can be enough
for the military judge to grant the accused some relief.
➢ Inadvertent vs. intentional
▪ A commander or superior does not have to intend to commit UCI or have some sinister
purpose. A commander or superior can have perfectly good intentions and still commit UCI.
This often happens when commanders coach or mentor subordinates about military justice or
issue policy letters.
➢ The MCM vs Administrative Matters
▪ The principles of UCI fully apply to Article 15s and all courts-martial. Because this concept
arises in the UCMJ, it is generally limited to procedures that are found in the UCMJ.
Therefore, accusatory UCI concepts generally do not apply to administrative proceedings like
administrative separation boards. In fact, there are several regulations that include
requirements for subordinates to initiate separation boards, GOMORs, or grade reduction
boards. The Secretary of the Army can direct a subordinate to initiate a GOMOR or a
separation board. A superior officer cannot do the same for a court-martial or Article 15.
However, the concept of adjudicative UCI does apply to administrative proceedings because
it is a violation of the UCMJ to tamper with an administrative proceeding.
➢ What is not considered UCI?
▪ Withhold authority over types of offenses or types of offenders. Often, battalion commanders
withhold drug offense and certain types of assaults to their level, and often, commanding
generals withhold the authority to punish officers and senior NCOs.
▪ Reach down and take specific cases.
▪ Send cases back down with guidance to resolve at their level, with their tools (including
taking no action).
U510 - LAW OF ARMED CONFLICT

❖ What is the legal basis of the Law of Armed Conflict?
➢ Hague Regulations
➢ Geneva Conventions
➢ Other international treaties
➢ Customary International law
❖ Why does the US Army need laws to govern armed conflict?

➢ To assist commanders and soldiers in mission accomplishment

➢ To regulate the use of force and prohibit unlawful conduct
➢ To protect against unnecessary suffering and excessive collateral damage
➢ To promote the humane treatment of noncombatants, wounded and sick, and children
❖ Basic principles of LOAC
➢ Military necessity – military force must be directed at legitimate military objectives
➢ Unnecessary suffering or humanity – it’s forbidden for soldiers to use weapons calculated to
cause unnecessary suffering
➢ Discrimination or distinction – soldiers must distinguish
➢ Proportionality – anticipated civilian death, injury, and property damage must not be excessive
❖ 10 Soldier’s Rules of LOAC
➢ Soldiers fight only combatants.
➢ Soldiers do not harm enemies who surrender. They disarm them and turn them over to their
superior.
▪ 5 S’s and T of Detainees
● Search
● Silence
● Segregate
● Safeguard
● Speed to rear
● Tag
➢ Soldiers do not kill or torture personnel in their custody.
➢ Soldiers collect and care for the wounded, whether friend or foe.
➢ Soldiers do not attack protected persons and protected places.
➢ Soldiers destroy no more than the mission requires
➢ Soldiers treat civilians humanely.
➢ Soldiers do not steal. Soldiers respect private property and possessions.
➢ Soldiers should do their best to prevent violations of LOAC.
➢ Soldiers report all violations of LOAC to their superiors.
L151 - EXAMINE KEY CONCEPTS OF THE ARMY PROFESSION

ADRP 1, The Army Profession (14 June 2015):
ADRP 6-22, Army Leadership (19 Sep 2012): Chapter 7, pp 7-1 thru 7-5, para 7-5 thru 7-31 and Table 7-
1.
FM 6-22, Leader Development (30 June 2015): Chapter 7
Discuss:
1. Why is the Army subordinate to civil authority?
2. What are the distinctive roles of Trusted Army Professionals?
3. What are the certification criteria for Trusted Army Professionals?
4. How are the distinctive roles and the certification criteria related to trust?
5. What is the difference between culture and climate?
6. How do you build professional organizational climates?
❖ Why is the Army subordinate to civil authority?

➢ civilian authority established and codified in Constitution
➢ American people exercise oversight through their elected and appointed officials
➢ Mutual trust: key condition for effective American civil-military relations
❖ What are the distinctive roles of Trusted Army Professionals?
➢ Honorable Servants of the Nation - professionals of character
➢ Army experts - professionals of competence
➢ Stewards of the Army Profession - committed, accountable
❖ What are the certification criteria for Trusted Army Professionals?
➢ military technical
➢ moral, ethical
➢ political, cultural

➢ leader human development

❖ How are the distinctive roles and the certification criteria related to trust?
❖ What is the difference between culture and climate?

➢ Culture
▪ How we do things, embedded and enduring
▪ long held beliefs and customs
▪ shared attitudes, values, goals, and practices of the larger profession
▪ environment of the Army as a profession
➢ Climate
▪ shared perceptions/attitudes -how members feel about a unit
▪ can be changed quickly; short-term
▪ often driven by observed policies and practices reflecting the leader’s character
❖ How do you build professional organizational climates?
➢ Leaders must manage climate
▪ may not be able to directly manage culture, but strive to understand it
▪ mutual trust in a positive climate
➢ Command Climate: a perception among the members of a unit about how they will be treated by
their leaders and what professional opportunities they see within the unit
▪ Conditions of positive climate (FM 6-22)
● Fairness and inclusiveness
● Open and candid communications
● Learning environment
● Assessing climate
● Dealing with ethics and climate
● Building teamwork and cohesion
● Encouraging initiative
● Demonstrating care for people
▪ 2 Strategies for Fostering Organizational Creativity
● Change the people (Training)
● Change the climate (change practices)
▪ Change always starts with assessment, individual or organizational
● Assessment can be formal or informal
▪ Positive Climate Indicators:
● Trust
● Teamwork
● Open/candid communications
● Soldier job satisfaction
● Soldiers and families attend unit social/sports activities

● Re-enlistment rates are high

❖ What makes the Profession of Arms?
➢ Military expertise
➢ Honorable service
➢ Trust
➢ Espirit de corps
➢ Stewardship of the profession
➢ Ethical foundation = legal, moral
❖ What is the foundation of Civilian-Military Relations?
➢ Declaration of Independence
➢ Constitution
➢ Federal Statute
➢ Oath of Office
➢ Tradition
❖ What are Civilian-Military Relations?
➢ The Constitution and Elected Representatives
➢ The People of our Nation
➢ The Armed Forces of our Nation
AS210.2 - MILITARY TERMS AND SYMBOLOGY

ADRP 1-02, Terms and Military Symbols, 07 Dec 2015, Chapter 3 (pg. 3-1 to 3-13)
“Understanding OPCON,” WWW.ARMY.MIL, 03 May 2010, http://www.army.mil/article/38414/, accessed
February 9, 2015 (5 pages)
FM 3-96, Brigade Combat Team
ADRP 3-90 Offense and Defense
Discuss:
❖ Military terms - facilitates a common understanding
➢ Organic - parts of the unit that are listed in its table of organization
➢ Assign - place units or personnel in an organization
➢ Attach - placement is relatively temporary
➢ Delay - trades space for time, slowing down enemy’s momentum
➢ clear - remove all enemy forces in an area
➢ OPCON - Operational Control - the authority to perform those functions of command over
subordinate forces involving organizing and employing commands and forces, assigning tasks,
designing objectives, and giving unrestricted authoritative direction necessary to accomplish
mission
➢ TACON - Tactical control - command authority over assigned or attached forces/commands;
limited to detailed direction within a specific task/mission
➢ ADCON - Administrative control - Direction or exercise of authority over subordinate or other
organizations in respect to administration and support
➢ FEBA - Forward edge of battle area - where ground units are deployed
➢ FLOR - forward line of troops
➢ Decision point - geographic place, specific key event, critical factor or function that allows
commanders to gain a marked advantage over an adversary or contribute materially to success
➢ Culminating point -point in time/space at which a force no longer possesses capability to continue
its current form of operations
➢ Destroy - physically render enemy ineffective
➢ Defeat - defeated force’s commander unwilling or unable to pursue
➢ Degrade - lessen their capabilities
➢ Cover - protection from effects of fires
➢ Screen - security task that provides early warning to be protected force
➢ Disrupt - cause enemy forces to commit prematurely, interrupt time table,
➢ Deny - actions to hinder or deny enemy use of space/personnel/supplies

➢ Decure - physical occupation is not required; prevents a unit/facility/geographical location from

being destroyed
➢ Seized - taking possession
➢ Fix - prevents enemy from moving any part of his force from a specific location for a specific
period
➢ On order - a mission to be executed at an unspecified time
➢ Be prepared to (BPT) - a mission assigned to a unit that might be executed
➢ Direct Support - Support relationship requiring a force to support another specific force and
authorizing it to answer directly to the supported force’s request for assistance
❖ Military Symbol - graphic representation that is used for planning or to represent the common
operational picture on a map/display/overlay
➢ Two categories:
▪ Framed - includes unit, equipment, installation, activity symbols
● Frame - border of a symbol (standard identity, physical domain, status of object)
♦ Rectangle (Friendly), Hostile, Neutral, Unknown/pending
● Color (fill) -
♦ Blue (friendly); Red (Hostile); Green (Neutral); Yellow (Unknown)
● Icon
♦ Main sector - reflect main function of the symbol (i.e. Field artillery)
♦ Sector 1 - specific capability of a unit (i.e. radar)
♦ Sector 2 - mobility (i.e. Air assault), size, range, altitude of unit equipment
♦ Full frame - main function of the symbol (i.e. Infantry) or may reflect modifying
information
● Modifiers
● Amplifiers
▪ Unframed - includes control measure and tactical symbols
● Control measures - means of regulating forces or warfighting functions (WFF)
♦ Points
♦ Lines
♦ Boundaries
♦ Areas
♦ WFF specific
● Tactical mission task - specific activity performed by a unit while executing a form of
tactical operation or form of maneuver
♦ ADRP 1-02 - page 333+
M111 - BRIGADE COMBAT TEAM (BCT)

FM 3-96, Brigade Combat Team, 8 October 2015, Chapter 1
ATP 4-90 Brigade Support Battalion, C1, 29 April 2016, pages 1-8 thru 1-12
Scan ADRP 1-02, Terms and Military Symbols, 7 December 2015, Chapter 3 and 4
“The Death of the Armor Corps” by COL Gian P. Gentile, located at
http://smallwarsjournal.com/blog/2010/04/the-death-of-the-armor-corps/
Discuss:
1. Describe the role of BCTs.
2. Understand the task organization of the three types of BCTs.
3. Analyze the strengths and weaknesses of the three types of BCTs.

❖ Types of BCTs
➢ Armor (ABCT)
▪ Task Org:
● Maneuver Bns
● Armored Cavalry Bn
● Field Artillery Bn
● Engineer Bn
● BSB
➢ Infantry (IBCT)
▪ Task Org:
● 3 Maneuver Bns
● Cav Bn
● Field Artillery Bn
● Engineer Bn
● BSB
➢ Stryker (SBCT)
▪ Task Org:
● 3 Maneuver Stryker Bns

● Scouts Bn
● FA Bn
● Engineer Bn
● BSB
AS210.1 - INTRODUCTION TO ARMY HEALTH SYSTEM (AHS) SUPPORT

"Battlefield Medicine", https://www.youtube.com/watch?v=kEjkVMjHVEo, minutes 0:00-35:55,

Read, FM 4-02, Army Health System dtd 26 August 2013, pages 9-25
Read, “Roles of Medical Care (United States)”, Chapter 2, (12 Pages)
Discuss:
❖ Army Health System - complex system of systems that is interdependent, interrelated, and requires
continual planning, coordination, and synchronization to effectively and efficiently clear the battlefield
of casualties and to provide the highest standard of care to our wounded or ill Soldiers
➢ Health Service Support (HSS)
▪ Sustainment WFF component
● Promotes, improves, conserves, restores health within a military system
● Providing medical care to Soldiers on the battle field
♦ Pertains to the treatment and medical evacuation of patients from the battlefield and
the required Class VIII supplies, equipment, and services to necessary to sustain
these operations.
♦ HSS encompasses three components — casualty care, medical evacuation, and
medical logistics
➢ Force Health Protection (FHP)
▪ Protection WFF component
● Medical portion of Protection WFF
● Comprised of preventative aspects of five Army HSS functions
● Preventative measures taken to promote, improve, conserve mental and physical well-
being of Soldiers
♦ encompasses preventive medicine, veterinary services, area medical laboratory
services and support, and the preventive aspects of dental services and combat and
operational stress control
❖ AHS Acronyms
➢ See slides
❖ AHS - Support planning
➢ Synchronized with tactical plan, based on commander's intent
➢ guided by AHS principles within context of roles of care
➢ Addresses all 10 MFAs
➢ Establishes priorities before/during/after operations
➢ Coordinated with supported and supporting medical units
❖ 6 AHS PRINCIPLES (“C3FMP”)

➢ Conformity - Medical planners must conform with strategic, operational, and tactical plans
➢ Continuity - Services that enhance and facilitate the continuum of care from the POI to lowest
level necessary care
➢ Control - Medical planners must skillfully join evacuation doctrine and execution with the combat
commander’s intent
➢ Flexibility - enhance the ability to rapidly task-organize and relocate
➢ Mobility - survivability and sustainability of medical units organic to maneuver elements must be
equal to the forces being supported
➢ Proximity - Location of assets is paramount to successful evacuation
❖ AMEDD battlefield rules
➢ The AMEDD has developed the battlefield rules to aid in establishing priorities and in resolving
conflicts between competing priorities within AHS activities. These battlefield rules are (in order
of their priority) to:
1. Be there (maintain a medical presence with the Soldier)
2. Maintain the health of the command
3. Save lives
4. Clear battlefield of casualties
5. Provide state-of-the-art medical care
6. Ensure early return to duty
❖ Roles of Care
➢ Role 1 - Care is rendered at unit Role 1/BAS
▪ Immediate life-saving care is rendered at a Role 1 (combat medic/treatment squad)

▪ COSC prevention measures

▪ Medical evacuation
▪ 3 MFAs: Medical Command, Treatment, Evacuation
➢ Role 2 - Care is rendered at a Role 2 EAB or BCT unit
▪ Basic resuscitation, stabilization, advance trauma management, emergency medical
management
▪ may include surgical capability
▪ 8 MFAs: All except vet and hospitalization
➢ Role 3 - Care is rendered at Role 3 EAB AHS unit
▪ Post-op treatment
▪ Wound surgery, damage control
▪ 1st step towards restoration of health
▪ 8 MFAs: Except Vet (usually given vet detachment) and Evacuation (ground ambulance or
MMB detachment)
➢ Role 4 - CONUS based hospitals, other safe havens
▪ Most definitive medical care
▪ All 10 MFAs
❖ Big Picture (POI to Definitive Care) – Cross Reference with AS213.2 Joint Medical Capabilities lesson
AS211.1 - BCT AHS SUPPORT

TC 8-800 Medical Education and Demonstration of Individual Competence, Chapter 1-2, (9 pages)
AR 40-501, Standards of Medical Fitness, Chapter 11, (4 pages)
Modification of Personnel Policy (MOD) 12 (22 pages)
❖ BCT AHS Support Personnel Locations

➢ All maneuver elements (IBCT and the SBCT) are configured similarly as the ABCT; however,
differences in types and quantities of vehicles and numbers of personnel assigned exist between
the IBCT, ABCT, and SBCT.
➢ Medical platoons/teams differ in types and quantities of vehicles and numbers of personnel
assigned
❖ Brigade Surgeon Section
➢ Special staff to the BDE Commander responsible for AHS support in the BCT

➢ Exercises technical control over medical activities

➢ Provides medical oversight and supervision for AHS support
➢ Keeps the BCT commander informed of the health of the command
➢ Ensures timely planning, integration, and synchronization of AHS support with the BCT maneuver
plan
➢ Coordinates medical support with the BSB medical operations section; BSMC; the battalion
medical platoons; and other staff elements
❖ Brigade Support Battalion (BSB) Medical Operations Section (MEDOPS)
➢ Sub-staff section within BSB Support Operation Officer (SPO) Section
➢ Provide planning and oversight of AHS support tasks
➢ Consider placement of all AHS support assets within the brigade
➢ Coordinates the ordering, receipt, and distro of class VIII and blood products
➢ Coordinates with the brigade surgeons cell and division surgeon section
➢ Medical operations officer is directly responsible for providing medical operations guidance and
status to the BSB Commander
❖ Battalion Medical Platoon/Section
➢ Point of Injury (PoI), Role 1 Treatment, Evacuation
➢ Combat Medics, Battalion Physician Assistant, +/- Field Surgeon (PROFIS)
▪ BCT medical platoons/teams differ in type and number of vehicles and personnel, providing 3
of 10 Medical Functional Areas (MFA):
● Medical Mission Command
● Medical Treatment (Role I)
● Medical Evacuation (CCP to AXP)
▪ Maneuver battalions and CAV Squadron:
● TO&E assigned MEDO, PA, and PSG. PROFIS field surgeon when requested and
approved.
● Treatment Squad (Battalion Aid Stations):
♦ Surgeon, PA, combat medics
● Ambulance Squad (Casualty Collection Point [CCP] to AXP):
♦ Combat medics
● Combat Medics Section (embedded in maneuver companies, PoI to CCP):
♦ Combat medics
▪ Non-maneuver battalions are assigned smaller treatment teams
● TO&E assigned MEDO, PA, and PSG. No PROFIS field surgeon.
● Fewer medics
● Less evacuation assets
▪ Field surgeon
● *Unauthorized position on MTOE except during deployment
● *The Bn PA and MEDO perform all HSS functions for entire SRM1
● *If a PROFIS is authorized AND requested, the PROFIS may perform functions
● *Doctrinally the platoon leader of the maneuver battalion’s medical platoon
● Responsible for all medical treatment provided by the platoon
● Responsible for AHS support advice to the maneuver battalion commander
● Coordinates AHS support with the battalion S-1, S-3 and, S-4
● Battalion surgeon, the field medical assistant, and the platoon sergeant comprise the
medical platoon headquarters
❖ Medical Company, Brigade Support
➢ Role 2 Treatment, Ancillary Care, Evacuation
▪ Provides AHS support to assigned BCT
▪ 8 of 10 Medical Functional Areas (MFA)
● Medical Mission Command
● Medical Treatment (Role II)
● Medical Evacuation (Ambulance Exchange Point [AXP] to Role II)
● Preventive Medicine
● Dental
● Medical Logistics (BMSO)
● Combat & Operational Stress Control
● Lab Services

❖ Medical Evacuation
➢ PoI to Role 1 to Role 2 and beyond
➢ Ambulance Exchange Points (AXP)

▪ BCT AHS Vehicles (Typically have at 3 personnel: driver, TC, medic)
● M997 - wheeled; IBCT
● M113 - ABCT
● M557 - Treatment platform
● M1133 – SBCT
➢ Evac from Role 2 to Role 3 - Ground MEDEVAC company, MMB, to Role 3
AS212.2 EAB MEDICAL EVACUATION
❖ Medical Evacuation
➢ Medical Evacuation is the process of moving any person who is wounded, injured, or ill to
and/or between medical treatment facilities while providing enroute care
▪ Benefits:
● Minimizes mortality by rapidly and efficiently moving the sick, injured, and wounded to an
HRP
● Serves as a force multiplier as it clears the battlefield enabling the tactical commander to
continue his mission with all available combat assets
● Provides medical economy of force
● Provides connectivity of the AHS as appropriate to the MHS
● Emergency movement of Class VIII, blood and blood products, medical personnel and
equipment
▪ *MEDEVAC assets are dedicated to MEDEVAC missions only!
▪ MEDEVAC begins at the point of injury
❖ Definitions & Terms
➢ CASEVAC - Readily available, no dedicated assets, no guaranteed enroute care
➢ MASCAL - Any large number of casualties produced in a relatively short period of time that
exceeds medical capabilities
➢ Inter Theater - Medical Evacuation that departs a theater of operation
➢ Intra Theater - Medical evacuation that does NOT depart a theater of operation
➢ Point of Injury (PoI) - Location in operational environment where casualty receives initial injury

❖ BCT MEDEVAC Review
❖ EAB MEDEVAC Assets

➢ Doctrinal designed to provide MEDEVAC from Role II to Role III
▪ Current operational environment allows for POI MEDEVAC
▪ Area Support Medical Company (ASMC) - provides MEDEVAC from POI or Role I for units
without organic Role II capabilities
➢ Ground MEDEVAC Assets
▪ Ground Ambulance Company (GA), (24) M997
▪ ASMC, Evacuation Platoon, (8) M997
➢ Aeromedical Evacuation Assets
▪ MEDEVAC Company, (15) HH-60M,
● (4) Forward Support Medical Platoon (FMSP); (1) Area Support Medical Platoon (ASMP);
(3) aircraft each
● Organic to a Division’s Combat Aviation Brigade (CAB) within the General Support
Aviation Battalion (GSAB)
❖ Aeromedical Evacuation
➢ (1) Hour Mission Standard = 60 min from notification (9-Line) to surgery
▪ 15 Minute wheels-up
▪ 20 minutes flight-time to LZ or (40 nautical miles, 74 kilometers, 46 miles)
▪ 5 minute load-time
▪ 20 minutes flight-time to MTF or (40 nautical miles, 74 kilometers, 46 miles)
➢ HH-60M MEDEVAC speed: 120 nautical miles per hour (knots)
➢ Stand Crew
▪ Pilot & Co-Pilot
▪ Crew Chief
▪ Flight Medic/Paramedic
➢ Mission Dependent Capability
▪ Enroute Critical Care Nurse (ECCN)
▪ Physician Assistant (PA)
❖ Linear Aeromedical Evacuation
➢ Forward Support Medical Evacuation Platoon (FSMP) provides evacuation within the Brigade
Combat Team Area of Operations to the appropriate level of care within the BCT’s medical
capabilities for the casualty/injury AND/OR to the predesignated Ambulance eXchange Point
(AXP) with Echelons Above Brigade (EAB) medical/evacuation assets.
▪ 3x Air Ambulances in Direct Support role to each BCT
➢ ASMP(3xAircraft) and 1xFSMP (3x Aircraft) go forward to the designated AXP with the BCT’s to
pull their patients from the BCT AO to the appropriate level of Echelons Above Brigade care.
▪ This element also provides Point Of Injury coverage to the Division rear area.
▪ This element has a total of 6x Air Ambulances in a General Support role

▪ Casualties are always pulled from lower to higher, by the higher level element.
▪ Casualties should not be taken to a higher level of care than their injuries require.
❖ Aeromedical Evacuation Rings
➢ Non-linear aeromedical evacuation
➢ MEDEVAC Coverage “Range Rings”
❖ Aeromedical Evacuation Authority
➢ Mission authority (Medical) is the validation of a medical mission and approval of use of
MEDEVAC aircraft by a medical officer (MEDO, BSC)
➢ Launch Authority (Aviation) – Aviation BDE CDR - IAW AR 95-1 launch requires appropriate
Aviation Command level approval based upon risk level
▪ (Low-Company, Moderate-BN, High-CAB, Ex-High-First General Officer)
▪ For Urgent and Urgent Surgical MEDEVAC missions, MEDEVAC company commanders
‘may’ be delegated Moderate risk approval Authority
➢ Patient Evacuation Coordination Cells (PECC) coordinate all patient movements within a Division
or Regional Command AO; usually seen in Medical BDEs
➢ Aeromedical evacuation assets will typically be placed in Direct Support and in geographical
proximity of supported units, but their command relationship will remain with the Combat Aviation
Brigade
❖ Evacuation Platform Capacities and Speeds
❖ MEDEVAC Planning
➢ Tactical commander’s plan for employment of operational forces
➢ Enemy’s most likely course of action
➢ Anticipated patient load
➢ Expected areas of patient density
➢ Availability of medical evacuation resources to include ground and air crews
➢ Availability, location, and type of supporting HRPs
➢ Road network/dedicated medical evacuation routes (contaminated and clean)
➢ Protection afforded medical personnel, patients, and medical units, vehicles
➢ Air control, engineer obstacle and fire support plans
➢ Weather conditions
➢ MEDROE
➢ Security of ambulance routes/ traffic density
➢ Lines of drift
❖ MEDEVAC Big Picture
AS212.1 EAB AHS SUPPORT

FM 4-02, Chapter 2, Section IV (Pages 56-61)
FM 4-02, Chapter 2, Section III (Pages 33-35, Scan 36-43)
FM 4-02, Chapter 2, Section III Pages 43-44, Scan 45-51)
FM 4-02, Chapter 2, Section III (Pages 36-43)
FM 4-02, Chapter 2, Section III (Pages 45-51)
FMSWeb - Force Management Website

Discuss:
1) Why are units designated as Echelons above Brigade units (EAB)?
EAB's provide roles of care greater than what is available organically in a BCT and/or at the same level
role care to non-BCT units without medical organic assets. EAB is defined as an EAB not because they
necessarily provide a higher role of care, but because they are assigned to units echelons of above BCT
level. Generally assigned MMB within a MEDBGE corps assets. (EAB AHS Support AS 212.1)
❖ EAB Medical Mission Command (MC)

➢ Medical Command (Deployment Support [DS])
● Medical Brigade (Support) - MEDBDE
♦ Multifunctional Medical Battalion (MMB)
➢ EAB Medical Companies and Detachments
♦ Combat Support Hospitals (CSH)
➢ Forward surgical teams (FSTs)
➢ Medical Augmentation Teams
♦ Medical Brigade (Support) is a subordinate of the MEDCOM (DS)
♦ Provides medical MC for all assigned and attached units in a theater
♦ Provides EAB AHS support to tactical commanders
♦ Medical Brigade (Support) is METT-C driven
♦ Theater (regionally) and operationally (strategically) focused
♦ Abbreviated as MEDBDE
▪ MEDCOM (DS) serves as the medical force provider within the theater
▪ Identifies and evaluates health care requirements
▪ Medical resources may be dispersed over an extended area
▪ Must have the ability to rapidly task organize and reallocate assets
▪ Assigned to the ASCC and is allocated on a basis of one per theater
▪ Regional and strategically focused
➢ EAB Surgeons
▪ ASCC Surgeon
▪ Corps/Theater Surgeon
▪ Division Surgeon
❖ EAB Medical Units
➢ Provide roles of care greater than what is available organically in a BCT and/or same level role
care to non-BCT units without organic medical assets
➢ Defined as EAB not because they necessarily provide higher role of care, but because the are
assigned to units echelons of above BCT level
Generally assigned to a MMB within a MEDBDE, corps assets
➢ Multifunctional Medical Battalion (MMB)
▪ MMB is a subordinate of the MEDBDE
▪ Provides medical MC for all assigned and attached units, to include:
● Medical Companies
● Medical Detachments
▪ Provides EAB AHS support to tactical commanders
▪ Medical Companies
● Area Support Medical Company (ASMC)
● Medical Logistics Company (MEDLOG)
● Ground Ambulance (GA)
● Dental Company (D)
▪ Medical Detachments
● Veterinary Services Detachment (V)
● Combat and Operational Stress Control (COSC)
● Preventive Medicine Detachment (PVNTMED)
♦ PM teams x3
● Blood Support Detachment (BSD)
♦ Collection, storage & distro team
♦ Collection, manufacturing & distro team
♦ Distro team

● Optometry Detachment (OPTO)

♦ X2 OPT teams: 2 officers, 2 NCOs, 2 junior enlisted each
➢ Combat Support Hospitals (CSH)
● Provides hospitalization and outpatient services for all classes of patients within the
theater
● 492 Personnel, greater than 50% PROFIS
● Possesses all 10 MFAs if Veterinary and Evacuation assets are attached
♦ 248 Beds (48 Intensive Care Unit and 200 ICW Intermediate Care Ward)
● Split based operations (84 bed and 164 bed package)
● Provides medical mission command for FSTs and other medical augmentation teams
● Generally assigned to a MEDBDE
● 72 hours required to become fully mission capable (FMC)
▪ CSH Redesign (Expeditionary “Field Hospitals”)
● Provides company level mission command of organic elements to include Army Health
System (AHS) support, planning, policies, and support operations within the hospitals
area of operations
● Capable of indefinite split-base capability
● Enhanced mobility when compared to the CSH, Army answer to EMEDs
● Provides hospitalization for up to 32 patients consisting of:
♦ (1) ward providing intensive nursing care for up to twelve(12)patients
♦ (1) ward providing intermediate nursing care for up to twenty (20) patients
● 36 operating room table hours per day
▪ Hospital Augmentation Teams
● Head and Neck Team (HNT)
● Pathology Team (PATH)
● Other detachments and teams, include:
♦ Medical Detachment (Minimal Care)
♦ Medical Team (Infectious Disease)
♦ Hospital Augmentation Team (Special Care)
♦ Medical Team (Renal Hemodialysis)
♦ See ATP 4-02.5, Casualty Care for details
▪ Forward Surgical Teams (FST)
● Provides rapidly deployable, forward urgent initial surgical service in the Brigade Combat
Team (BCT) area of operations (AO
● FST Capabilities:
♦ 20 Personnel, able to operate independently for up to 72 hours
♦ 2 Operating Tables, approx. 30 patients in 72 hours
♦ 50 Units of packed red blood cells, approx. 4 units of blood per patient
♦ 2 General Surgeons, 1 Orthopedic Surgeon, 2 Anesthesia Providers
♦ Generally assigned to Combat Support Hospitals (CSH)
♦ 90 minutes required to become fully mission capable (FMC)
▪ Forward Resuscitation and Surgical Teams (FRST)
● Provides rapidly deployable, forward damage control resuscitation (DCR) damage control
surgery (DCS) within the BCT AO
● 20 Personnel, able to operate independently for up to 72 hours, or more
♦ 2 General Surgeons, 2 Orthopedic Surgeon, 2 Anesthesia Providers
♦ 2 Operating Tables, approx. 30 patients in 72 hours (15 cases/team)
♦ POST OP nursing – 8 Patients simultaneously, up to 6 Hrs.
● Can split into 2 teams (10 SM /team)
♦ Limitation on logistic support therefore – 12 cases/72 hrs. per team
● Can split/deploy only surgical team (6 SM/team)
♦ 24 hours OPS only – 4 cases per team
● UNDER DEVELOPMENT/INITIAL FIELDING – to replace FSTs
❖ Medical Treatment Big Picture

M117 - FRAMING THE OPERATIONAL ENVIRONMENT

ADRP 5-0, The Operations Process, 17 May 2012, para 1-32 thru 1-46 AND para 2-33 thru 2-51
FM 3-12 Cyberspace and Electronic Warfare Operations, 11 April 2017, para 1-50 thru 1-136
ATP 2-01.3, Intelligence Preparation of the Battlefield/Battlespace, 26 March 2015, para 1-1 thru 1-21
ADRP 3-0, Operations, 11 November 2016, para 1-12 thru 1-21
Discuss:
1. Analyze the critical variables of PMESII-PT to understand their impact on the OE
2. Analyze the various actors or factions to understand their impact on the OE
3. Analyze the enemy and their impact on ULO and the OE
❖ Strategic Operational Environment –

➢ the global environment in which the US President employs all the elements of national power
(diplomatic, informational, military, and economic)
➢ encompasses the OE of the future; used for concept and requires development, experimentation,
and studying the factors that shape the OE
▪ Capability
▪ Ability to detect change
▪ Ability to relate results to forces in operational environment
❖ Operational Environment (OE) –
➢ composite of the conditions, circumstances, and influences that affect the employment of
capabilities and bear on the decisions of the commander (JP 3-0)
➢ Pose realistic challenges for training and capabilities development for Army Forces and their joint,
governmental, interagency, and multinational partners
➢ Conditions and influences that affect where Soldiers, leaders, and Civilians live, work, train, and
fight
❖ Operational Variables – PMESII-PT
➢ The 8 variables don’t exist in isolation. Linkages of the variables cause complex and often
simultaneous dilemmas that a military force might face.
➢ Represent a “system of systems”
➢ Political – Military – Economic – Social – Infrastructure – Information – Physical Env. - Time
➢ Future OE Impacts
▪ Increased velocity and momentum of human interaction and events
▪ Potential overmatch
▪ Proliferation of Weapons of Mass Destruction (WMDs)
▪ Spread of Advanced Cyberspace and Counter-Space capabilities
▪ Demographics and Operations among populations in cities in complex terrain
❖ Information environment
➢ Includes:
▪ Physical dimension (brick and mortar centric)
● Assets (factories, networks, equipment)
● Associated infrastructure
▪ Informational dimension (data centric)
● Information (content, flow, quality)
● Automation
▪ Cognitive dimension (human centric)
● Opinion and knowledge (public, private, leadership)
● Assumptions
➢ Cyberspace can alter the information that is received; it can be swayed with bias, timing, etc.
➢ Information received can be from:
▪ Enemy
▪ Friendly
▪ Adversary
▪ Neutral
❖ 6 global trends in OE
➢ competing cultures, civilization, associated ideologies

➢ information and communications technology proliferation

➢ globalization/integration (positive and negative implications)
➢ weapons of mass destruction proliferation
➢ science, technology, and engineering advances
➢ increasing resource constraints (energy and water, sustainability issues increasing in importance)
❖ Actors in OE
➢ Potential adversaries
▪ Strategy: Preclude US from executing its own “way of war”
● Recognizes conventional confrontation with the US is a losing proposition
● Focuses on US vulnerabilities
● Utilizes “home field” advantages
● Nontraditional employment of all possible capabilities
▪ Capabilities: Capabilities that create a “Strategic Edge”… specifically designed to impact US
actions
➢ Nation-states
▪ Core – eg. USA, UK, France
▪ Transition – eg. Russia, China, India
▪ Rogue – eg. N. Korea, Iran, Cuba, Libya, Syria, Venezuela
▪ Failed or failing – eg. Haiti, Somalia, Kosovo, Afghanistan, Darfur, Liberia
➢ Non-state actors
▪ Rogue actors
● Insurgent
● Terrorist
● Drug-trafficking
● Criminal
▪ Third-party actors (generally non-hostile)
● Humanitarian relief organizations
● Refugees/IDPs
● Media
♦ Global information network
♦ Objective or biased
♦ On the battlefield – embedded
♦ Manipulated by others
♦ Affect public opinion
● Transnational corporations
♦ Help build infrastructure
♦ Promote economic gain
♦ Concern about collateral damage
♦ Armed security forces
● Other civilians on the battlefield
❖ Biggest casualty producer – IED
❖ IPB – Intelligence Preparation of the Battlefield
➢ To collect, analyze, and visualize…to selectively apply and maximize combat power at critical
points in time and space
➢ Situational awareness – immediate knowledge of the conditions of the operation, constrained
geographically and in time
➢ Situational understanding – the product of applying analysis and judgment to relevant information
to determine the relationships among the mission variable to facilitate leader decision-making
❖ Enemy descriptors
➢ Enemy forces – determine what you do and don’t know
❖ Information Flow
➢ Assess – Information Requirement - elements required for planning & executing
➢ Analyze – Intelligence Requirement - fills gaps, identified indicators of enemy actions or intent
▪ IR – set by the commander; the intelligence you need to learn/keep “an eye out for”
➢ Determine:
▪ Priority Intelligence Requirements (PIR) – what you know; to anticipate and state priority
during task planning or decision-making

▪ Commander’s Critical Information Requirement (CCIR) – what you need to know; directly
affects decision-making and successful execution of mission
M113 - MISSION COMMAND: WARFIGHTING FUNCTIONS

ADRP 6-0, Mission Command, 28 Mar 2014, Chapter 3
ADRP 6-0, Mission Command, Para. 40 thru 50, 12 Mar 2014
Discuss:
1) What are the Warfighting functions? Mission Command, Fires, Sustainment, Intelligence,
Protection, Movement and Maneuver
2) Add leadership and information to the warfighting functions and you get: Elements of Combat
Power
3) Who drives the operations process? Commander
4) What are the two parts of the mission command warfighting function? Leadership (commander
and staff) and systems
❖ Mission command has direct (central) relationship to other warfighting functions:

➢ Protection
➢ Intelligence
➢ Movement and maneuver
➢ Fires
➢ Sustainment
❖ Identify the five mission command systems that support the commander
➢ Personnel: most important component
➢ Networks
➢ Information systems: SOP
➢ Processes and procedures
➢ Facilities and equipment
❖ Primary commander’s tasks (3 mission command tasks - LEADS)
➢ Drive the operations process
➢ Develop teams
➢ Inform and influence audiences
❖ Primary staff tasks (4 mission command tasks - SUPPORTS)
➢ Conduct the operations process
➢ Conduct knowledge management and information management
➢ Synchronize information-related capabilities
➢ Conduct Cyber Electromagnetic Activities (CEMA)
❖ Additional 5 mission command tasks
➢ Conduct military deception
➢ Conduct civil affairs operations
➢ Install, operate, and maintain the network
➢ Conduct airspace control
➢ Conduct information protection
❖ Discuss the commander’s and staff role in the operations process
➢ Commander’s lead soldiers and organizations through purpose, direction, and motivation
▪ Understand the operational environment and the problem
▪ Visualize the desired end state and operational approach
▪ Describe the commander’s visualization in time, space, purpose, and resources
▪ Direct forces and warfighting functions throughout preparation and execution
➢ Commander assesses progress through continuous monitoring and evaluation
➢ Staffs support through running estimates.
▪ Common Operating Pictures (COPs)
➢ Additional Commanders Tasks
▪ Develop Teams that:
● Are adaptive and anticipate transitions
● Accept risk to create opportunities

● Influence friendly, neutral, adversaries, enemies, and unified action partners

▪ Inform and Influence
● Ensures actions, themes, and messages complement and reinforce each other
● Through engagements, radio/TV, social media/websites, ops briefings, etc.
● Staff assist commanders in creating shared understanding inside and outside the
organization
S100 SPACE IMPACTS ON ARMY OPERATIONS

Discuss:
1. Identify Capabilities of Space Enabled Equipment
2. Identify Space Linkages
3. Identify Space threat capabilities
❖ Army is the largest user of satellite enabled capabilities, integrated into all six Warfighting Functions
❖ Satellites enable the Army Warfighter the ability to Maneuver and Attack with great precision (GPS),
Communicate across the globe (SATCOM, Collect information throughout AOR (ISR), and see the
battlefield (FFT)
❖ Emerging EW threats imply that future Army engagements will face the potential for operations in a
Denied, Degraded, or Disrupted Space Operational Environment (D3SOE)
❖ Space Operation Requirements
➢ COIN vs. Near Peer
▪ Uncontested space/Space supremacy vs. Contested space/Space Parity
▪ Negligible requirements to attach threat’s use of space vs. Significant requirements
▪ Significant augmentation vs. Negligible augmentation
▪ Fixed command post/stable networks vs. Mobile command post and networks
❖ Capabilities of Space Enabled Equipment
➢ Position Navigation and Timing (GPS)
▪ Timing important for synchronizing communications
▪ GPS is critical to civilian and military operations.
▪ The GPS satellite constellation is positioned to provide worldwide support to the warfighter.
▪ The GPS signal is very weak, and susceptible to enemy jamming and other electromagnetic
interference.
▪ 4 satellites in view are required to receive a GPS ground fix (3 for trilateration and the 4th for
timing)
▪ Generally 8-11 satellites are in view at any given time
▪ GPS TTPs:
● Encrypt your GPS receivers (e.g. DAGR)
♦ Receive 2 GPS Signals
♦ More resistant to adversary jamming
♦ The DAGR screen reflects “JAMMING DETECTED”
● Block the jamming signal using different means:
♦ Terrain (hills, mountains, valleys, etc.)
♦ Vehicles
♦ Buildings
♦ Your body
● Maintain skills in traditional navigation methods
♦ Map/compass
♦ Distance/Direction
♦ Dead reckoning
♦ Terrain association
● Develop PACE Plan [Primary, Alternate, Contingency, Emergency]
➢ Satellite Communications (SATCOM)
▪ Provides:
● Supports all Army Warfighting Functions
● Beyond line of sight voice and data communications

●Reduces Fratricide and increased C2 (Command and Control) Situational Awareness

(e.g. Friendly Force Tracking)
▪ SATCOM Mitigation:
● Troubleshoot equipment. Additionally:
♦ Ensure your terminal has line of sight to the communication satellite
♦ Weather factors may affect satellite communications (Staff Weather Officer, S6,S2)
● Understand the tactical situation (S2 IPB) to determine if there is an enemy jamming
threat to your communications
● Report interference in accordance with unit SOP (S6, EWO, S2)
● Be prepared to operate without SATCOM
♦ Line of sight radios, use of re-trans systems, couriers
♦ Operating independently within your Commander’s “intent”
♦ Develop a PACE Plan
➢ Space Based ISR
▪ Intelligence, Surveillance, and Reconnaissance (ISR)
● Many ISR missions are conducted from Space:
♦ This includes multiple types of imagery and signals collection
♦ Both U.S. Government systems and commercial companies contribute to the ISR
efforts
♦ Your S2 is the unit POC to both access, and exploit data collected by these ISR
satellites
● Benefits of space-based ISR
♦ Collects in denied areas of the world where aircraft, UAS, and ground intel cannot
access
♦ A variety of satellite sensors can collect against many different types of targets
♦ The imagery from commercial satellites can be excellent for tactical unit planning and
can normally be released to coalition partners
♦ Space ISR assists the S2 with “All Source” intelligence
● Limitations
♦ Physics
♦ Terrestrial Environment
♦ Solar Environment
♦ Enemy Actions - can deny, degrade, disrupt the Space Operational Environment
(D3SOE)
❖ Space Linkages
➢ Space Support to the Warfighter
➢ Space Linkages to the Warfighter
❖ Space Threat Capabilities

➢ Ukrainian Conflict Lessons Learned
▪ GPS Jamming
▪ Signals Interception, Targeting, and Disruption
▪ Unmanned Aircraft Systems (UAS)
▪ CYBER Operations

▪ Space Based Commercial Imagery

➢ GYPSY KILO (GK)
▪ GK: GPS jamming exercise conducted during a unit FTX at Ft Carson, CO and at White
Sands Missile Range (WSMR) in Feb and Mar 2015 respectively. Observations from the
FTX:
● Over dependence on Space capabilities at tactical (Co/Plt) level; space linkages taken for
granted
● Significant reliance on JBC-P for situational awareness and communications
● 80% of Soldiers failed to encrypt their DAGRs
▪ Impacts of the GPS jamming included:
● Units became disoriented; Soldiers lacked basic map reading/land navigation skills
● Degraded JBC-P Common Operating Picture; staff lacked ability to conduct alternate
analog operations (map reading, graphic control measures, tracking charts, maintain
battle log, etc.)
● Soldiers used civilian GPS receivers; vulnerable to enemy manipulation
➢ Peer/Near Peer Threat
▪ Increase in:
● The possibility of Collateral Damage (which could include civilian casualties), and
Fratricide (friendly force inflicted) as high precision munitions (EXCALIBUR, JDAM)
become less reliable, and we have a less clear picture (poor and less accurate Common
Operating Picture (COP) of the battle space.
● Ammo Expenditure increases as “dumb rounds” must replace precision rounds (which
means transportation and associated fuel requirements rise substantially)
● Paper maps must be obtained in sufficient quantities to meet tactical force requirements.
● Your unit must be prepared to revert to “Analog” methods. This means manually (map,
acetate, unit symbols, phase lines, check points, etc.) tracking the battle. Increased
communication limitations with dispersed elements around the battlefield. Additionally, all
units must be prepared to conduct manual land navigation (thus the need for maps, and
compass)
M114 - MISSION COMMAND STAFF TASKS

The Battle Staff Handbook
ADRP 6-0
Discuss:
1. Analyze the staff characteristics (FM 6-0, Chap 2) of a good, effective staff officer and how they
contribute to executing Mission Command Staff Tasks.
2. Explain how the components and tasks of Information Management help staff officers exercise the Art
of Command and Science of Control.
3. Discuss the relationship between information management and knowledge management and how they
contribute to achieving a shared understanding.
4. Explain the Knowledge Management Components and the four Content Management Tasks and how
they support the operations process.
5. Identify the Information-Related Capabilities (IRC) that inform and influence audiences.
6. Discuss how IRC is synchronized to support successful Unified Land Operations.
7. Identify the fundamentals of CEMA and planning considerations.
❖ Primary Staff Responsibilities

➢ Support the commander
➢ Responsibility within their specific expertise; advising and informing the commander within field
❖ Common Staff Duties and Responsibilities
➢ Conducting staff assistant visits
➢ performing risk management, IBPs
❖ Staff Characteristics
➢ seek shared understanding with OE with commander, subordinates

➢ continually reassess changes within OE

❖ Discuss the difference between information management and knowledge management
➢ Information management – provides the timely and protected dissemination of relevant
information to commanders and staffs
▪ Science
▪ Focused on “how”
➢ Knowledge management – the process of enabling knowledge flow to enhance shared
understanding, learning, and decision-making
▪ Art
▪ Focused on “why”
❖ Knowledge management (KM) fundamentals
➢ Shared understanding and decision making are enhanced by…
▪ Creating knowledge
▪ Organizing knowledge
▪ Applying knowledge
▪ Transferring knowledge
➢ Knowledge Management allows units to focus and direct: right information, right form, right
person, right time, right place, make decisions
➢ Knowledge Management (KM) Components
▪ People
▪ Process
▪ Tools
▪ Organization
➢ Steps of KM Process (cyclical process)
1. Assess – Evaluate - start with a process and evaluate it; influenced by commander’s guidance;
knowledge gaps and information requirements
2. Design – Tailor - processes for SIGACTS, patrol debriefs, SLEs, GRINTSUMs, LOGSTATs
3. Develop – SOPs, battle drills, business rules
4. Pilot – Measure - rehearsals, CPX, PCCs
5. Implement – Train - Orders, FRAGO, commander’s emphasis, deployment
❖ KM Components
➢ Knowledge management bridges the Human and Technical Dimensions:
❖ Information operations (IO) - integrated employment, during military operations, of information-

related capabilities in concert with other lines of operation to influence, disrupt, corrupt, or usurp the
decision-making of adversaries and potential adversaries while protecting our own
❖ Identify the Information-Related Capabilities that inform and influence audiences.
➢ Public affairs
➢ Military information support operations
➢ Combat camera
➢ Soldier and leader engagement
➢ Civil affairs operations
➢ Operations security
➢ Military deception
❖ Other capabilities to support IO efforts:

➢ Cyber Electromagnetic Activities (CEMA)

➢ Presence, Posture, and Profile
➢ Physical Attack
➢ Physical Security
❖ Discuss how IRC is synchronized to support successful Unified Land Operations.
➢ As a synchronizing function, IO holistically ties together information-related capabilities to achieve
effects in the IE that support attainment of operational objectives and the commander’s desired
end state. Although the staff lead is the IO officer (Functional Area 30) or IO planner (P4 Skill
Identifier/Additional Skill Identifier) at BN and below, the entire staff contributes to the
synchronization process, primarily through the IO Working Group (IOWG).
❖ CEMA Purposes
➢ Build, Operate, and Defend the Network
➢ Gain Situational Understanding through CEMA
➢ Protect Individuals and Platforms
➢ Attack and Exploit Adversary Systems
❖ Pillars of CEMA
➢ Electronic warfare - Use electromagnetic and directed energy to control the electromagnetic
spectrum or to attack the enemy
▪ Electronic Attack, Electronic Protection, Electronic Warfare Support
➢ Cyberspace operations - Employ cyberspace capabilities to achieve objectives
▪ Defensive Cyberspace Operations, Offensive Cyberspace Operations, DOD Information
Network Operations
➢ Spectrum management operations - Plan, coordinate, and manage the use of the EMS through
operational, engineering, and administrative procedures to deconflict all systems
❖ Functions of cyberspace
➢ DODIN operations – operations to design, build, configure, secure, operate, maintain and sustain
DOD networks to create and preserve information assurance on the DOD information networks
▪ Handled by Def. Information Systems Agency, Network Enterprise Center, Army Network
Enterprise Technology Command
➢ Defensive Cyber Operations (DCO) – passive and active cyberspace operations intended to
preserve the ability to utilize friendly cyberspace capabilities and protect data, networks, net-
centric capabilities, and other designated systems
▪ Handled by Combatant commanders (IDM), joint force commanders, SROE
➢ Offensive cyber operations (OCO) – operations intended to project power by the application of
force in or through cyberspace
▪ Handled by President, Sec. of Defense
❖ CEMA planning considerations
➢ Significant legal and policy considerations
➢ May require long lead times
➢ Extensive coordination
➢ Employ alternative effects
➢ Create simultaneous and near instantaneous effects
➢ Possibilities of unintended or cascading effects
➢ Situational understanding is incomplete without cyberspace and the EMS
➢ Leveraged to protect and ensure access to mission command system
O501 - DOCTRINE FOUNDATIONS

ADP 3-0 Operations
FM 3-0 Army Operations
Army Pubs - ADPs, ADRPs, FMs, etc.
Discuss:
1. Describe the Army’s operational concept.
2. What are the Elements of Unified Land Operations?

3. The science and art of tactics; solving tactical problems; and common tactical concepts such as
Tactical Mission Tasks.
4. What are the personnel recovery planning considerations in ULO?
5. What are Information Operation capabilities and how they are integrated in ULO?
6. Roles and capabilities of integrating Cyber Electronic Activities (CEMA) in ULO.
❖ The role of doctrine

➢ Army doctrine is a body of thought on how Army forces operate as an integral part of a joint force
➢ Capstone doctrine serves as the basis for decisions about organization, training, leader
development, material, Soldiers, and facilities
▪ Eg. ADP 1 – The Army, ADP 3-0 – ULO
➢ Doctrine is…
▪ a guide to action rather than a set of fixed rules
▪ a statement of how the Army intends to fight
▪ provides a means of conceptualizing campaigns and operations
▪ helps potential partners understand how the Army will operate
▪ establishes a common frame of reference and a common cultural perspective to solving
military problems
➢ Enduring themes of Army doctrine
▪ Emphasis on leadership and soldiers
▪ Importance of initiative
▪ Mission command
▪ OE
▪ Simultaneous operations
▪ Concept of combat power
▪ WFF
▪ Operations process
▪ Joint interdependence
▪ Principles of war
▪ Operational art
▪ Unified action
❖ Doctrine Hierarchy
➢ ADP, ADRP, FM, ATP
❖ Mission and role of the Army in ULO
➢ We derive our mission from the intent of Congress and through the laws governing the Armed
Forces.
➢ The Constitution of the United States gives Congress the authority to determine the size and
organization of the Army, and gives the President overall command of the Armed Forces. The
Army’s mission is based on Title 10, United States Code (USC), and Department of Defense
Directive (DODD) 5100.01:
➢ “The mission of the United States Army is to fight and win the Nation’s wars through prompt and
sustained land combat, as part of the joint force. We do this by - organizing, equipping, and
training Army forces for prompt and sustained combat incident to operations on land; integrating
our capabilities with those of the other Armed Services; accomplishing all missions assigned by
the President, Secretary of Defense, and combatant commanders; remaining ready while
preparing for the future.” – ADP 1
❖ The Army’s operational concept
➢ A composite of the conditions, circumstances, and influences that affect the employment of
capabilities and bear on the decisions of the commander.
▪ Operational variables – PMESII-PT
▪ Mission variables – METT-TC
❖ ULO:
➢ Success requires fully integrating Army operations with the efforts of joint, interagency, and
multinational partners
➢ Central idea of ULO is that Army units seize, retain, and exploit the initiative to gain and maintain
a position of relative advantage in sustained land operations through simultaneous offensive,
defensive, and stability operations in order to prevent or deter conflict, prevail in war, and create
the conditions for favorable conflict resolution.

➢ Central idea applies to all military operations (offensive, defensive, stability, DSCA)
➢ US Army conducts ULO which are executed through Decisive Actions by means of the Army
Core Competencies and guided by mission command.
➢ US Army develops operations characterized by the Tenets of ULO with a cognitive link between
strategic objectives and tactical actions, which are also organized by the Operations Process,
Operational Framework, and WFF.
➢ Executed through Decisive Action (TASKS)
➢ Guided by Mission Command (PHILOSOPHY)
▪ To do this:
● Develop Operations characterized by Tenets and Principles of operations
● Cognitively link tactical actions to strategic objectives
● Organize effort within a commonly understood construct (Operations Structure)
♦ Operations Process (Provide a broad process for conducting operations
➢ Plan - Army Design methodology; MDMP; TLPs
➢ Prepare
➢ Execute
➢ Assess
♦ Operational Framework (Basic options for visualizing and describing operations)
➢ Decisive - Shaping - Sustaining
➢ Deep-Close-Support
➢ Main-Supporting Efforts
♦ Elements of Combat Power (Provide intellectual organization for common critical
tasks):
➢ Mission Command (6 WFFs) +
➢ Information +
➢ Leadership
❖ Elements/Foundations of Unified Land Operations
➢ Initiative
▪ Degrade
▪ Prevent
▪ Follow-up
▪ Continue to exploit
▪ From enemy’s point of view: actions must be rapid, unpredictable, and disorienting
➢ Decisive action (DA): offense, defense, stability, DSCA (Defense support of civil authorities)
▪ via Core Competencies: Combined Arms Maneuver + Wide Area Security
● Combined Arms Maneuver: application of the elements of combat power in unified action
to defeat enemy ground forces; to seize, occupy, and defend land areas; and to achieve
physical, temporal, and psychological advantages over the enemy to seize and exploit
the initiative
● Wide Area Security: application of the elements of combat power in unified action to
protect populations, forces, infrastructure, and activities; to deny the enemy positions of
advantage; and to consolidate gains to retain the initiative
▪ Offensive, Defensive, Stability DA conducted outside the US
➢ Mission Command - philosophy of command that emphasizes broad mission-type orders,
individual initiative within the commander’s intent, and leaders who can anticipate and adapt
quickly to changing conditions
❖ Tenets of ULO
➢ Flexibility – mix of capabilities; collaborative planning
➢ Lethality – expert application of lethal force
➢ Adaptability – willing to accept prudent risk
➢ Synchronization – arrangement of military actions to produce maximum relative combat power
➢ Integration – joint operations
➢ Depth – arranging activities across the entire operational framework to achieve the most decisive
result
❖ Operations Principles
➢ Mission command
➢ Develop the Situation Through Action

➢ Combined Arms
➢ Adhere to Law of War
➢ Establish and Maintain Security
➢ Create multiple dilemmas for the enemy
❖ Operational art
➢ Applies to any formation that must effectively arrange multiple, tactical actions in time, space, and
purpose to achieve a strategic objective, in whole or part
➢ How commanders balance risk and opportunity
➢ Elements of Operational Art
▪ End state and conditions
▪ Centers of gravity – source of power that provides moral or physical strength, freedom of
action, or will to act
▪ Operational approach: Direct or indirect approach
● Operational approach is the manner in which a commander contends with a center of
gravity
● Defeat mechanism – defeat enemy physically and/or psychologically
● Stability mechanism – friendly forces establish lasting, stable peace
▪ Decisive points – keys to attacking or protecting centers of gravity; geographic or events
▪ Lines of operations (directional orientation of a force) & Lines of effort (links multiple tasks
and mission using logic of purpose)
▪ Operational reach - distance & duration across which a joint force can successfully employ
military capabilities
▪ Tempo - relative speed and rhythm over time with respect to the enemy
▪ Basing - provides support and services for sustained operations
▪ Phasing (planning/execution tool to divide an operation in duration or activity) and transitions
(mark a change of focus between phases, operations, etc)
▪ Culmination - point in time/space where a force no longer possesses capability to continue
current form of operations)
▪ Risk - continually assess and mitigate risk
❖ Art of Tactics
➢ Solve tactical problems within the commander’s intent by choosing from interrelated options
➢ Three Interrelated Aspects:
▪ The creative and flexible array of means to accomplish assigned missions.
▪ Decision making under conditions of uncertainty when faced with a thinking and adaptive
enemy.
▪ Understanding the effects of combat on Soldiers.
❖ Science of Tactics
➢ Understanding physical capabilities of organizations and systems, as well as techniques, and
procedures that can be measured and codified
➢ Includes:
▪ The physical capabilities of friendly and enemy organizations and systems
▪ Techniques and procedures used to accomplish specific tasks (tactical terms and control
graphics that compose the language of tactics)
▪ Techniques and procedures for employing the various elements of the combined arms team
to create or produce greater effects
❖ The relationship between operational art and tactical operations
➢ Operational art is the pursuit of strategic objectives, in whole or in part, through the arrangement
of tactical actions in time, space, and purpose.
➢ Operational art is not associated with a specific echelon or formation
▪ Not exclusive to theater and joint force commanders
▪ Applies to any formation that must effectively arrange multiple, tactical actions in time, space,
and purpose to achieve a strategic objective, accomplished through sequencing,
prioritization, timing, and risk
➢ Operational art - how commanders balance risk and opportunity to create and maintain the
conditions necessary to seize, retain, and exploit the initiative and gain a position of relative
advantage while linking tactical actions to reach a strategic objective.
➢ The science and art of tactics; solving tactical problems; and common tactical concepts such as
Tactical Mission Tasks

▪ Tactics occur at the company and below level. The tactical mission is assigned by the
battalion commander.
❖ Concept of Operations - statement that directs the manner in which subordinate units cooperate to
complete the mission
➢ Decisive Operation - directly accomplishes the mission. It determines the outcome of a major
operation, battle, or engagement. The decisive operation is the focal point around which
commanders design the entire operation
➢ Shaping Operation - operation at any echelon that creates and preserves conditions for the
success of the decisive operation
➢ Sustaining Operation - operation at any echelon that enables the decisive operation or shaping
operations by generating and maintaining combat power
❖ Describe Army and Joint doctrine and how they are nested?
❖ Central idea: synchronization, coordination, and/or integration of the activities of governmental and
non-governmental entities with military operations to achieve unity of effort (JP 1)
➢ Horizontal nesting – to right and left
➢ Vertical nesting – to higher and lower levels
❖ CEMA in Operations [Slide 69]
➢ Build, operate, and defend the network
➢ Attack and exploit enemy systems
➢ Gain situational understanding
➢ Protect individuals and platforms
❖ Planning for Personnel Recovery - integrate into planning for ULO using MDMP:
➢ Focused through 3 focal groups (Commander/Staff + Unit/Recovery Force + Individual/Isolated
Person)
➢ To Accomplish the 5 PR tasks:
▪ Report, Locate, Support, Recover, Reintegrate
➢ Utilizing the 4 methods of recovery:
▪ Immediate, Deliberate, External Supported, Unassisted
O505 - DEFENSIVE OPERATIONS (DO)
Discuss:
1) What kind of casualties will you see more during defense? IDF, potential CBRNE, DNBI, Force
Health/PM
❖ Tasks of DO
➢ Mobile defense - destroy or defeat the enemy through a decisive attack by a striking force. The
striking force is a dedicated counterattack force in a mobile defense constituted with the bulk of
available combat power. A fixing force supplements the striking force
➢ Area defense - deny enemy forces access to designated terrain for a specific time rather than
destroying the enemy outright
➢ Retrograde - organized movement away from the enemy; fire support and obstacle plans; reserve
in a support by role fire
▪ There are three forms: delay, withdrawal, and retirement
❖ Purposes of Defensive Operations
➢ Deter or defeat enemy offenses
➢ Gain time
➢ Achieve economy of forces
➢ Retain key terrain
➢ Protect the populace, critical assets, and infrastructure
➢ Develop intelligence
❖ Characteristics of defensive operations
➢ Disruption - unhinge enemy preparation/attacks, disrupt tempo & synchronization to prevent
massing combat power
➢ Flexibility - by designating supplementary positions, designing counterattack plans, and preparing
to counterattack

➢ Maneuver - allows the defender to take full advantage of the area of operations and to mass and
concentrate when desirable
➢ Massing effects - mass the effects of overwhelming combat power where they choose and shift it
to support the decisive operation
➢ Operations in depth - Synchronization of decisive, shaping, and sustaining operations facilitates
mission success to prevent the enemy from gaining momentum in the attack
➢ Preparation - study ground; select positions of massing of fires on likely approaches; canalize
enemies with obstacles; coordinate & rehearse actions on ground
➢ Security - prevent enemy intelligence, surveillance, and reconnaissance assets from determining
friendly locations, strengths, and weaknesses
❖ What should we take into account when planning a defensive operation?
➢ 7 Step Engagement Area Development
▪ ID all likely enemy avenues of approach
▪ Determine likely enemy schemes of maneuver
▪ Determine where to kill the enemy
▪ Emplace weapon systems
▪ Plan and integrate obstacles
▪ Plan and integrate indirect fires
▪ Rehearse
❖ Obstacle types
➢ Existing
▪ Natural
▪ Manmade
➢ Reinforcing
▪ Tactical
▪ Protective
❖ Individual Obstacles
➢ Demolition
▪ Blown bridges
▪ Abatis
▪ Road crater
➢ Constructed
▪ Wire
▪ Tetrahedron
▪ Tank Ditch
➢ Mines
▪ Conventional
▪ Scatterable
❖ Obstacle effects
➢ Disrupt
➢ Turn
➢ Fix
➢ Block
❖ Different Forms of Defense
➢ Defense of a linear obstacle – area or mobile defense along or behind a linear obstacle
➢ Defense of a perimeter – area or mobile defense
➢ Reverse slope defense – denying the enemy the topographical crest; masks main defensive
positions from enemy observation and direct fire
❖ Primary Defensive Tasks
➢ Area defense – deny enemy access to designated terrain for a specific time, limiting their freedom
of maneuver and channeling them into killing areas
➢ Mobile defense – force oriented defensive action that focuses on the destruction of the enemy
forces rather than the retention of terrain
▪ Greater mobility
▪ Minimum force
▪ Maximum combat power
▪ Designate a reserve

➢ Retrograde – executed to gain time, preserve forces, place the enemy in unfavorable positions, or
avoid combat under undesirable conditions
▪ Combination of delay, withdrawal, and retirement operations
▪ Need for detailed, centralized planning and decentralized execution
❖ 5 Battle Positions
➢ Strong point - heavily fortified position tied to a natural or reinforcing obstacle to create defensive
anchor, or deny enemy key terrain
➢ Primary - covers the enemy’s most likely avenue of approach into AO
➢ Alternate - covers the enemy’ most likely avenue of approach to AO and occupied when primary
becomes untenable/unsuitable
➢ Supplementary - covers the best sectors of fire and defensive terrain along avenue of approach;
not primary avenue of attack
➢ Subsequent - position a unit expects to move during course of battle
❖ Defensive Planning considerations
➢ Commander’s intent
➢ Priorities of work
➢ Security operations
▪ Deceive the enemy as to friendly locations, strengths, and weaknesses
▪ Inhibit or defeat enemy reconnaissance operations
▪ Provide early warning and disrupt enemy attacks
➢ Security and reconnaissance operations
➢ Obstacles
➢ Position forces in depth
➢ Prepare reserves
➢ Designate counterattack forces
➢ Conduct rehearsals
➢ Preparation continues
➢ Force protection - preserve combat power
➢ Information operations
▪ Military deception
▪ Operations security
▪ Electronic warfare
➢ Disrupt enemy’s tempo and synchronization
▪ Defeat or misdirect enemy reconnaissance
▪ Break up formations
▪ Isolate units
▪ Interrupt fire support
▪ Interrupt enemy reserves
➢ Spoiling attacks
➢ Counterattacks
➢ Offensive IO
➢ Area defense / mobile defense / retrograde
❖ Two reasons for transition:
➢ If defense is successful, transition to the offense.
▪ Attack using forces not previously committed to the defense (preferred)
▪ Attack using the currently defending forces (faster reaction but may lack stamina to continue)
➢ If defense is unsuccessful, transition to retrograde operations.
▪ Usually involves a combination of delay, withdrawal, and retirement operations
▪ Accompanied by efforts designed to:
● Reduce enemy strength and combat power.
● Provide friendly reinforcements.
● Concentrate forces elsewhere for the attack.
● Prepare stronger defenses elsewhere within the AO.
● Lure or force part or all of the enemy force into areas where it can be counterattacked
❖ Contingency planning for transition:
➢ Establishes the required organization of forces.
➢ Decreases the time needed to adjust the tempo of combat operations from defensive to offensive.

➢ Reduces the amount of time and confusion inherent when a unit is unsuccessful in its defensive
efforts and must transition to retrograde operations
❖ What are the key elements of Dept of Defense Personnel Recovery?
➢ 3 focal groups (Cdr & staff, unit or recovery force, the individual or isolated person)
➢ 5 PR tasks (report, locate, support, recover, re-integrate)
➢ 4 methods of recovery (unassisted, immediate, deliberate, and external supported recovery
O504 - FUNDAMENTALS OF OFFENSIVE OPERATIONS
❖ Purposes of Offensive Tasks

➢ Defeat, destroy or neutralize enemy force
➢ Secure terrain
➢ Deprive enemy of resources
➢ Gain information
➢ Deceive/divert enemy
➢ Hold enemy in position
➢ Disrupt enemy attack
❖ Primary offensive tasks
➢ Movement to contact – move to regain contact with the enemy; enemy’s position is unknown
➢ Attack - destroy or defeat enemy forces and/or to seize and secure terrain
▪ Ambush
▪ Counterattack
▪ Demonstration
▪ Feint
▪ Raid
▪ Spoiling attack
➢ Exploitation - follows conduct of successful attack to disorganize enemy in depth
➢ Pursuit - catch/cut off escaping enemy IOT destroy it
❖ Characteristics of offensive operations
➢ Surprise
➢ Concentration
➢ Audacity
➢ Tempo
❖ Forms of Maneuver: distinct tactical combinations of fire and movement + unique set of doctrinal
characteristics
➢ Envelopment – attack from behind enemy’s position
➢ Flank attack – attack from the side/flank
➢ Frontal attack – attach over a broad front; preferred when the enemy force is weaker
▪ Advantage with the defense → Will most likely have the most casualties
➢ Infiltration – send small forces, undetected, thru enemy lines, to attack from behind them
➢ Penetration – attack is concentrated on a narrow front
➢ Turning movement – attack an objective behind the enemy to get them to move out of their
defensive position
❖ Tactical Enabling Tasks
▪ Reconnaissance
▪ Security operations
▪ Troop movement
▪ Relief in place
▪ Passage of lines
▪ Encirclement operations
❖ Security Operations
➢ Fundamentals
▪ Screen
▪ Guard
▪ Cover
▪ Area security
▪ Local security

➢ Tasks
▪ Screen
▪ Guard
▪ Cover
▪ Area security
▪ Local security
❖ Breaching
➢ Intelligence
➢ Organization
▪ Support, Beach, Assault
➢ Fundamentals
▪ Suppress, Obscure, Secure, Reduce, Assault (SOSRA)
➢ Mass
➢ Synchronization
❖ Transitions - to defensive or stability operations
➢ Defensive transition - victory achieved, reaches culminating point, or change in mission from
higher HQ
▪ Culminating Point causes:
● Loss of momentum due to heavily defended areas that cannot be bypassed.
● Resupply of fuel, ammunition, supplies, or repair parts fails to keep up with expenditures.
● Soldier exhaustion, increase in casualties and equipment loss.
● Unexpected enemy surprise movements, reserves not available
O502 - STABILITY OPERATIONS

ADRP 3-07, Stability
Discuss:
❖ Stability operations – aims to create a condition so the local populace regards the situation a
legitimate, acceptable, and predictable
➢ End State: everlasting peace or a self-sustaining country/government
➢ Focus on identifying and targeting the root causes of instability and by building the capacity of
local institutions
➢ Instability sources
▪ Decreased support for the government based on what locals actually expect
▪ Increased support for anti-government element, which usually occurs when locals see
spoilers as helping solve the priority grievance
▪ Undermining of the normal functioning; emphasis must be on return to the established norms
❖ Army’s five primary stability tasks
➢ Establish civil security (includes security forces assistance)
➢ Establish civil control
➢ Restore essential services
➢ Support to governance
➢ Support to economic and infrastructure development
❖ Purposes of stability operations
➢ Provide a secure environment
➢ Secure land areas
➢ Meet the critical needs of the populace
➢ Gain support for host-nation government
➢ Shape the environment for interagency and host-nation success
❖ How do the primary stability tasks link to Department of State (DOS) post-conflict reconstruction and
stabilization technical sectors?
➢ Dept of State is designated to coordinate US Gov’t efforts in stabilization and reconstruction
activities. DOS developed a matrix of stability-focused, stabilization, and reconstruction essential
tasks.
▪ Dept of State Stability sectors (technical areas) – help to focus and unify reconstruction
and stabilization efforts:

● Security
● Justice and reconciliation
● Humanitarian assistance and social well-being
● Governance and participation
● Economic stabilization and infrastructure
▪
❖ Stability Mechanisms
➢ Compel - use/threatened use of force to establish dominance/control, behavioral change,
compliance
➢ Control - imposing civil order
➢ Influence - imposing will of friendly forces on situation
➢ Support - focuses on ability to establish, reinforce, set conditions for national power to function
effectively
❖ Challenges facing brigade combat team (BCT) commanders while conducting stability operations:
➢ The staff’s job isn’t to get from red to green (on the “lines of effort”) by end of the command, but to
get from red to green eventually.
➢ You are looking to make progress in a stable way so that you don’t regress. Set goals and
achieve what is reasonable in that time.
❖ Importance of Information Operations to Stability Operations
➢ requires a mastery of inform and influence activities— the integration of designated information-
related capabilities in order to synchronize themes, messages, and actions with operations to
inform
➢ Soldier and leader engagement often proves the most critical component of information
operations
❖ Provincial Reconstruction Team (PRT)

AS213.1 - AHS SUPPORT TO STABILITY

Discuss:
1. Why would the Army conduct stability operations_____________ and _____________?
Humanitarian Assistance Disaster Relief (HADR)
Transition from Offense or Defense of Operations
2. AHS support will include partnerships with _____________ and ___________ organizations?
Governmental and Non-Governmental
3. The Department of State is the lead element for stability operations? T/F.
4. AHS support will include the management of donated medical supplies? T/F.
5. A transition plan is not important? T/F.
❖ Purpose for DoD Support Stability Operations

➢ A powerful national security instrument that supports USG efforts globally through:
▪ Stability - Global Health Engagement (GHE) contributes to:
● Social well-being (sanitation and clean water, access to medical care)
● Governance (part of the social contract between government and people, lends to
government legitimacy)
● Economic development (enhance local skills and capacity, Lab employ locals)
● Security in partner nations (health in foreign military forces leads to ready partners and
self reliance)
▪ Cooperation - GHE enhances collaboration with foreign ministries and civil structures
● vital component of theater cooperation plans with the COCOMS
● Often military to military, but can be military to civilian.
♦ Programs in Disaster preparedness, interoperability, and targeted medical
capabilities such as Battlefield care
▪ Capacity - GHE contributes to improving partner nation capacity and increasing self reliance
❖ Whole of Government Approach - Diplomacy, Development and Defense (3D)
❖ Command Structure
➢ Department of State
➢ U.S. Agency for International Development (USAID)
▪ Office of Civil-Military Cooperation
▪ USAID’s Office of Foreign Disaster Assistance
● The Office of Foreign Disaster Assistance Military Liaison Unit
❖ Stability Principles
➢ Conflict transformation
➢ Unity of Effort
➢ Legitimacy and host-nation ownership
➢ Building partner capacity
❖ Stability Tasks
➢ AHS support to (2) tasks will be primarily DoD personnel and not host nation
▪ Establish civil control
▪ Support to governance
▪ Establish civil security*
▪ Restore essential services*
▪ Support to economic and infrastructure development*
*AHS capabilities can be utilized the most to assist with meeting end state
❖ In relation to Medical Functional Areas:
➢ Medical Mission Command
▪ Networks & equipment in host nation may not be compatible; need for interpreters; working
with civil affairs assets in theater
➢ Treatment
▪ ASMC and BSMC will still be providing Role 1 and 2 care; may be a delay in offering
MEDEVAC support; Increased patient holding times
➢ Hospitalization
▪ AHS support resources or modules that are normally only deployed with a combat support
hospital may be included in the task organization (even though the full hospital unit may not
be deployed)

▪ Ancillary services may be employed outside hospital setting when supporting stability tasks
➢ MEDEVAC
▪ May not follow traditional movement flow; use civilian controlled airspace, cross national
borders, and obtain route approval.
➢ Medical Logistics
▪ consider contract support, host-nation support, international standardization agreements, and
other services (if available) as a means to augment and assist military capabilities
▪ Caution must be exercised when acquiring medical supplies and equipment locally, as the
supplies may not meet U.S. standards or be cleared for use by the FDA and equipment may
not be approved for use aboard U.S. military aircraft
➢ Laboratory
▪ Clinical services - Role 2 or 3; standard lab services; may not deploy into AO
▪ Operational services - focused on total health of environment; consultation/troubleshooting
for MTFs; coordinate with Vet/PM/Chem
➢ Dental
▪ Augment HN programs - Oral health promotion/disease prevention programs; assessments
➢ Preventative Medicine
▪ Assess health threat; control arthropod/foodborne/waterborne diseases; environmental
injuries
➢ Combat Operational Stress Control
▪ Misconduct stress behaviors (poor Soldier behavior can turn HN against military)
➢ Veterinary
▪ Coordination with such agencies as the Department of State, USAID, host-nation Ministry of
Agriculture
O503 - TACTICAL LOGISTICS

ADRP 4-0 Sustainment, July 2012. Preface, Introduction, and Chapter 1
ADRP 4-0 Sustainment, July 2012. Paragraphs 3-96 through 3-117
FM 3-96 Brigade Combat Teams, October 2015. Chapter 9, 9-3 through 9-100
FM 6-0, Commander and Staff Organization and Operations, May 2014, Chapter 5
ATP 4-90, Brigade Support Battalions, April 2014, Chapters 1 & 2
Discuss:
1) What is the objective of sustainment-logistics?
2) Can sustainment/logistics be separated from operations?
3) What are the principles of sustainment?
4) What are the Sustainment Functions?
❖ 8 Principles of Sustainment
➢ Integration - Synchronizing logistics operations with all aspects of joint operations
➢ Anticipation - forecasting and initiated necessary actions and preparation
➢ Responsiveness - providing right support at the right time
➢ Simplicity - avoiding unnecessary complexity
➢ Economy - most efficient support, least wasteful
➢ Survivability - ability to protect support functions from destruction or degradation
➢ Continuity - uninterrupted, steady sustainment
➢ Improvisation - ability to adapt
❖ 13 Sustainment Functions
➢ Logistics
▪ Supply
▪ Field services
▪ Maintenance
▪ Transportation
▪ Distribution
▪ Operational contract support
▪ General engineering support

➢ Personnel Services
▪ Human resources support
▪ Religious support
▪ Financial management operations
▪ Legal support
▪ Band support
➢ Health service support
❖ BCT Sustainment Sub-Functions
❖ Sustainment of ULO
➢ Requires joint interdependence
▪ Deliberate and mutual reliance on joint sustainment can reduce duplication and increase
efficiency
➢ Stability, Offensive, Defensive, and DSCA
➢ Offensive Operations
▪ Higher fuel consumption
▪ Historically, ammunition expenditures are lower; however, responsive resupply is critical
▪ Preplanned push packages of essential items
▪ Maximum use of throughput required
▪ Higher casualty rates
▪ Field services sometimes are suspended
▪ Maintenance priorities established focusing on major weapon systems
➢ Defensive Actions
▪ Supply activity is the greatest in the preparation stage
▪ Increase combat loads at battle positions
▪ Plan for increased Class V expenditures
▪ Increased Class IV requirements- request throughput
▪ Resupply should be conducted during limited visibility hours
▪ Reduced equipment evacuation
▪ Increased demand for Class II NBC items
➢ Stability Operations
▪ Supply activity is the greatest in the preparation stage
▪ Increase combat loads at battle positions
▪ Plan for increased Class V expenditures
▪ Increased Class IV requirements- request throughput
▪ Resupply should be conducted during limited visibility hours
▪ Reduced equipment evacuation
▪ Increased demand for Class II NBC items
➢ Defense Support of Civil Authorities (DSCA)
▪ Sustainment is the primary focus
▪ Army sustainment units conduct the decisive action
▪ Interagency coordination
▪ Distribution of food, water, supplies, and medical
▪ Transportation, supply, and medical units are in high demand
❖ Tactical-level sustainment organizations and their capabilities
➢ FSC pushes supplies forward to the companies/troops

➢ Replenishment is on an as-required and METT-TC basis

❖ Core concepts and terms of the Modular Force Logistic Concept (MFLC)
➢ Modular units/capability
➢ Throughput of supplies to BSB
❖ Logistic planning considerations
➢ Location
➢ Security
➢ Echelonnement
➢ Protection
O507 - JOINT OPERATIONS

Joint Publication, JP 3-0, Joint Operations, January 2017.
· Optional: listen to Joint Publication 1-0, Joint Personnel Support, May 2016 Podcast at
http://www.dtic.mil/doctrine/docnet/podcasts/JP_1/podcast_JP_1.htm
Discuss:
1) What are the principles of Joint Operations?
2) What are the Range of Military Operations (ROMO) for planning a Joint Operation?
3) What are the operational variables (PMESII)?
4) What are the levels of war?
❖ Principles of Joint Operations [“MOUSE MOSS + LPR”]

➢ Mass
➢ Objective
➢ Unity of command
➢ Security
➢ Economy of force
➢ Maneuver
➢ Offensive
➢ Surprise
➢ Simplicity
➢ Legitimacy
➢ Perseverance
➢ Restraint
❖ Range of Military Operations (ROMO) for planning a Joint Operation
➢ Military engagement
➢ Security cooperation
➢ Deterrence activities
➢ Crisis response
➢ Limited contingency operations
➢ Major operations – series of tactical actions, such as battles, engagements, and strikes, and is
the primary building block of a campaign
➢ Campaigns – a series of related military operations aimed at accomplishing a military strategic or
operational objective within a given time and space
❖ Operational Variables (PMESII-PT)
❖ Levels of War
➢ Strategic (“Ends”)
▪ National Policy
▪ Theater Strategy
➢ Operational (“Ways”)
▪ Campaigns - series of related military operations aimed at accomplishing a strategic or
operational objective within a given time and space
▪ Major Operations - series of tactical actions (battles, engagements, strikes); building block of
campaign
➢ Tactical (“Means”)

▪ Battles
▪ Engagements
▪ Small Unit and Crew Actions
❖ Joint Task Force: organized to accomplish missions with specific, limited objectives that do not
require a centralized control of logistics; may have geographical or functional basis
❖ Considerations for using Cyberspace Electromagnetic Activities (CEMA) in Joint Operations
➢ Significant legal and policy considerations
➢ May require long lead times due to availability of assets and approval authority considerations
➢ CO require extensive coordination for most missions that extend outside of LandWarNet
➢ EW can be enabled and executed at all levels and can emphasize supporting the tactical
commander
➢ CEMA offers the option to employ alternative effects to achieve objectives formerly attained only
by physical destruction
➢ CEMA can create simultaneous and near instantaneous effects across multiple domains; effects
may occur in friendly, neutral, and adversary portions of cyberspace and the EMS
➢ Possibilities of unintended or cascading effects exist and may be difficult to predict
➢ Situational understanding of the operational environment is incomplete without the inclusion of
cyberspace and the EMS
➢ CEMA must be leveraged to protect and ensure access to the mission command system
AS213.2 - JOINT MEDICAL CAPABILITIES

MCWP 4-11.1, Health Service Support Operations, pgs. 1-4 to 1-9, 3-8 to 3-13, & 3-18 to 3-10.
USAF Annex 4-02 Enroute Care pgs. 1-3 & USAF Annex 4-02 Medical Objectives pgs. 1-7.
USCG COMDTINST M6000.1F, Chapter 2, Section H pgs. 1-3.
NORTHCOM Medical Capabilities Smartbook, 2014, Chapter 3.
❖ USAF HSS Assets and Capabilities

➢ AMFS: Air Force Medical Service
➢ EMEDS: Expeditionary Medical Support - “Portable hospitals”
▪ Deploys within 24 hours, medical supplies for 5 days/24h operations
▪ Modular build-up of capabilities organized into 3 force modules: EMEDS Health Response
Team (HRT), EMEDS+10 (Role 2), EMEDS+25 (Role 3)
● Expeditionary Combat Support (ECS)
● Base Operating Support (BOS)
▪ Provides individual bed-down and theater-level medical services for deployed forces or select
population groups
▪ Forward stabilization, primary care, dental services, and force health protection
▪ Prepares casualties for evacuation to next level of care
➢ TAES: Theater Aeromedical Evacuation System
▪ Lighter and more modular, optimize use of limited aircraft
▪ immediate, versatile, flexible
▪ Enroute Patient Staging System (ERPSS) & Critical Care Air Transport Teams (CCATT) =
“Care in the Air”
● Basic Crew Complement
♦ 2 Flight Nurses
♦ 3 AE Medical Technicians
● Augmented Crew
♦ 3 Flight Nurses
♦ 4 AE Medical Technicians
● Critical Care Air Transport Teams
♦ 1 Critical Care Physician
♦ 1 Critical Care RN
♦ 1 Cardiopulmonary Technician
▪ Tanker Airlift Control Center (TACC)

▪
Air Mobility Command direct reporting unit that plans, schedules and directs organic and
commercial missions to include AE
▪ Refueling, special operations, AE support, operational support and Presidential airlift
➢ Aircraft for Patient Movement
▪ C-130 H/J models
▪ C-17 Globemaster III
▪ KC-135 Stratotanker
❖ USN HSS Assets and Capabilities
➢ Operational Fleet Components
▪ Casualty Receiving and Treatment Ships (CRTSs)
▪ Hospital Ships (T-AHs)
▪ Fleet Hospitals (FHs) / Expeditionary Medical Facilities (EMF)
➢ Casualty management: transfer from sea to land
▪ Patient transfer and evacuation
▪ At sea transit
▪ Regional transfer
➢ Transfer from shore
➢ Transfer from ship
➢ Medical Capabilities Afloat
▪ USNS (T-AHs): USNS Mercy and USNS Comfort
▪ Nimitz Class
▪ San Antonio Class
➢ Flexible, mobile, readily responsive; support amphibious and naval forces; disaster release
➢ EMF Capabilities
▪ Role III - standardized, modular, flexible, ashore combat service support
▪ Medical/dental capability to support:
● Marine Corps Air/Ground Task Forces (MAGTF) ashore
● Navy amphibious task force units deployed ashore
● Forward deployed Navy elements of the Fleet
● Army and Air Force units ashore
▪ In addition to pre-positioned assets, activated EMF receives “Just-in-Time” consumable
material to support first 30 days of activation
➢ Expeditionary Resuscitative Surgical System (ERSS)
▪ Modular, mobile, mission-specific, non-enduring and low capacity afloat medical capability to
perform trauma resuscitation and stabilizing, life-sustaining surgery on kinetically injured
patients at or near the point of injury, and follow-on patient movement to higher levels of care
➢ Forward Deployable Preventive Medicine Unit (FDPMU)
▪ USN/USMC
● Robust technical support of disease surveillance and control efforts
● Provide technical expertise to Marine Corps Security Force Battalions (Force Auxiliary
Support Teams (FAST)
● Enhanced Nuclear Biological and Chemical (ENBC) Teams – support to MEU’s
▪ Microbiology
❖ USMC HSS Assets and Capabilities
➢ Marine Expeditionary Unit (MEU)
▪ Normally forward-deployed in/near
● Northeast Asia
● Southwest Asia
● Indian Ocean
● Mediterranean Sea
▪ On-scene, on-call, immediately employable
▪ Capable of conducting conventional & select maritime special purpose missions:
● Over the horizon
● By surface and air
● From the sea
● Under adverse weather conditions
➢ Marine Expeditionary Brigade
▪ Able to respond to a full range of crises and contingencies

▪ Can serve as enabler for joint / combined forces

▪ Deployment options:
● By Amphibious Task Force (ATF)
● By Maritime Prepositioning Squadron (MPS)
● By Strategic Air Lift
➢ USMC HS Functions: Casualty Management, Force Health protection and prevention, Medical
logistics, Medical command and control (C2), medical stability operations
➢ Depends on Navy/Army for all 10 MFAs for their HSS
❖ USCG HSS Assets and Capabilities
➢ National strike force (NSF)
➢ 35 clinics + 7 satellite clinics
➢ 62 sick bays afloat + 72 sick bays ashore
▪ USCG has no higher medical capabilities than Lvl 1 (EMT) on most expeditionary missions;
USCG must rely on DoD medical support when deployed
▪ USCG relies on “lifts of opportunity” for evacuation and does not operate a medical transport
capability
OP111 - OPERATIONS PROCESS

Discuss:
1. What is the difference between OPCON and TACON?
a. OPCON deals with operational support of the FSC has full control over the mission units
are organic most of the time; has the authority to organize commands and forces to
employ those forces as the receiving CMD considers necessary to accomplish the
mission
i. Examples of OPCON: Assigned gaining unit or Organic HQ
b. TACON has limited of the mission by executing certain missions FSMT (non-organic) –
Limits authority to direct control of administrative movements or maneuvers within the
operational area.
i. Examples of TACON: Attached gaining unit
❖ Define: Mission command - the preferred method of exercising command and control.
➢ It is the exercise of authority and direction by the commander using mission orders to enable
discipline initiative within the commander’s intent to empower agile and adaptive leaders in the
conduct of ULO.
❖ The Operations Process: the Army’s framework for exercising mission command.
➢ Major mission command activities during operations:
▪ Planning
▪ Preparing
▪ Executing
▪ Assessing
❖ Fundamentals of the Operations Process
➢ Describes the general nature of operations in which commanders, supported by their staffs
exercise mission command.
➢ Describes the operations process and highlights the commander’s role in its execution.
➢ Discussions of the integrating processes, continuing activities, and running estimates are
provided.
➢ Key Concepts: Fundamentals of the Operations Process
▪ The Nature of Operations
▪ Mission Command
▪ The Operations Process
▪ Principles of Operations Process
▪ Integrating Processes and Continuing Activities
▪ Battle Rhythm
▪ Running Estimates
❖ The Nature of Operations
➢ Human endeavors

➢ Dynamic operational environment

➢ Uncertainty
➢ Adapt to changes
❖ Principles of the Operations Process
➢ Understand – commanders understand those conditions that represent the current situation to:
▪ Visualize - …envision a set of desired future conditions that represents the operation’s end
state
● Current situation ↷ Operational Approach ↷ End State
▪ Describe – commanders describe their vision to their staffs to facilitate shared understanding
and purpose; commander’s intent is clear and concise; CCIR; Essential elements of friendly
information
♦ CCIR: Priority intelligence + Essential Elements of Friendly information (EEFI)
▪ Direct – commander’s prepare and approve plans/orders, assign tasks, etc.
● Establishing commander’s intent, setting achievable objectives, and issuing clear tasks to
subordinate units, allocating resources
➢ …commander’s lead and assess; they drive the operations
▪ Leads:
● Through leadership, commanders provide purpose, direction, and motivation to
subordinate commanders, their staff, and Soldiers.
● In many instances, a commander’s physical presence is necessary to lead effectively
▪ Assesses:
● Commanders continuously assess the situation to better understand current conditions
and determine how the operation is progressing.
● Commanders incorporate the assessments of the staff, subordinate commanders, and
unified action partners into their personal assessment of the situation
● Based on their assessment, commanders modify plans and orders to adapt the force to
changing circumstances.
❖ Situational Understanding
➢ Operational (PMESII-PT) and mission variables (METT-TC)
➢ Cultural understanding
➢ Red-teaming: provides commanders an independent ability to fully explore alternative plans and
operations in the context of the OE and from the perspective of others
❖ Critical thinking – purposeful and reflective judgment about what to believe or what to do
❖ Creative thinking – create something new or original; leads to new insights, new ways of
understanding, and new perspectives
❖ Integrated planning
➢ Conceptual planning (what to do and why) – concepts drive details
➢ Detailed planning (how to do it) – details influence concepts
❖ Army Planning Methodologies
➢ Army Design Methodology
➢ ⇱MDMP
➢ ⇱TLPs
❖ Army Design Methodology
➢ 1. Frame an operational environment (current state and desired end state)
➢ 2. Frame the problem (what are the obstacles?)
▪ What is going on in the environment?
● RAFT: Relationships, Actors, Functions and Tensions
▪ What do we want the environment to look like?
▪ Where -conceptually- should we act to achieve our desired state?
▪ How do we get from the current state to our desired state?
➢ 3. Develop an operational approach (what actions will resolve the problem?)
▪ Using lines of effort that graphically articulate the links among tasks, objectives, conditions,
and the desired end state
➢ 4. Develop the plan using MDMP
❖ Command Relationships
➢ Organic
➢ Assigned

➢ Attached
➢ OPCON (operational control)
➢ TACON (tactical control)
➢ ADCON (administrative control)
❖ Key Components of a Plan

➢ 1. Unit’s task organization
➢ 2. Mission statement - the task, together with the purpose, that clearly indicates the action to be
taken and the reason therefore
➢ 3. Commander’s intent - a clear, concise mission statement of what the force must do and the
conditions the force must establish with respect to the enemy, terrain, and civil considerations
that represent the desired end state; understood by leaders/Soldiers two Echelons lower than
CoC
▪ Key tasks
▪ End state
➢ 4. Concept of operations - a statement that directs the manner in which subordinate units
cooperate to accomplish the mission and establishes the sequence of actions the force will use to
achieve the end-state
▪ Nested concepts
▪ Decisive Points and Objectives
▪ Sequencing Actions and Phasing
▪ Lines of Operations - directional orientation of a force in time and space in relation to the
enemy and links the force with its base of operations and objectives
▪ Lines of Effort – links multiple tasks using the logic of purpose rather than geographical
reference to focus efforts toward establishing operational and strategic conditions
➢ 5. Tasks to subordinate units – a clearly defined and measurable activity accomplished by
individuals and organizations; 5 W’s
➢ 6. Coordinating instructions – CCIRs, fire support coordination, and airspace coordinating
measures, rules of engagement, risk mitigation measures, and the time or condition when the
operation order becomes effective
➢ 7. Control measures – a means of regulating forces or warfighting functions by assigning
responsibilities, coordinate actions between forces, impose restrictions, or establish guidelines to
regulate freedom of action

❖ Planning Pitfalls
➢ Attempting to forecast and dictate events too far into the future
➢ Trying to plan in too much detail
➢ Using the plan as a script for execution
➢ Institutionalizing rigid planning methods
❖ Preparation Activities – performed by units and soldiers to improve ability to execute an operation:
➢ Continue to coordinate and conduct ➢ Conduct rehearsals
liaison ➢ Refine the plan
➢ Initiate information collection ➢ Integrate new Soldiers and units
➢ Initiate security operations ➢ Complete task organization
➢ Initiate troop movement ➢ Train
➢ Initiate sustainment preparations ➢ Perform pre-operations checks and
➢ Initiate network preparations inspections
➢ Manage & Prepare terrain ➢ Continue to build partnerships with
➢ Conduct confirmation briefs teams
❖ Plans to Operations Transitions
❖ Fundamentals of Execution
➢ Seize the initiative through action
➢ Accept prudent risk to exploit opportunities (risk that’s inherent in the operation)
❖ Responsibilities During Execution
➢ Commanders focus their activities on directing, assessing, and leading while improving their
understanding and modifying their visualization. Commanders locate themselves where they can
exercise command and sense the operation
▪ Make execution and adjustment decisions throughout execution process
➢ Deputy commanders - May serve as senior advisors to their CDR or directly supervise a specific
WFF (i.e. sustainment)
➢ The staff integrates forces and warfighting functions to accomplish the mission.
➢ The current operations integration cell is the integrating cell in the command post with primary
responsibility for execution
❖ Rapid Decision-making & Synchronization Process (RDSP)
➢ Technique that commanders and staffs use during execution.
➢ While the military decision-making process (MDMP) seeks the optimal solution, the RDSP seeks
a timely and effective solution within the commander’s intent, mission, and concept of operations
❖ Assessments and the Operations Process
➢ Assessment: determination of the progress toward accomplishing a task, creating an effect, or
achieving an objective
➢ Measures of Effectiveness (MOE): “Are we doing the right thing?”
➢ Measures of Performance (MOP): “Are we doing things right?”

❖ Effective Assessments
➢ Commanders integrate their own assessments with those of the staff, subordinate commanders
➢ Commanders establish priorities for assessment in their planning guidance, CCIRs, and decision
points
➢ Effective assessment relies on an accurate understanding of the logic (reasoning) used to build
the plan
➢ Establishing cause and effect is sometimes difficult, yet crucial to effective assessment
➢ Effective assessment incorporates both quantitative (observation-based) and qualitative (opinion-
based) indicators. Human judgment is integral to assessment.
OP121.1 INTRO TO MILITARY DECISION MAKING PROCESS (MDMP)
❖ STEPS OF MDMP
❖ The Commander’s Role in MDMP

➢ use their experience, knowledge, and judgment to guide staff planning efforts & follow the status
of the planning effort, participate during critical periods of the process, & make decisions based
on the detailed work of the staff. CDR focuses activities on understanding, visualizing, and
describing
❖ The Staff’s Role in MDMP
➢ XO: manages and coordinates staff’s work and provides quality control
➢ Staff: Help CDR understand situation, make decision, and synchronize those decisions into a
fully developed plan or order
▪ Help CDR understand and visualize: Ourselves, The Enemy, The Terrain → Impact on
Combat Power
▪ Provide recommendations; manage information within area of expertise; ID and analyze
problems
➢ Staff Structure

▪Grouping of staff members by area of expertise under a coordinating, special, or personal

staff officer
● A principal staff officer leads each staff section: may be a coordinating, special, or
personal staff officer for the commander.
● The number of coordinating, special, and personal principal staff officers and their
corresponding staff sections varies with different command levels.
♦ Coordinating staff officers - commander’s principal assistants who advise, plan, and
coordinate actions within their area of expertise or a warfighting function
Assistant chief of staff (ACOS), G-1 (S-1)—personnel.
ACOS, G-2 (S-2)—intelligence.
ACOS, G-3 (S-3)—operations.
ACOS, G-4 (S-4)—logistics.
ACOS, G-5—plans.
ACOS, G-6 (S-6)—signal.
ACOS, G-7 (S-7)—inform and influence activities.
ACOS, G-8—resource management.
ACOS, G-9 (S-9)—civil affairs operations.
Division or higher: Chief of fires + Chief of protection + Chief of
sustainment
❖ Missions Orders is a form of communication
➢ 3 types of orders
▪ OPORD – operation
▪ FRAGORD – fragmentary
▪ WARNORD - warning
➢ When issuing an order – 5 paragraphs
▪ Situation (AI, AO, enemy and friendly forces)
▪ Mission (5 W’s)
▪ Execution (commander’s intent; concept of operations - decisive, shaping, sustaining; etc)
▪ Sustainment (concept of support – logistics, personnel, Army Health System Support)
▪ Command and signal
❖ STEP 1 - RECEIPT OF MISSION

❖ Input
➢ Higher HQ plan or order or a new mission anticipated by the commander
❖ Process (Tasks)
➢ Alert the staff and other key participants
➢ Gather the tools
➢ Update running estimates
➢ Conduct initial assessment
➢ Issue the Commander’s initial guidance
➢ Issue the initial warning order
❖ Output
➢ Commander’s initial guidance
➢ Initial allocation of time
➢ WARNORD #1
AS214.1 AHS PLANNING

Read, FM 4-02, Army Health System dtd 26 August 2013, pages 91-97
Discuss:
❖ AHS Concepts Review

❖ Medical Planning & MDMP
➢ Medical Planner & MDMP
▪ Step 2 Mission Analysis
● Medical Intelligence Preparation of the Battlefield (IPB)

● Health Threat
● Initial Casualty Estimate
● Treatment & EVAC Running Estimates
▪ Step 3 COA Development
● Medical Concept of Support (COS) for each COA
● Refined Casualty, Treatment, EVAC Estimate for each COA
▪ Step 4 COA Analysis
● Identify medical actions, reactions, and counteractions
● Identify medical risks associated with each COA
▪ Step 7 Order Production, Dissemination, and Transition
● Complete AHS Plan
● Contribution to Annex E (Protection)
● Contribution to Annex F(Sustainment)
❖ Medical Intelligence Preparation of the Battlefield (IPB)
➢ Task
▪ Define an operational environment (OE)
● Medical aspects of operational variables (PMESII-PT)
▪ Conduct threat integration (general and health)
▪ Describe the operational effects on deployed forces and AHS operations
➢ Purpose
▪ Identify medical considerations during MDMP
▪ Provide better healthcare on the battlefield
▪ Apply medical doctrine and conserve the fighting strength
▪ Enable commanders to accomplish their mission
❖ Threat Integration
➢ The AMEDD views threats from two perspectives:
▪ General Threat
▪ Health Threat
➢ General Threats, includes traditional considerations:
▪ The OE, to include PMESII-PT
▪ Enemy capabilities and assets
▪ Non-state and individual actors
❖ Health Threat
➢ The health threat is the AMEDD’s primary concern
➢ A composite of ongoing or potential enemy actions
➢ Reduced effectiveness results from sustained wounds, injuries, or diseases
❖ Casualty Estimate - Conducted at brigade-level and above
➢ Casualty estimates influence:
▪ Commander’s evaluation of COAs
▪ Personnel replacements, flow planning, and allocation among forces
▪ AHS Concept of Support (COS)
▪ Transportation planning, including both inter and intra-theater
▪ Evacuation policy
▪ Drives MEDEVAC running estimate
▪ Casualty Estimate – EVAC Standard & Non Standard Assets = Shortfall or Excess
❖ Initial Casualty Estimate - Conducted by G-1/S-1
➢ Broad operational parameters required to conduct initial casualty estimate:
▪ Enemy and Friendly Forces
▪ Time
▪ Operational Environment
➢ Used to anticipate:
▪ Class VIII requirements
▪ HSS Assets
▪ FHP Assets
➢ Logical starting point
➢ Conducted during mission analysis
➢ Relevant historical data is better

❖ Refined Casualty Estimate

➢ Refined Casualty Estimate - Conducted by medical planners during course of action development
▪ Requires a developed concept of operations and scheme of maneuver
▪ Determine friendly and enemy casualties
▪ Considerations include:
● Terrain; Weather; Time of Day/Year; Troop Population; Force Posture; Weapons
Sophistication; Surprise; Mobility; Human Factors
● Primary casualty estimation tool & Medical and Casualty Estimator (MACE)
❖ MACE
➢ Developed by the Center for AMEDD Strategic Studies (CASS)
▪ https://cass.amedd.army.mil/ako/mace
➢ Used to predict casualty data during MDMP
➢ Simulates DNBI, WIA, KIA data
➢ MACE implements the casualty estimation methodology with a simulation, to allow for multiple
iterations which enable provision of range estimates
➢ Data fed by Joint Theater Trauma Registry (JTTR) / Joint Medical Workstation (JMEWS) data
➢ Outputs:
▪ Battle Casualties
▪ DNBI Casualties
▪ Distribution of injuries by region
▪ Nature of injuries
▪ Medical estimate totals
❖ MFA Planning Considerations
➢ Medical Mission Command
▪ What mission command infrastructure will be established for the operation? What is the
nature of the operation and its anticipated duration?
▪ What is the anticipated level of violence to be encountered? What are the capabilities of all
Service component medical assets in theater?
▪ Are communications systems and automation equipment interoperable?
➢ Medical Treatment
▪ What units will provide Role 1 and Role 2 medical care?
▪ Will troop clinics/dispensaries be established in areas of troop concentrations?
▪ Do any operations security requirements exist which must be accommodated?
➢ Medical Logistics
▪ Have we designated a single integrated logistics manager for the operation? How will medical
equipment maintenance and repair be accomplished?
▪ Are there any Unit/Service-specific MEDLOG requirements?
▪ How are blood management functions/activities conducted? How will medical waste be
collected and disposed of?
➢ Veterinary Services
▪ Is it anticipated that veterinary personnel will be required to perform their alternate wartime
role during the operation? Where will veterinary resources be located?
➢ Preventative Medicine
▪ What is the health threat in the AO? Have site surveys been conducted for areas to be
inhabited by US forces?
▪ Have Soldiers been properly trained and certified by support PVNTMED resources for
insecticide spraying?
▪ Is it anticipated that refugee, retained persons, and/or EPW/detainee operations will be
required?
▪ Do units have field hygiene and sanitation supplies and equipment on hand? Do Soldiers
have personal protective supplies and equipment available or issued?
▪ If continuous operations are anticipated, have work/rest schedules (sleep plans) been
developed and implemented when appropriate? Is a command policy established and
disseminated on water discipline?
➢ Dental
▪ Is it anticipated that dental personnel will be required to perform their alternate wartime role
during the operation? Where will dental resources be located?
➢ COSC

▪ During the operation is it likely that a mass casualty situation will develop? What is the
likelihood of an attack?
➢ Laboratory
▪ What procedures will be used to submit samples/specimens for analysis by CONUS-support
base laboratories?
▪ How will samples/specimens of suspect biological warfare and chemical warfare agents be
transported?
➢ Hospitalization
▪ When in the operation is it likely that a mass casualty situation will develop?
▪ What is location and capacity of Role III care in time and space? Do lines of evacuation
extend to Role III care? What units are providing MEDEVAC for the Role III units in the OE?
▪ Has appropriate coordination been conducted with the CSH/EMEDS staff?
❖ Medical Regulating
➢ Actions and coordination necessary to arrange for the movement of patients through the
roles of care and to match patients with a medical treatment facility that has the necessary
health service support capabilities, and available bed space
➢ Efficient and safe movement of patients
➢ ROLE 3/MED BDE:
▪ Conducted by PAD cells in EAB organizations
▪ Arrange for inter-theater patient evacuation with U.S. Transportation
▪ Using Transportation Command Regulating and Command & Control
▪ Evacuation System (TRAC2ES) TRAC2ES is first employed at the ROLE 3/MED BDE.
Information entered in TRAC2ES can be viewed globally
➢ ROLE 2 and below:
▪ At ROLE 2 and below, medical regulating is conducted IAW internal unit
▪ SOPs or IAW guidance from Division HQ (spreadsheets etc.)
❖ CBRN Planning Considerations
➢ Does the enemy have CBRN capabilities? What is the likelihood of deploying CBRN weapons?
➢ What is likely delivery method and path of contaminations (plume)? What units will most likely
come in contact with contaminants?
➢ What is status of Chemical Decontamination/Treatment MESs? Chemical Biological Protective
Shelters? Does the AHS plan include a CBRN response plan?
➢ Are decontamination (decon) and treatment assets co-located? Are decon assets positioned
before treatment assets in the line of evacuation? Have “dirty” evacuation platforms and routes
been identified?
➢ Is additional manpower/support required in the event of CBRN MASCAL?
❖ MASCAL Planning
➢ MASCAL - when the number of casualties exceeds the available medical capability to rapidly
treat and evacuate them
▪ Coordination and synchronization of additional medical support and augmentation;
Communications frequencies and call signs for mission command
▪ Quickly locating the injured and clearing the battlefield; Providing effective tactical combat
casualty care for the injured
▪ Accurate triage and rapid evacuation of the injured (I-D-M-E)
● Immediate (~20%): Require immediate, resuscitative treatment
● Delayed (~20%): Patient can tolerate delay prior to time-consuming operative
intervention without compromising the likelihood of a successful outcome
● Minimal (~40%): Relatively minor injuries, often on ambulatory patients, requiring no
more than cleansing, minimal debridement, antibiotics and first aid type dressings
● Expectant (~20%): Wounds so extensive that even if they were the sole casualty and
had optimal resources, their survival would still be unlikely
▪ Coordinating with key personnel and units in the use of nonmedical vehicles for medical
evacuation or casualty transportation.
▪ Non-medical personnel for litter teams identified and trained; Maintain trained and equipped
CLS.
❖ AHS Concept of Support (COS) - completed for each COA; each should include:
➢ Maneuver Plan
➢ HSS/FHP Assets Available

➢ Statement and Sketch (see FM 6-0)

➢ 10 Medical Functional Areas (MFAs)
➢ Time Distance Analysis (Air/Ground)
➢ Casualty Estimate
➢ Shortfalls
❖ AHS Staff Estimates
➢ Casualty Estimates
➢ Treatment Team Status (62B/65D)
➢ Evacuation Platform Status (Ambulatory/Litter)
➢ MEDEVAC running estimates
➢ Bed/Patient Hold Status
➢ Critical CL VIII, Blood Status
➢ MES Percentages
➢ Aeromedical Evacuation assets and support relationships
➢ EAB Assets and support relationships
➢ MFA statuses
➢ Location of AHS assets
❖ AHS Plan - developed by Medical Planners during orders production, to include:
➢ Communication PACE Plan
➢ Graphic Overlay
➢ Identify CASEVAC and medical platforms
➢ Establish Primary/ Alternate Routes
➢ Time / Distance Analysis Conducted for Air and Ground
➢ BDE AXP’s Planned / Supported
➢ HLZ’s Pre-Planned
➢ Security Assets Dedicated
➢ Roles of Care / Capabilities Identified
➢ Triggers to execute ground MEDEVAC vs CASEVAC
➢ Location of ALL medical assets in OE
❖ MEDICAL FUNCTIONAL AREAS (MFAS)

10 MFAS: MEDICAL MISSION COMMAND
❖ Medical Mission Command

➢ Scalable and tailorable mission command modules
➢ Provides seamless, state-of –the-art health care system
➢ Strategically, operationally, and tactically responsive
➢ Medical Commands →Medical Brigades→ Multifunctional Medical Bns & CSH
➢ Integrates vertically and horizontally with tactical commander’s warfighting function of mission
command
▪ Medical Commander
▪ Command Surgeon
▪ Medical Planner
❖ Medical Command Organizations
➢ Medical Command (Deployment Support) - one MEDCOM (DS) per theater
▪ Serves as the medical force provider
▪ Accomplishes Title 10 responsibilities
▪ Mission Command of AHS units within AO
▪ Advise the Theater Army Commander/other senior-level commanders
▪ Assist with coordination and integration of strategic capabilities
▪ Coordinates w/ the USAF theater patient movement requirements center
▪ Health threat monitoring
➢ Medical Brigade (Support) - (MEDBDE [SPT]) - one MEDBDE (SPT) for 2-6 Battalions
▪ Subordinate mission command organization of the MEDCOM (DS)
▪ One MEDBDE (SPT) may provide DS to a tactical commander, while another may provide
AHS support to an EAB sustainment force
▪ Mission command of subordinate and attached units
▪ MMB & CSH
➢ Medical Battalion (Multifunctional)
➢ Combat Support Hospital
❖ Medical Commander
➢ Exercises mission command (authority and direction) over his subordinate medical resources
➢ Analytic and intuitive approaches
➢ Commander focuses on higher role intent and decisions only they can make
➢ Medical commander retains a regional focus, but still provides direct support to tactical
commander
❖ Command Surgeon
➢ Designated at all roles of command
➢ Planning and monitoring execution of the medical mission
➢ Assures all medical functional areas are incorporated into plans and operations orders
➢ Technical supervision of medical operations
➢ Develops and coordinates Health Service Support (HSS) and Force Health Protection (FHP)
annexes of operation plans to support tactical commander's decisions and intent
❖ Medical Planner
➢ Analyzes the HSS/FHP requirements BEFORE, DURING, and AFTER an operation
➢ Concurrently conducts HSS/FHP Estimate as the tactical staff conducts MDMP
➢ Develops HSS/FHP plan for each COA developed
➢ Considers the medical supportability of each proposed COA
➢ Integrates and Synchronizes HSS/FHP plan with tactical plan
❖ Communications
➢ Theater-wide trend analysis and enhanced medical situational awareness
➢ Integrates and supports a comprehensive medical information system
➢ Medical Communications for Combat Casualty Care (MC4)
➢ Secure, accessible, life-long electronic medical records
➢ Quick, accurate access to patient histories
➢ Casualty resuscitation information
➢ Medical logistics support
➢ Patient tracking

10 MFAS: MEDICAL TREATMENT

❖ ⇱Treatment - Echelons Above Brigade (EAB)
➢ MEDCOM (DS)
▪ MEDBDE (Support) – Consists of:
● Multi-Functional Medical Battalion (MMB) → “a mix of everything”
● Combat Support Hospital (CSH) → Forward Surgical Team
➢ MMB Capabilities
▪ MFAS: MC, Med TMT, MEDEVAC, PM, Dental, Vet Services, Med Log, COSC, Lab
▪ Medical Detachments
● Ground Ambulance (GA)
● COSC
● ASMC
♦ Treatment Platoon
➢ Medical Treatment Squad x2
➢ Area Support Squad
♦ Ambulance Platoon
➢ Ambulance Squad x4
● PREV MED
● MEDLOG
● Dental
● Blood
● Optical
● VET
▪ Medical C2, staff planning, supervision of operations, medical and general logistics support
as required, and administration of the assigned and attached units conducting FHP
operations in its supported AO.
▪ Capable of split-based operations using HHD as early entry package or full MMB as a
campaign package
▪ Coordination of medical regulating and patient movement with the MED BDE (SPT) intra-
theater patient movement center (IPMC) or the MEDCOM (DS) theater patient movement
center (TPMC), as required.
▪ Consultation and technical advice on PVNTMED, medical entomology, medical and OEH
surveillance, and sanitary engineering), pharmacy procedures, COSC and MH, medical
records administration, VET services, nursing practices and procedures, medical laboratory
procedures, and automated medical information systems to supported units. Monitors and
provides advice and consultation on dental support activities within the BN AO.
❖ ⇱Treatment – Brigade Combat Team and the FST

❖ Brigade Combat Team (BCT)
➢ ABCT
➢ Brigade Engineer Battalion (Role 1)
➢ Combined Arms Battalion, HHC, Medical Platoon (Role 1)
➢ Reconnaissance Squadron (Role 1)
➢ Fires Battalion (Field Artillery) (Role 1)
➢ Brigade Support Medical Company (BSMC)
▪ Found in the BSB; 3 organic to BSB
❖ Role II: BSMC vs. ASMC
➢ Brigade Support Medical Company (BSMC)
▪ Mission: To provide Role II care, ground evacuation, medical supply, preventive medicine,
and combat stress control to assigned and attached units of the BCT
▪ 8 MFAS - Includes all the capabilities of Role I plus:
● Advanced Trauma Management
● Ancillary Services - Dental, Lab, X-Ray, and Patient Hold (20 beds)
▪ Behavioral Health
▪ Physical Therapy
▪ Preventive Medicine
▪ Evacuation platoon

▪BMSO - Medical Supply Office (CL VIII ASL)

● Use of blood/blood products (not organic, only when FST is attached)
▪ BSMC is assigned to Brigade Support Battalion (BSB)
▪ During deployments, BSMC remains task organized to BSMC
➢ Area Support Medical Company (ASMC)
▪ Mission: Provide Role 2 HSS and ground evacuation to non-BCT units of the ASCC, Corps,
and Division
▪ Includes all the capabilities of Role I plus:
● Ancillary Services - Dental, Lab, X-Ray, and Patient Hold (40 beds)
▪ Treatment capabilities nearly identical to the BSMC
▪ Evacuation platoon
▪ No Medical Supply Office (zero CL VIII ASL) or Preventive Med
▪ Use of blood/blood products (not organic, only when FST is attached)
▪ ASMC is assigned to a Multifunctional Medical Battalion (MMB)
▪ During deployments, ASMC may be task organized under the MEDBDT SPT providing
support to MEDBDT SPT/DIV/Corps
❖ Forward Surgical Team (FST)
➢ Bridging the gap: Medical Treatment & Hospitalization
▪ Mission: To provide a rapidly deployable immediate surgery capability, enabling patients to
withstand further evacuation. It provides surgical support forward in operational areas.
▪ Provides surgical care as far forward as a BSMC (attached)
➢ Provides urgent, initial surgery for non-transportable patients
▪ Surgical capability is based on two operating room tables with a surgical capacity of 24
operating room table hours per day
▪ Surgery: initial surgery and postoperative care for 30 critically wounded patients for organic
equipment
➢ Assigned to CSH
➢ FST Capabilities:
▪ 100% mobile with 20 Soldiers
▪ Requires 1.5 hrs set-up to be fully functional
▪ Continuous operations in conjunction with a Medical Company for up to 72hrs
(approximately 30 patients)
▪ Urgent initial surgery for otherwise non-transportable patients
▪ 2 OR Tables (48 Hrs/20 Surgeries)
▪ 8 Patient Hold
▪ 1x Team Chief (61J), 2x General Surgeon (61J), 1x Orthopedic Surgeon 61M), 3x Med
Surgical Nurse (66H), 2x Nurse Anesthetist (66F), 1x OR Nurse 66E), 1x 70B
10 MFAS: MEDICAL EVACUATION

ATP 4-25.13 Casualty Evacuation (FEB 13)
ATP 4-02.2 Medical Evacuation (AUG 014)
ATP 4-02.3 Army Health System Support to Maneuver Forces (JUN 14)

❖ Medical Regulating - ⇱Army Health System

➢ The coordination and control of moving patients to MTFs which are best able to provide the
required specialty care.
➢ Entails identifying the patients awaiting evacuation, locating the available beds, and coordinating
the transportation means for movement.
➢ Factors that influence scheduling of patient movement include:
▪ Patient’s medical condition (stabilized to withstand evacuation)
▪ Tactical situation
▪ Availability of evacuation means
▪ Locations of MTFs with special capabilities or resources
▪ Current bed status of MTFs
▪ Surgical backlogs
▪ Number and location of patients by diagnostic category
▪ Location of airfields, seaports, and other transportation hubs
▪ Communications capabilities (to include radio silence procedures)
❖ AMEDD Medical Evacuation System
➢ Medical evacuation - the system which provides the vital linkage between the roles of care
necessary to sustain the patient during transport.
➢ Army MEDEVAC - a multifaceted mission accomplished by a combination of dedicated ground
and air evacuation platforms synchronized to provide direct support, general support, and area
support within the AO.
➢ Medical evacuation resources/assets are used to transfer patients between MTFs within the AO
and from MTFs to USAF mobile aeromedical staging facilities or aeromedical staging facilities
➢ Medical personnel providing en route care may be paramedics, nurses, or other properly trained
medical specialists based on the appropriate role of care
❖ Evacuation Doctrine
➢ Theater Evacuation Policy:
▪ Established by SECDEF, with the advice of the Joint Chiefs of Staff, and upon the
recommendation of the combatant commander
➢ The policy establishes, in number of days, the maximum period of non-effectiveness
(hospitalization and convalescence) that patients may be held within the AO for treatment (Upon
arrival to Role 3)
➢ The service component commander is responsible for –
▪ Medical evacuation at the operational level (PEC: Patient Evacuation Cell)
➢ Executing the medical evacuation of his forces
➢ Strategic aeromedical evacuation is the responsibility of the U.S. Transportation Command
❖ CASEVAC vs MEDEVAC
➢ Medical Evacuation (MEDEVAC)
▪ The transport of casualties on a standard evacuation platform (ground/air ambulance)
▪ Includes en-route care from medical personnel.
▪ Evacuation platform has medical capabilities to sustain the casualties while en-route to
care
➢ Casualty Evacuation (CASEVAC)
▪ The transport of casualties on a non-standard or non-medical evacuation platform.
▪ Does not include en-route care from medical personnel.
▪ Vehicle does not have medical capabilities to sustain the casualties while en-route to care.
➢ MEDEVAC - a medical designed vehicle, medical equipment, and medical personnel to provide
treatment
➢ CASEVAC – lacks one of the three
❖ Evacuation Platform Capabilities:

❖ Role I & II
➢ Light- M997
➢ Stryker- M1133
➢ Armored- M113
❖ Combat Aviation Brigade (CAB)
➢ 4 Types of Combat Aviation Brigades
▪ Expeditionary, Light, Medium, Heavy
➢ The General Support Aviation Battalion (GSAB) MEDEVAC
➢ Medical Operations Cell (MOC) BDE and BN Level
▪ Planning and coordination for air ambulance employment and utilization.
➢ Medical Company (Air Ambulance)
▪ 15 aircraft, 5 PLT deployable MEDEVAC unit
▪ Forward Support Medical Platoon (FSMP)
➢ Forward Support Medical Platoon
▪ 3 Aircraft, 3 Crew
▪ Agile, flexible, and employable
▪ (24-hour operations)
❖ Direct Support vs. General Support
➢ Medical Brigade tracks/coordinates patient movement at all stages of movement
➢ Direct Support: Forward Support Medical Plt (FSMP) provides evacuation within BCT AO to
appropriate care/AXP with EAB
▪ 3x Air Ambulances in DS role to each BCT
➢ General Support: ASMP & 1x FSMP provide evacuation from BCT AO to EAB medical care (also
POI EVAC in DIV support area)
▪ 6x Air Ambulances in GS role to Division
❖ Inter-Theater Evacuation
➢ USAF role in medical evacuation
➢ C-130 Hercules
➢ C-17
10 MFAS: HOSPITALIZATION
❖ Role 3 Care
➢ Includes capabilities of Role I and II, plus definitive surgery
➢ For Soldiers who require comprehensive preoperative, general anesthesia, initial wound surgery,
and post-operative treatment
❖ Role 3 CSH: Split-Based Capability
➢ Assigned to Med BDE or MEDCOM (DS) or JTF
➢ Has 248 beds to support surgical and hospitalization requirements
➢ Composed of:
▪ Headquarters, Headquarters Detachment (HHD)
▪ Hospital Company 16 bed (Bravo Co)
▪ Hospital Company 84 bed (Alpha Co)
● 44 Bed Early Entry Hospitalization Element

● 40 Bed Hospital Augmentation Element (beds only)

➢ Capabilities:
▪ Six operating rooms with 96 operating table hours per day
● 2 – ICUs for up to 24 patients
● 3 – ICWs for up to 60 patients
▪ Telemedicine consultation capability will be provided by the medical detachment,
telemedicine
▪ Provides clinical LAB services including microbiology screening, blood banking, and radiology
▪ Is comprised of three subordinate areas and can have 7 different detachments assigned
based on mission need
❖ The 84 Bed Hospital Company

➢ 44 Bed - First Increment
▪ Capabilities:
● Twenty-four (24) hour operations
● Three (3) days of supply
● Tactical mobility (100 percent mobile for unit equipment; transportation support will be
required for personnel)
● Supports Force XXI forces
● Thirty-six OR table hrs/day (3 hrs per case, 12 cases per day = 44 required beds)
❖ Augmentation Teams
➢ The CSH may be augmented by one or more medical detachments, hospital augmentation
teams, or medical teams. These may include:
▪ Medical detachment (minimal care) - Forward surgical team (FST)
▪ Hospital augmentation team (head and neck)
▪ Hospital augmentation team (special care)
▪ Hospital augmentation team (pathology)
▪ Medical team (renal hemodialysis)
▪ Medical team (infectious disease)
❖ Role 4 - patients evacuated if cannot return to duty within 7 days
➢ Role 1-3 capabilities + restorative medical treatment (convalescence)
10 MFAS: DENTAL SERVICES

❖ Recommended Readings: FM 4-02.9

❖ Mission of dental services

➢ Promote dental health
➢ Prevent and treat oral and dental disease
➢ Provide far forward dental treatment
➢ Provide early treatment of severe oral and maxillofacial injuries
➢ Augment medical personnel (as necessary) during mass casualty op erations
❖ Dental Readiness Classifications
➢ Class 1 - Current examination, no dental treatment; worldwide deployable
➢ Class 2 - Current exam, requires non-urgent treatment or follow-up; world-wide deployable
➢ Class 3 - Current exam, will require urgent/emergent dental care; normally not considered
deployable
➢ Class 4 - Requires examination, unknown dental readiness; normally not considered deployable
❖ Categories of Operational Dental Care
➢ Comprehensive Dental Care
▪ Restore an individual to optimal oral health, function and esthetics
▪ Normally fixed facility-based (MTF/DTF)
▪ More Complex; Extended period of reception
➢ Preventative Dentistry
▪ Important part of dental program: Hygiene practices
▪ Diet and Tobacco management
➢ Operational Dental Care
▪ Emergency Dental Care
● Provide relief of oral pain
● Elimination of acute infection
● Control of life-threatening oral conditions
● Treatment of trauma to teeth, jaws, and associated facial structures
● AT ROLE 1 (May be provided by PA or Physician)
▪ Essential Dental Care
● Helps prevent potential dental emergencies
● Maintains oral fitness
● Highest category of operational dental care
❖ Dental Elements in BCT
➢ Area Support Squad
▪ Direct Support to the assigned BCT
▪ Capabilities:
● Assigned to medical companies at brigade level
● Organic to brigade support medical company
▪ Limitations:
● Can be overwhelmed with # of patients at AO without additional assistance à augment
with dental company
▪ Units without organic dental receive care from Dental Company (area support)
❖ Dental in ASMC
➢ Area Support Squads
▪ General Support to units in Area of Operation (AO) without direct support
▪ Capabilities:
● Assigned to medical companies at brigade level
● Organic to brigade support medical company
▪ Limitations:
● Can be overwhelmed with # of patients at AO without additional assistance → augment
with dental company
▪ Units without organic dental receive care from Dental Company (area support)
❖ Dental Elements in EAB
➢ DENTAL STAFF POSITIONS
▪ Army Service Component Command Surgeon’s Cell: no dental surgeon
▪ MEDCOM Deployment Support: Dental Surgeon (63R), Preventative Dentistry Officer, one
senior dental NCO (SGM)
▪ Medical Brigade (MEDBDE): May have dental on staff (Ops)
➢ Dental Company (Area Support - Medical Company)

▪ Area of Operation
● DC employed with the MEDCOM (DS) or the MEDBDE (support) within a theatre
● May be employed in the BCT area to provide forward emergency and preventive dental
care
▪ Capabilities:
● One company per 43,000 soldiers // one dentist per 1,175 soldiers
● Command and control of dental elements
● Operational dental care
● Reinforcement and reconstitution of BCT dental assets
● Far forward operational dental care to forward deployed troops Augment medical during
mass casualty
▪ Limitations
● Depends on supported unit for finance, religious, legal, laundry & bath, supplemental
transport support, security etc
10 MFAS: PREVENTATIVE MEDICAL SERVICES
❖ Mission of Preventive Medicine Detachment

➢ Anticipates, Predicts, Identifies, Prevents, and Controls for:
▪ Communicable Diseases
▪ Illness (Vector, food, and waterborne)
▪ Injuries
▪ Disease related to Occupational Environmental Health
▪ DNBI
▪ COSR
➢ Provides technical consultation support on PVNTMED issues throughout the AO
▪ 72D - “Professional Generalist”
● 72D N4: Environmental Engineer
▪ 72A - Health Physicist
▪ 72 C - Audiology
➢ Provides specialized PVNTMED support in the areas of:
▪ DNBI surveillance and epidemiology
▪ Health physics (NBC environmental threat surveillance)
▪ Medical Entomology
▪ Environmental health assessment and engineering
▪ Health Education and Promotion (training to units in AO)
▪ Retrograde cargo inspection
➢ Evaluates:
▪ Elements of the health threat
▪ Risk to the force associated with identified elements of the medical threat
▪ Integration of medical threat planning into FHP operations
❖ Preventive Medicine in BCT
➢ Field Sanitation Teams - Role 1 Asset
▪ 2 unit field sanitation teams per Company-sized element
● 2 Soldiers per team (medic / NCO) - 40 hour class
▪ Capabilities:
● Water testing

● Entomology
● food service sanitation
● Heat/cold injuries
❖ Role II Assets (BSMC only):
▪ Running estimates
▪ Educates Soldiers in DNBI prevention measures
▪ Educates Soldiers in CBRNE prevention measures
▪ Trains unit field sanitation teams (FSTs) (one per company)
▪ Provides technical consultation on site selection for FOBs, Detainee Internment Facilities, etc
▪ Conducts field water vulnerability assessment
▪ Investigates disease outbreaks and recommends control measures
❖ Role 3
▪ Typically at MMB
▪ 1 per 17,000 troops supported at EAB
▪ Area Medical Support
● Water surveillance; food inspections; medical entomology; CRBN recon; support to BCT
ESEOs; outbreak investigations
➢ MEDDAC/MEDCEN PM
▪ Work with Army Public Health Nurses (APHN)
▪ Coordinate with DPW, Water Authority, MWR, AAFES
▪ Responsible for all Industrial Hygiene/Public Health related issues for garrison
▪ Provide recommendations to the garrison CMDR
❖ Role 4 - Public Health Command
➢ Aligned with RHC
➢ Provides reachback support to all MTFs and BCTs within region
➢ Responsible for all PH related issues in region
❖ Preventive Medicine in the EAB
➢ Preventative Med Detachment
▪ HQ Section: 4 personnel
▪ PVNTMED Teams: 3 teams x 3 personnel each
10 MFAS: COMBAT OPERATIONAL STRESS CONTROL (COSC)
❖ Combat Operational Stress Control:

➢ “Control of stress is often the decisive difference between victory and defeat across the range of
military operations”. – ATP 4-02.8
➢ Actions taken by leadership to prevent, identify and manage COSR
❖ COSC Elements in BCT
➢ Role I (BAS/UMT)
▪ COSC Preventive Measures
▪ Battle Buddies, Leadership, Chaplain, Medics, PA
➢ Role II (BSMC)
▪ First role to have official COSC MFA support
▪ Support the commanders in the prevention and control of COSR
● Behavioral Health Officer (Psychologist/Social Worker) X 2

● Behavioral Health NCO X 1

● Behavioral Health SPC X 1
❖ COSC Elements in EAB
➢ ASMC
▪ Support the prevention and control of COSR
● Behavioral Health Officer X 1
● Behavioral Health Specialist X 1
➢ COSC Detachment
▪ Unit Needs Assessment ▪ Traumatic Event Management
▪ Stabilization ▪ Reconditions
▪ Consultation/Education ▪ Reconstitution
▪ Restoration
❖ Stress Threat
❖ Intervention and Control

➢ Interventions
▪ Universal – Targets the AO
▪ Selective – Targets a unit or Soldier at risk
▪ Indicated – Targets an identified Soldier or Unit with signs of COSR
▪ Treatment – Targets the individual with behavioral disorder to prevent loss from duty
➢ Control Principles –“BICEPS”
▪ B = Brevity (brief patient hold unless psychological emergency)
▪ I = Immediacy
▪ C = Contact (maintain with contact with chain of command as needed)
▪ E = Expectancy
▪ P = Proximity (treatment as close to unit/duty as possible)
▪ S = Simplicity

10 MFAS: VETERINARY SERVICES
❖ Vet Services Mission

➢ Build a highly skilled, adaptive and empowered Vet Team to support full-spectrum operations for
the DoD
➢ Animal: Preventive care, animal handler/owner education and animal treatment
▪ Food: protecting military personnel and their families from food-borne disease through
surveillance, auditing, and assessing vulnerabilities
➢ No organic veterinary assets in BCT; majority of veterinary assets in the theater is assigned to
EAB veterinary units and must be projected forward to provide care in the brigade area
❖ Vet Roles of Care and Capabilities
➢ Role 1: Does not involve veterinarian – it takes place with the MWD Handler or if available (rare-
usually with Special Ops or Rangers) 68T at the point of illness or injury
▪ Animal Handler – Non-veterinary personnel perform limited lifesaving and first aid
procedures until an animal care specialist or a veterinarian is available.
▪ Animal Care Specialist - Animal care specialists are organic to Army engineer, Ranger,
USN, and medical detachment (veterinary service support) units.
● Supervises or provides the care, management, treatment, and sanitary conditions for
animals - primary responsibility for the prevention/control of diseases transmitted from
animal to man and comprehensive care for government-owned animals
▪ MWD handler or corpsman/medic can perform basic emergency aid procedures and prepare
the MWD for transport/evacuation to a higher role of veterinary medical care
▪ Animal care specialists (Army MOS 68T):
● Provide emergency care for stabilization and movement of patients to higher roles of care
● Take medical histories and complete physical examinations
● Identify and treat many common acute and chronic problems
● Interpret laboratory results
● Dispense, administer, and manage medications and other therapies
● Provide Military Working Dog (MWD) handlers with animal health and first aid instruction
● Assist veterinarians in the care of MWDs, as needed
➢ Role 2
▪ Veterinary Care is now available with VSST:
● Level 1 capabilities
● Resuscitation
● Stabilization
● Emergency Medical procedures
● Forward Emergency Resuscitative Surgery
● Limited X-ray, laboratory work (can be supported by human clinics/hospitals), dental work
➢ Role 3
▪ Veterinary Specialist is now available: (Usually HQ) Dog Center Europe + 19
CONUS/OCONUS
● Level 1 & 2 capabilities
● Increased # of 68Ts
● Referral for diagnostic, therapeutic and surgical procedures
● Provides advanced clinical medicine and surgery

● Hospitalization
● X-ray, laboratory procedures, and dental procedures
● More complete pharmacy
● Theater-wide patient tracking of MWDs
● Establish theater MWD evacuation policy
➢ Role 4 - found only in CONUS at Military Working Dog Veterinary Service (Lackland AFB, TX)
▪ Expands the capabilities available at Role 1-3
▪ Additional specialized vet medical, surgical care, rehab therapy, and convalescent capability
❖ MFMB Vet Detachment
➢ Simple veterinary care goes through the VSST, who will get it approved by MDVS commander
▪ ex. Physical exams for redeployment but cannot leave FOB so vet has to travel
➢ Food inspection (ex. MREs) off the FOB - that request can go straight to the VSST who will get
approval from their MDVS commander.
➢ Larger tasks such as requesting a VSST for aiding in stability operations and Vet Civil Affair
Programs (VETCAPs) go up to the MEDBDE CDR, down to MMB CDR, then to MDVSS CDR,
and to the VSST Officer
➢ Typically, the VSST in that area is under ADCON (the unit vet services are supporting has
administration authority (supplies housing, food, etc..) but not able to tell the VSST what to do
operationally to the units they are supporting
▪ Using VSST for work other than their mission - units would have to talk to the MDVS CDR.
❖ MTOE VSST structure and personnel
➢ 60 authorized personnel
▪ HQ x1
▪ Food Procurement & Lab team x1
▪ Vet Medical and Surgical Team (VMST) x1
▪ Vet Service Support Team (VSST) x5
❖ Joint Theater Trauma System Clinical Practice Guideline (CPG)
➢ Provides clinical medical guidelines for a non-veterinary Health Care Provider (HCP) to work on a
MWD for management of seriously ill or injured MWDs, to assist in recognition and initial
resuscitation and stabilization of life- and limb-threatening conditions that warrant HCP
intervention in the absence of veterinary personnel.
➢ HCPs should only perform medical or surgical procedures necessary to manage problems that
immediately threaten life, limb, or eyesight, and to prepare the dog for evacuation to definitive
veterinary care.
10 MFAS: MEDICAL LOGISTICS (MEDLOG)

❖ Medical Logistics: functional area for the joint force surgeon’s health service support mission that
includes:
➢ Management of materiel and equipment
➢ Equipment maintenance and repair
➢ Optical fabrication and repair
➢ Blood distribution
➢ Patient movement item management
➢ Technology and facilities
➢ Services and contracting support
❖ Levels of Medical Logistics

❖ Operational MEDLOG Managers

➢ SIMLM vs. TLAMM
➢ Theater Lead Agent Medical Materiel (TLAMM): organization or unit designated by the
combatant commander to provide the operational capability for medical supply chain
management and distribution from strategic to tactical levels
▪ “Prime vendor” - Joint Operations
▪ Capabilities:
● Medical supply & Medical equipment maintenance
● Optical fabrication
● Assembly and fielding of medical assemblages
● Management of vaccines
● Contingency Drugs
● Emergency Sets
● Blood Distribution Support
▪ TLAMM selects the most direct route [MEDLOG Co. ↔ FDT ↔ CSH]
➢ MEDCOM Deployment Support
▪ The role of the MEDCOM (DS) is to control and supervise Class VIII supply and resupply
within the theater
▪ Maintains the command link between the MED BDE and the coordination link with the TSC
through the MLMC
➢ Medical Logistics Management Center (MLMC)
▪ Mission: To provide centralized, Theater Army level inventory management of Class VIII
material in accordance with the Theater Army Surgeons policy.
● Co-locates with the TSC Distribution Management Center for CL VIII
● Assigned to Medical Command (Deployment Support)
● Basis of allocation (BOA) – 1 required in the force
● Contains a non-deploying base unit
♦ 2 Forward Teams (Early Entry)
♦ 2 Forward Teams (Follow On)
● Each team deploys and supports a Theater Army
➢ Medical Logistics Company (MLC)
▪ Attached to a Multifunctional Medical Bn (MMB) or Senior Medical Headquarters within the
Area of Operations (AO)
▪ Responsible for the planning, coordination and supervising the execution of the Class VIII
mission within the MMB AO including:
● Class VIII / Blood management / Medical maintenance / Lens optical fabrication
● Replenishing supplies by ordering via TLAMM
● No organic blood support capability
● Warehousing 1000-1500 lines

▪ MLC Duties:
● Forward Distribution Team (FDT):
♦ FDTs facilitate CL VIII pushes forward
♦ 3 teams out of three different section.
♦ 3-5 person teams
♦ Augment Roles 1-3
♦ Oversight and coordination by Shipping Section
● Contact Repair Team (CRT)
♦ Provides reinforcement field and limited sustainment maintenance
♦ Up to 3 CRTs
▪ CSH MEDLOG - CSH requisitions flow:
● Place CL VIII requisitions to the TLAMM or MLC using DMLSS / DCAM
● Order processed & requisitioned pulled
● Order ships into theater to the MLC (or straight back to CSH)
● MLC receives supplies; facilitates distribution to CSH
● Can receives medical materiel sets (MMS) resupply sets from MLC
♦ CL VIII(b): Handled by Joint Blood Program
❖ Tactical MEDLOG Managers
➢ Brigade Medical Supply Office (BMSO): BMSC’s medical supply element & HQ section (C Co.)
▪ BCT Class VIII Request Flow:
● From Area Support [CLS/68W] → Bn Aid Stations (BAS) ⇔BMSO ⇔Forward Surgical
Team (FST) & BSMC ⇔BMSO ⇔MEDLOG Co. (MLC) → Forward Distro Team (FDT) →
BMSO
● 100-300 critical line items
▪ Medical Maintenance
● Field Level Maintenance
● Non mission capable (NMC) equipment
♦ Evacuate equipment to BMSO
♦ MEDLOG Company Combat Repair Team (CRT)
♦ Evacuate to MLC for exchange
● Maintains moderate bench stock
● Facilitates equipment exchange/cross-leveling within the BCT
● Standard Army Maintenance System (SAMS-1E)(Vice GCCS-A)
➢ Battalion Aid Station (BAS)
▪ Requisition Supplies:
● Primary means – DCAM (LVL I) or manual form (DA 2404)
● Alternate means – manual forms, customer reorder lists, or push packages
▪ Receive CL VIII from BMSO via:
● Brigade Support Battalion Tactical Convoy
● Supply Point Distribution
▪ Medical Maintenance:
● Medical equipment repair support from 68A in BMSO.
● Operator maintenance required (DA 2404s)
● Evacuate Non-Mission Capable (NMC) maint significant equipment to BMSO.
▪

Fig. MEDLOG Support Flow
10 MFAS: MEDICAL LABORATORY SERVICES

❖ Lab Functions
➢ Clinical Lab Functions
▪ Analysis of Medical Specimens
▪ Blood Banking (Type & Crossmatch)
➢ Area Medical Lab (AML)
▪ Deployable unit tasked with:
● Surveillance
● Analytical lab testing
● Health hazard Assessment for: Environmental, Occupational, Endemic, CBRNE
❖ Lab in BCT
➢ Role 1 - none
➢ Role 2 (BSMC)
▪ First role with lab capabilities
▪ Performs basic analysis of blood and urine
● Hematology
● Microbiology
● Serology
● Urinalysis
▪ Blood storage - Capable to hold up to 50 units of blood
● Can be doubled with an FST attached
❖ Lab in EAB
➢ MED Co. Area Support Squad
▪ Basic analysis of blood and urine
➢ Area Medical Lab (AML)
▪ Only 1 in Army - Aberdeen, MD
▪ Force Health Protection - Confirmatory analytical lab testing and health hazard assessments
➢ CSH
▪ Higher level of analysis
▪ Larger blood banking capability
AS213.3 PRESERVATION OF REMAINS

❖ AHS Support & Post-Mortem Care
➢ Quartermaster Corps is primarily responsible for the care and disposition of remains
➢ The AMEDD does have a supporting role to play
➢ All medical plans must include coordination with Mortuary Affairs (MA) to ensure expeditious
movement and preservation of remains
➢ MEDEVAC platforms should never be used to transport remains
❖ Provider Post-Mortem Care

➢ Do not remove any treatment adjuncts from the body, they will be needed during the autopsy;
send any clothing, body armor or helmets that have been removed during treatment with the body
➢ Weapons, ammunition, and classified material should be removed; everything else stays in place
➢ Do not wash any portion of the body
➢ Place body in a human remains pouch (HRP), if unavailable, shroud the remains with a blanket,
poncho, mattress cover or other appropriate item
❖ General Post-Mortem Care
➢ Ensure the body is place in a shaded cool area if possible, that is separated from the remaining
casualties until the remains can be placed in refrigeration
➢ Place the remains in a refrigerated environment as soon as possible, if unavailable wet ice may
be temporarily used
➢ The temperature should be maintained between 34 and 37 degrees Fahrenheit, taking care not to
freeze the body.
➢ Ensure the body has the proper identification
▪ At least three tags are required;
● Big Toe, Wrist, and remains pouch itself
❖ Commander Responsibilities
➢ All Commanders have the responsibility to care for deceased personnel within their AO. The
immediate responsibility includes:
➢ Recovery and evacuation of human remains (HR) to the nearest MACP
➢ Timely and accurate submissions of a DA 1156 Casualty Feeder Card
➢ Safeguard any personal effects (PE) in the unit area until appointment of a Summary Courts
Martial Officer (SCMO)
➢ All personnel should be trained in the basic Mortuary Affairs tasks included in STP 21-1 SMCT
Warrior Skills Level 1
▪ 101-515-1999 Recover Isolated Remains
▪ 101-515-1998 Evacuate Isolated Remains
❖ Staff Responsibilities
➢ S1/G1
▪ Ensure accuracy and completeness of DA 1156
▪ Forward DA 1156 to appropriate level headquarters without delay
▪ IAW AR 600-8-1 the BN CDR of field grade designee will verify the accuracy and
completeness of the DA form 1156
▪ SCMO activities should be monitored by the S1/G1
▪ SCMO are appointed on orders by the first O-6 in the chain of command
▪ SCMO activities and inventory timelines will vary based on location and operation
➢ S3/SPO
▪ A unit fatality collection point should be identified separate to a casualty collection point
▪ Submit “Hero Flight” request
▪ Coordinating evacuation of HR from the unit fatality collection point to the nearest MACP
▪ Request assistance through the BSB SPO when recovery is outside of unit capabilities
➢ S4/G4
▪ Maintain the following MA equipment stocks:
● 1.Human remains pouches (HRP) – stock HRPs at a quantity equal to 5% of the
personnel strength
● 2.Personal Protective Equipment (PPE) - Latex gloves and surgical masks for recovery
operations
● 3. Footlockers (Gorilla / Tuff boxes), padlocks and railroad seals for SCMO inventories
▪ Develop an issue system to account for and track MA stocks.
● Some units have include HPPs and PPE as par of vehicle BII, others have created MA
kits that are issued for convoy and patrol operations
OP121.2 MISSION ANALYSIS & CASUALTY ESTIMATION
❖ STEP 2: Mission Analysis: Commanders (supported by their staffs and informed by subordinate and
adjacent commanders) gather, analyze, and synthesize information to orient themselves on the
current conditions of the operational environment.

❖ Most important step in the MDMP: no amount of subsequent planning can solve a problem
insufficiently understood, also the most difficult step
➢ If the commander or staff misinterpret the higher headquarters’ plan, time is wasted.
➢ The commander and staff may identify difficulties and contradictions in the higher order.
❖ Liaison officers (LNOs)
➢ Familiar with the higher headquarters plan can help clarify issues.
➢ Use requests for information (RFIs) to clarify or obtain additional information from the higher
headquarters.
❖ Input-Process-Output
❖ Task 1: Analyze higher HQ or order

➢ The higher headquarters’:
▪ Commander’s intent
▪ Mission.
▪ Concept of operations
▪ Available assets
▪ Timeline
➢ The missions of adjacent, supporting, and supported units and their relationships to the higher
headquarters’ plan
➢ The missions or goals of unified action partners that work in the operational areas
➢ Their assigned area of operations
❖ Task 2: Perform initial IPB
➢ The systematic process of analyzing the mission variables of enemy, terrain, weather, and civil
considerations in an area of interest to determine their effect on operations
➢ ID critical gaps in CMDR knowledge of OE:
➢ “METT-TC”
▪ Enemy: Identity, Disposition, size, Location
▪ Terrain: Observation and Fields of fire, Avenues of approach, Key terrain, Obstacles and
movement, Cover and concealment (OAKOC)
▪ Weather: visibility, wind, precipitation, temperature, etc

▪ Civil considerations: Areas, Structure, Capabilities, Organizations, People, Events (ASCOPE)

➢ Modified Combined Obstacle Overlay (MCOO)
▪ Graphic of the battlespace’s effects on military operations
➢ Develop threat models which portray how threat forces normally execute operations and how they
have reacted to similar situations in the past
▪ Creating and updating threat characteristics
▪ Developing the situation template
▪ Creating threat/adversary capabilities statement
▪ Determining the High Value Target List (HVTL)
▪ Updating the intelligence estimate
➢ Develop graphic overlays (enemy situation templates) and narratives (enemy COA statements)
for each possible enemy COA
▪ ID likely objectives and end state
▪ ID the full set of COAs available to the threat
▪ Evaluate and prioritize each threat COA
▪ Develop each COA in the amount of detail time allows
▪ ID high value targets (HVT) for each COA
▪ ID initial collection requirements for each COA
❖ Task 3: Determine Specified, Implied, and Essential Tasks
➢ Specified Tasks:
▪ Specifically assigned to a unit by its higher headquarters
▪ Typically found in paragraphs 2 and 3 of the higher hq’s order, but may be listed in annexes,
overlays, directives, and/or assigned verbally during collaborative planning sessions
➢ Implied Tasks:
▪ Must be performed to accomplish a specified task or the mission, but are not stated in the
higher headquarters order
▪ Derived from a detailed analysis of the higher order and METT-TC factors
➢ Essential Tasks: Those tasks that must be executed to accomplish the mission. Essential tasks
are always included in the unit’s mission statement.
➢ The staff also identifies any be-prepared or on-order missions:
▪ Be-Prepared Mission: Assigned to a unit that might be executed (generally a contingency
mission).
▪ On-order Mission: A mission to be executed at an unspecified time.
❖ Task 4: Review available assets and ID resource shortfalls
➢ Examine additions to and deletions from the current task organization, command and support
relationships, and status (current capabilities and limitations) of all units
➢ Consider relationships among essential, specified, and implied tasks, and between them and
available assets:
▪ Determine if they have the assets needed to accomplish all tasks
▪ If there are shortages, identify additional resources needed for mission success
➢ ID any deviations from the normal task organization and provide them to the commander to
consider when developing the planning guidance
❖ Task 5: Determine constraints
➢ Constraint: restriction placed on the command by a higher command
▪ based on resource limitations (i.e. organic fuel transport capacity) or physical characteristics
of OE (i.e. # of vehicles that can cross a bridge in specified time)
➢ Dictates an action or inaction, thus restricting the freedom of action of a subordinate commander.
▪ Can take the form of a requirement to do something
● “Maintain a reserve of one company,” “Must maintain Level II Health Support at FOB
Delta”
➢ Can also prohibit action:
➢ “No reconnaissance forward of Phase Line Bravo before 1700”, “All convoys will have a minimum
of 3 vehicles”
❖ Task 6: ID critical facts and develop assumptions
➢ Facts:
▪ Statements of truth or statements thought to be true at the time

▪ Facts concerning the operational and mission variables serve as the basis for developing
situational understanding
➢ Assumptions:
▪ Suppositions on the current situation or a presupposition on the future course of events
▪ Assumptions are:
● assumed to be true in the absence of positive proof; necessary to complete an estimate
of the situation make a decision on the course of action
➢ Must continually attempt to replace assumptions with facts
➢ Throughout the MDMP, list and review the key assumptions on which fundamental judgments
rest
❖ Task 7: Begin Risk Management (CRM)
➢ CRM consists of five steps. The first four steps are conducted in the MDMP:
▪ Step 1, Identify hazards.
▪ Step 2, Assess hazards to determine risk.
▪ Step 3, Develop controls and make risk decisions.
▪ Step 4, Implement controls.
▪ Step 5, Supervise and evaluate.
❖ Task 8: Develop initial CCIRs and EEFIs
➢ CCIR fall into one of two categories:
➢ Priority Intelligence Requirement (PIR): an intelligence requirement that the commander and staff
need to understand the adversary or the operational environment
➢ Friendly Forces Information Requirement (FFIR): information the commander and staff need to
understand the status of friendly force and supporting capabilities
➢ Essential Elements Of Friendly Information (EEFI): help the commander understand what enemy
commanders want to know about friendly forces and why
▪ Identify those elements of friendly force information that, if compromised, would jeopardize
mission success; Have the same priority as CCIRs and require approval by the commander
❖ Task 9: Develop initial information collection plan
➢ sets reconnaissance, surveillance, and intelligence operations in motion
➢ PIR → (serious incident report (SIR) → ISR task
❖ Task 10: Update plan for use of Available time
➢ Timeline management normally purview of XO/Chief of Staff
➢ Compare the time needed to accomplish tasks to the higher headquarters timeline to ensure
mission accomplishment is possible in the allotted time
➢ The refined timeline includes:
▪ Subject, time, and location of briefings the commander requires.
▪ Times of collaborative planning sessions and the medium over which they will take place.
▪ Times, locations, and forms of rehearsals.
❖ Task 11: Develop initial information themes and messages
➢ Information theme: unifying or dominant idea or image that expresses the purpose for military
action.
➢ Message: verbal, written, or electronic communications that supports an information theme
focused on a specific actor or the public and in support of a specific action (task).
❖ Task 12: Develop proposed problem statement
➢ Problem Statement: the description of the primary issue or issues that may impede commanders
from achieving their desired end state
➢ To help identify and understand the problem, the staff:
▪ Compares the current situation to the desired end state
▪ Brainstorms and lists issues or obstacles that will impede the command from achieving the
desired end state
▪ Determines the primary obstacles that will impede the command from achieving the desired
end state
❖ Task 13: Develop a proposed mission statement
➢ Who will execute the operation (unit/organization)?
➢ What is the unit’s essential task(s)?
➢ When will the operation begin (by time or event) or what is the duration of the operation?
➢ Where will the operation occur (AO, objective, grid coordinates)?

➢ Why will the force conduct the operation (for what purpose)?
➢ If operation is phased, each phase may have different essential task
❖ Task 14: Present MA briefing
❖ Task 15: Develop and issue initial commander's intent
➢ Summarize visualization to provide basis for unity of effort throughout the force
➢ Nested within higher CMDR’s intent
▪ In the absence of orders, the commander’s intent + the mission statement, directs
subordinates toward mission accomplishment. It must be easy to remember and clearly
understood by subordinates two echelons down. Typically, three to five sentences long
❖ Task 16: Develop initial planning guidance
➢ Conveys the essence of the commander’s visualization
➢ Outlines an operational approach - the broad general actions that will produce the conditions that
define the desired end state
➢ Outlines specific COAs the commander desires the staff to look at as well as rules out any COAs
the commander will not accept
➢ Describes when, where, and how the commander intends to employ combat power to accomplish
the mission within the higher commander’s intent
➢ Provide planning guidance by warfighting functions (WFF) tailored to meet specific needs
❖ Task 17: Develop CoA evaluation criteria
➢ Standards the commander and staff will later use to measure the relative effectiveness and
efficiency of one COA to other COAs
➢ Helps to eliminate a source of bias prior to COA analysis and comparison
➢ Evaluation criteria address factors that affect success and those that can cause failure
➢ Must be clearly defined and understood by all staff members before starting the war game to test
the proposed COAs
➢ The COS / XO initially determines each proposed criterion with weights based on the assessment
of its relative importance and the commander’s guidance
❖ Task 18: Issue a WARNO
❖ Casualty Estimation
➢ Estimates and Planning
▪ Estimate required resources during MA
▪ Used to anticipate daily requirements
▪ A logical starting point to apply your experience
▪ Broad Operational Parameters:
● Forces
● Time
● Operational Environment
➢ Automated Casualty Estimate Tools
▪ Casualty estimation (G1) - SABRE
▪ MACE - implements the casualty estimation methodology with a simulation, to allow for
multiple iterations which enable provision of range estimates, instead of a single point
estimate
● ⇱https://cass.amedd.army.mil/
● Section 1
♦ Scenario: constant derived from historical battle losses it represents the daily
average casualties
♦ Terrain Data: difficult terrain decreases casualty rates on both sides and creates a
stronger defense for the defenders
♦ Weather Data: severe weather decrease casualty rates on both sides and bad
weather creates tougher conditions for the attacker and decreases their strength
♦ Time Data: casualty rates increase during the day and decrease during the night
♦ Primary Month of Operation: factors in determining DNBI casualty rates
● Section 2: Blue vs. Red Forces
♦ Input The Troop Population: number of soldiers within range of hostile firepower

♦ Posture Data: the stronger the defensive position the less casualties for the defender
♦ Sophistication Data: weapons based, the more sophisticated a force is the lower their
casualty rate should be, this is relative to the opponents sophistication
♦ Surprise Data: the more surprised a force is the higher the casualty rate
♦ Mobility Data: considering all equipment relative to the opponent
♦ Human Factors: effective differences not associated with theoretical combat power
relationships relative to the opponent
OP121.3 COA DEVELOPMENT
❖ 8 Tasks in CoA Development:

1. Analyze relative combat power
2. Generate options
3. Array initial forces
4. Develop the scheme of maneuver
5. Assign headquarters
6. Prepare COA statements and sketches
7. Conduct COA briefing
8. Select or modify COA for analysis
❖ CoA Screening Criteria
➢ Feasible: can accomplish the mission within the established time, space, and resource limitations
➢ Acceptable: must balance cost and risk with the advantage gained
➢ Suitable: can accomplish the mission within the commander’s intent and planning guidance
➢ Distinguishable: must differ significantly from the others
➢ Complete: Each COA must show:
▪ How the decisive operation accomplishes the mission
▪ How shaping operations create and preserve conditions for success
▪ How sustaining operations enable shaping and decisive operations
▪ How to account for decisive action tasks
▪ Tasks to be performed and conditions to be achieved
❖ CoA Development Illustrations
➢ Sketches are intended to provide examples of each COA development task
▪ Only the major actions in each task are included for clarity and illustration purposes
▪ Complete COA Sketch example from ATTP 5-0.1, Commander and Staff Officer Guide, Sep
11, p. 4-21
❖ Task 1: Assess Relative Combat Power
➢ Combat power: the total means of destructive, constructive, and information capabilities that a
military unit can apply at a given time
▪ The effect created by combining the elements of intelligence, movement and maneuver, fires,
sustainment, protection, mission command, information, and leadership.
▪ The goal is to generate overwhelming combat power to accomplish the mission at minimal
cost.

➢ To assess relative combat power, planners initially make a rough estimate of force ratios of
maneuver units two levels down.
▪ Compare all types of maneuver battalions with enemy maneuver battalion equivalents
▪ Compare friendly strengths against enemy weaknesses, and vice versa, for each element of
combat power
➢ Analyze force ratios and determine/ compare each force’s strengths and weaknesses as a
function of combat power
➢ Gain insight into:
▪ Friendly capabilities that pertain to the operation.
▪ The types of operations possible from both friendly and enemy perspectives.
▪ How and where the enemy and friendly forces may be vulnerable.
▪ Additional resources that may be required to execute the mission.
▪ How to allocate existing resources.
➢ Assess both tangible and intangible factors, such as morale and levels of training
➢ Planners compare enemy and friendly strength & weaknesses for each element of combat power
➢ Elements of Our Medical Combat Power
▪ Treatment Capacity; Evacuation capacity, FHP; Other?
● Steer towards what is more important in OFF, DEF, STABILITY and DSCA. BCT CDR
cares about different stuff for different operations but I would submit that priorities are
treatment, evac, med log, all else for OFF and DEF. Only in STAB does BCT CDR get
emotional about FHP
➢ Elements of Enemy Combat Power for Medical planning
▪ Casualty Estimate (#); Situation Template; Maneuver Plan
▪ WHEN, WHERE and HOW many casualties is the meat here. If you want the FHP tie in is
potential patient population with vector risk to create a patient density
❖ Task 2: Generate Options
➢ Brainstorm to generating options
➢ COA needs to defeat all feasible enemy COAs
▪ Decisive operation: Operation nested within the higher headquarters’ concept of operations
and considers ways to mass lethal and nonlethal effects of overwhelming combat power to
achieve it
▪ Shaping operations: Establish a purpose for each shaping Operation that is tied to creating or
preserving a condition for the decisive operation’s success
▪ Sustaining operations: Operation necessary to create and maintain the combat power
➢ Determine the doctrinal requirements for each proposed operation, including doctrinal tasks for
subordinate units
➢ Examine each COA to determine if it satisfies the screening criteria (feasible, acceptable,
suitable, distinguishable, and complete).
➢ Determine purpose and essential tasks for each decisive, shaping, and sustaining operation
❖ Task 3: Array Forces
➢ Determine relative combat power:
▪ Required to accomplish each task
▪ With regard to civilian requirements and conditions that require attention and then array
forces and capabilities for stability tasks
▪ Planners initially make a rough estimate of force ratios of maneuver units two levels down.
The numbers depict minimum historical minimum planning ratios required to accomplish a
specific task
➢ Counterinsurgency operations: develop force requirements by gauging troop density - the ratio of
security forces (including host-nation military and police forces as well as foreign
counterinsurgents) to inhabitants. Most recommendations range from 20 to 25 counterinsurgents
for every 1,000 residents
➢ Proceed to array friendly forces starting with the decisive operation and continuing with all
shaping and sustaining operations
▪ The initial array of ground forces is normally two levels down
➢ Focus on generic ground maneuver units without regard to specific type or task organization, and
then consider all appropriate intangible factors.
▪ Do not assign missions to specific units. only consider which forces are necessary to
accomplish its task

❖ Task 4: Develop a Broad Concept

➢ The broad concept describes:
▪ How arrayed forces will accomplish the mission within the commander’s intent and
▪ Will provide the framework for the concept of operations
▪ Summarizes the contributions of all warfighting functions
▪ Presents an overall combined arms idea that will accomplish the mission.
➢ Use both lines of operations and lines of effort to build a broad concept
▪ Lines of operations portray the more traditional links among objectives, decisive points, and
centers of gravity
▪ Lines of effort link multiple tasks with goals, objectives, and end state conditions
▪ Develop lines of effort by:
● Confirming end state conditions from the initial commander’s intent and planning
guidance
● Determining and describing each line of effort
● Identifying objectives (intermediate goals) and determining tasks along each line of effort
➢ includes the following:
▪ The purpose of the operation
▪ A statement of where the commander will accept risk
▪ Identification of critical friendly events and transitions between phases
▪ Reserve, its location and composition
▪ Information collection activities
▪ Essential stability tasks
▪ Identification of maneuver options that may develop during an operation
▪ Assignment of subordinate areas of operations
▪ Scheme of fires
▪ Themes, messages, and means of delivery
▪ Key control measures
▪ Decisive operation, its task and purpose, linked to how it supports the higher headquarters’
concept
▪ Shaping operations, their tasks and purposes, linked to how they support the decisive
operation.
▪ Sustaining operations, their tasks and purposes, linked to how they support the decisive and
shaping operations.
❖ Task 5: Assign HQ
➢ Consider the types of units to be assigned to a headquarters and the ability of that headquarters
to control those units.
➢ Generally, a headquarters controls at least two subordinate maneuver units, but not more than
five
❖ Task 6: Prepare CoA Statements and Sketches
➢ COA statement clearly portrays how the unit will accomplish the mission and is a brief expression
of how the combined arms concept will be conducted (8 paragraphs):
▪ Mission
▪ Intent
▪ Decisive Operations
▪ Shaping Operations
▪ BCT Fires
▪ Tactical Risk
▪ BCT Information Collection Plan
▪ Sustaining Operations
➢ The sketch provides a picture of the movement and maneuver aspects of the concept, including
the positioning of forces
➢ Statement + sketch = the who (generic task organization), what (tasks), when, where, and why
(purpose) for each subordinate unit
➢ Includes at a minimum the array of generic forces and control measures, such as:
▪ The unit and subordinate unit boundaries.
▪ Unit movement formations (but not subordinate unit formations)
▪ The line of departure (LD), or line of contact (LC) and phase lines (PL), if used
▪ Information collection graphics

▪ Ground and air axes of advance

▪ Assembly areas, battle positions, strong points, engagement areas, and objectives
▪ Obstacle control measures and tactical mission graphics
▪ Fire support coordination and airspace control measure
▪ Main effort
▪ Location of command posts and critical information systems nodes
▪ Known or templated enemy locations
▪ Population concentrations
❖ Task 7: Conduct CoA Briefing
➢ Updated IPB
➢ Possible enemy COAs (minimum of MLCOA, and MDCOA).
➢ The approved problem statement and mission statement
➢ The commander’s and higher commander’s intent
➢ COA statements and sketches, including lines of effort if used
➢ Rationale for each COA, including:
▪ Considerations that might affect enemy COAs
▪ Critical events for each COA
▪ Deductions resulting from the relative combat power analysis
▪ The reason units are arrayed as shown on the sketch
▪ The reason the staff used the selected control measures
▪ The impact on civilians
▪ How it accounts for minimum essential stability tasks
▪ Updated facts and assumptions
▪ Refined COA evaluation criteria
❖ Task 8: Select or Modify CoAs for Continued Analysis
➢ After COA briefing, the commander:
▪ Selects or modifies those COAs for continued analysis
▪ Issues planning guidance
▪ If all COAs are rejected, the staff begins again.
▪ If one or more of the COAs are accepted, staff members begin COA analysis
▪ The commander may create a new COA by incorporating elements of one or more COAs
developed by the staff. The staff then:
● Prepares to war-game this new COA
● Must incorporate those modifications and ensure all staff members understand the
changed COA prior to war-gaming
OP121.4 COA ANALYSIS, COMPARISON, AND DECISION

❖ COA analysis identifies for each COA:
➢ Difficulties or coordination problems
➢ Probable consequences of planned actions
❖ COA analysis (war-gaming) is a disciplined process
❖ COA analysis includes:
➢ Rules and steps that help commanders and staffs visualize the flow of the operation, given the
force’s strengths and dispositions, enemy’s capabilities and possible COAs
➢ Impact and requirements of civilians in the AO, and other aspects of the situation.
❖ War-gaming focuses the staff’s attention on each phase of the operation in a logical sequence. It is
an iterative process of action, reaction, and counteraction.
❖ Each critical event within a proposed COA should be war-gamed using the action, reaction, and
counteraction methods of friendly and enemy forces interaction.
❖ CoA Analysis:

➢ Task 1: Gather the tools

▪ Running estimates.
▪ Threat templates and models.
▪ Civil considerations overlays, databases and data files.
▪ Modified combined obstacle overlays and terrain effects matrics.
▪ A recording method (synchronization matrix or sketch note - will be addressed at Task 6,
Select a Method to Record and Display Results).
▪ Completed COAs, including graphics.
▪ Means to post or display enemy and friendly unit symbols and other organizations.
▪ Map of the AO
➢ Task 2: List all friendly forces
▪ The commander and staff consider all units that can be committed to the operation, paying
special attention to support relationships and constraints. The friendly force list remains
constant for all COAs.
➢ Task 3: List assumptions
▪ The commander and staff review previous assumptions for continued validity and necessity.
During the course of mission analysis and COA development, the commander and staff may
have obtained updated or additional information that may confirm or deny initial assumptions
➢ Task 4: List known critical events and decision points
▪ Critical events: those events that directly influence mission accomplishment
● Events that trigger significant actions or decisions (such as commitment of an enemy
reserve), complicated actions requiring detailed study (such as passage of lines)
● The essential tasks. The list of critical events includes major events from the unit’s
current position through mission accomplishment.
♦ Examples: POI – Role II; At casualty belts; Movements of BSMC, FST or FSMT;
CLVIII Critical Resupply; Phase III specific requirements
▪ Decision points: those points in space and time when the commander or staff anticipates
making a key decision concerning a specific course of action.
● May be associated with CCIRs that describe what information the commander needs to
make the anticipated decision.
● Does not dictate what the decision is, only that the commander must make one
➢ Task 5: Select the War-Gaming Method
▪ Belt method: Divides the AO into belts (areas) running the width of the AO. The shape of
each belt is based on the factors of METT-TC
● Sequential analysis of events in each belt - Preferred because it focuses simultaneously
on all forces affecting a particular event
▪ Avenue-in-depth method: Focuses on one avenue of approach at a time, beginning with the
decisive operation
▪ Box method: Detailed analysis of a critical area, such as an engagement area, a river
crossing site, or a landing zone. It is appropriate when time is constrained, as in a hasty
attack

➢ Task 6: Select a technique to Record and Display Results

▪ War-game results provide a record from which to build task organizations, synchronize
activities, develop decision support templates, confirm and refine event templates, prepare
plans or orders, and compare COAs. Two techniques commonly used:
● Synchronization matrix (synch matrix): Allows the staff to synchronize the COA across
time, space, and purpose in relationship to potential enemy and civil actions.
♦ Time or phases of the operation, the most likely enemy action, the most likely civilian
action, and decision points for the friendly COA
♦ Developed around selected WFFs and their subordinate tasks and the unit’s major
subordinate commands
♦ Matrix may be modified to fit unit needs
● Sketch note: Uses brief notes concerning critical locations or tasks and purposes. The
commander and staff note locations on the map and on a separate war-game worksheet
using sequence numbers to link notes to corresponding locations on the map or overlay.
♦ Use the war-game worksheet to identify all pertinent data for a critical event
♦ Assign each event a number and title and use the columns on the worksheet to
identify and list in sequence
➢ Task 7: War-Game the Operation and Assess the Results
▪ During the war-game, the commander and staff try to foresee the actions, reactions, and
counteractions of all participants to include civilians.
● Actions are those events initiated by the side with the initiative.
● Reactions are the opposing side’s actions in response.
♦ Stability operations, the war-game tests the effects of action, including intended and
unintended effects, as they stimulate anticipated responses from civilians and civil
institutions.
● Counteractions are the first side’s responses to reactions.
▪ Sequence of action-reaction-counteraction continues until the critical event is completed or
until the commander decides to use another COA to accomplish the mission
➢ Task 8: Conduct a War-Game Briefing (optional)
▪ Time permitting - staff delivers a briefing to all affected elements to ensure everyone
understands the results of the war-game.
▪ War-game briefing format:
● Higher headquarters’ mission, commander’s intent, and military deception plan.
● Updated IPB
● Friendly and enemy COAs that were war-gamed, including:
♦ Critical events
♦ Possible enemy actions and reactions
♦ Possible impact on civilians
♦ Possible media impacts
♦ Modifications to the COAs
♦ Strengths and weaknesses
♦ Results of the war-game
▪ Assumptions
▪ War-gaming technique used
❖ CoA Comparison
➢ Task 1: Conduct Advantages and Advantages Analysis
▪ Staff presents findings for others’ considerations
▪ use evaluation criteria developed before war-game - outline each CoA, highlighting its
advantages/disadvantages
➢ Task 2: Compare CoAs
▪ Most common technique is the decision matrix, which uses evaluation criteria to assess the
effectiveness and efficiency of each COA.
▪ Decision matrices alone cannot provide a total basis for decision solutions
● Greatest value is providing a method to compare COAs against criteria that, when met,
suggest a great likelihood of producing success
● Weights for each criterion - totals compared to determine “best” COA on both criteria
alone & weighted scores
➢ Task 3: Conduct a CoA decision briefing

▪ Commander’s intent of the higher and next higher commanders

▪ Status of the force and its components
▪ Current IPB
▪ COAs considered, including:
● Assumptions used
● Results of running estimates
● A summary of the war game for each COA, including critical events, modifications to any
COA, and war-game results
● Advantages and disadvantages (including risk) of each COA
● The recommended COA
❖ CoA Approval
➢ After selecting a COA, the commander issues the final planning guidance. The final planning
guidance includes:
▪ A refined commander’s intent (if necessary)
▪ New CCIRs to support execution
▪ Any additional guidance on:
➢ Priorities for the warfighting functions
➢ Orders preparation
➢ Rehearsal
➢ Preparation
➢ Priorities for resources needed to preserve freedom of action and ensure continuous sustainment
➢ Risk
➢ Based on the commander’s decision and final planning guidance, staff issues a WARNORD to
subordinate headquarters which includes:
▪ Mission
▪ Commander’s intent
▪ Updated CCIRs and EEFIs
▪ Concept of operations
▪ The AO
▪ Principal tasks assigned to subordinate units
▪ Preparation and rehearsal instructions not included in SOPs
▪ A final timeline for the operations
OP121.5 ORDERS PRODUCTION
❖ COA statement becomes the concept of operations for the plan.

❖ COA sketch becomes the basis for the operation overlay.
❖ Orders and plans provide all the information subordinates need for execution.
➢ Commanders review and approve orders before the staff reproduces and disseminates them
unless they have delegated that authority
➢ Subordinates immediately acknowledge receipt of the higher order.
❖ If possible, the order is briefed to subordinate commanders face-to- face by the higher commander
and staff.
➢ Conduct confirmation briefings with subordinates immediately afterwards.
❖ Task 1: Produce and disseminate orders
➢ Plans and Orders Reconciliation

▪ Occurs internally as the staff conducts a detailed review of the entire plan or order
● Ensures that the base plan or order and all attachments are complete and in agreement
● Identifies discrepancies or gaps in planning. If staff members find discrepancies or gaps,
take corrective actions
● Compare the commander’s intent, mission, and commander’s CCIRs against the concept
of operations and the different schemes of support
● Ensure attachments are consistent with the information in the base plan or order
➢ Plans and Orders Crosswalk
▪ Compare the plan or order with that of the higher and adjacent commanders
● To achieve unity of effort
● Ensure the plan meets the superior commander’s intent.
➢ Approving the Plan or Order
▪ Final action in plan and order development is the approval of the plan or order by the
commander
● Commanders review and approve orders before the staff reproduces and disseminates
them, unless delegated
● Subordinates immediately acknowledge receipt of the higher order
▪ If possible, the commander and staff brief the order to subordinate commanders in person
▪ Conduct confirmation briefings with subordinates immediately afterwards
● Confirmation briefings can be conducted collaboratively with several commanders at the
same time or with single commanders.
● These briefings may be conducted in person or by video teleconference
❖ Task 2: Transition from planning to operations
➢ Step 7 bridges the transition between planning and preparations
▪ Transition is a preparation activity that occurs within the HQ
▪ Responsibility for developing and maintaining the plan shifts from the plans or future
operations cell (FUOPS) → current operations cell (CUOPS)
▪ Ensures members of CUOPS fully understand the plan before execution
➢ This transition is the point at which the current operations cell becomes responsible for controlling
execution of the operation order
➢ This responsibility includes:
▪ Answering requests for information concerning the order
▪ Maintaining the order through fragmentary orders
➢ This transition enables the plans cell to focus its planning efforts on sequels, branches, and other
planning requirements directed by the commander
OP131 REHEARSALS AND FRAGORDS

❖ Rehearsal Types:
➢ (Confirmation Brief) - normally conducted immediately following an OPORD or a FRAGORD;
ensures that subordinate commanders understand the intent, task, purpose, and overall
framework of the operation.
➢ Backbrief - conducted throughout the MDMP process; allows the higher commander to learn
how subordinates intend to accomplish their mission and identifies problems within his
subordinate's concept of operations
➢ Combined Arms Rehearsal - conducted by maneuver unit HQs after subordinates have issued
their OPORDs to ensure that subordinate's plans are synchronized and meet the higher
commander's intent
➢ Support Rehearsal - conducted by one or more related systems (i.e., Fire support or CSS). Like
the combined arms rehearsal- ensure that subordinate systems' plans are synchronized and
meet the higher CDR's intent
➢ Battle Drill or SOP rehearsal - ensure that all participants understand a specific technique.
Although they can be performed at all echelons, they are normally conducted at platoon and
below. Ex: lane-marking drill, bangalore torpedo drill, and tank plow operations
❖ Rehearsal Techniques

❖ Ground Rules
➢ Rehearsal director—
▪ States the standard (Commander’s definition of success)
▪ Ensures all understand the parts of the OPORD to rehearse
▪ Quickly reviews the rehearsal SOP (if all are not familiar)
▪ Establishes a timeline (designates the rehearsal starting time in relation to H-hour)
▪ Establishes the time interval to begin & track rehearsal
▪ Updates friendly and adversary activities (as necessary)
➢ The rehearsal director concludes the orientation with a call for questions
❖ Conducting a Rehearsal (Rehearsal Steps)
➢ Step 1 – Deployment of Enemy Forces (G-2/S-2) - ISR status is briefed
➢ Step 2 – Deployment of Friendly Forces (G-3/S-3) - Current unit dispositions & any points of
emphasis
➢ Step 3 – Initiate Action (Advancement of the Enemy) (G-2/S-2) - Based on the SITEMP; enemy is
portrayed as uncooperative, but is not invincible
➢ Ties enemy actions to specific terrain or friendly actions
➢ Step 4 – Decision Point (DP) - Taken from the DST; CDR’s assessment of whether or not DP
➢ Step 5 – End State Reached
➢ Step 6 – Reset
▪ CDR states next branch to rehearse
▪ Continues until all DPs & branches the cdr wants to rehearse have been addressed
▪ At the end of the rehearsal, the recorder restates any changes, (i.e. changes to the COA,
Changes to the MOE / MOP, coordination, & Synchronization) or clarifications the cdr directs,
& estimates how long it will take to codify changes in a written FRAGORD
➢ Following the rehearsal: CDR leads an AAR; Staff makes any necessary changes to the OPORD,
DST - execution matrix; Staff publishes verbal or written FRAGORDS ASAP
❖ FRAGORD production
➢ Fragmentary order is issued as needed after an OPORD - change or modify that OPORD or to
execute a branch or sequel to that order (JP 5-0).
➢ FRAGORDs include all five OPORD paragraph headings and differ only from OPORDs in the
degree of detail provided.
➢ After each paragraph heading, it provides either new information or states “no change.”
▪ Address only the parts of the OPORD that have changed
➢ FRAGORDs may be issued as overlay orders
HA253.1 INTRO TO HEALTH LAW

Refer to slides
AO220.1 ARMY MEDICINE

❖ Discuss:
➢ 1.Army Medicine is comprised of _____________ and _____________.
▪ AMEDD & MEDCOM
➢ 2.The Surgeon General (TSG) leads the ___________ and commands the ___________.
▪ leads the AMEDD; commands the MEDCOM
➢ 3. T/F. AHS TOE units are assigned to the AMEDD

➢ 4. T/F. TDA units are deployable
❖ Army Medicine Mission, Vision, and Priorities

➢ Mission: Army Medicine provides responsive and reliable health services and influences Health
to improve readiness, save lives, and advance wellness in support of the Force, Military Families,
and all those entrusted to our care. Army Medicine provides sustained health services and
research in support of the Total Force to enable readiness and conserve the fighting strength
while care for our Soldiers for Life and Families
➢ Vision: Strengthening the health of our Nation by improving the health of our Army.
➢ Army Medicine Priorities:
▪ Combat Casualty Care
▪ Ready and Deployable Medical Force
▪ Readiness of the Force
▪ Health of the Soldier and Beneficiaries
❖ Army Medicine Overview
➢ Army Medicine supports the Army through two distinct organizations:
▪ Army Medical Department (AMEDD)
● The AMEDD is led by the Surgeon General (TSG) of the U.S. Army
● The AMEDD supports all three Army compositions: Active, Reserve, and National Guard
● The AMEDD is comprised of eight corps:
♦ Medical Corps (MC)
♦ Medical Service Corps (MS)
♦ Army Nurse Corps (AN)
♦ Medical Specialist Corps (SP)
♦ Dental Corps (DC)
♦ Veterinary Corps (VC)
♦ Enlisted Corps
♦ Civilian Corps
▪ U.S. Army Medical Command (MEDCOM)
● MEDCOM is the second largest Army Command and provides mission command for
fixed facility healthcare and other healthcare activities
➢ Army Medicine also trains and provides AHS personnel to Geographic Combatant Commander
for assignments within the Army Operating Force
❖ OTSG + MEDCOM = “Onestaff”
➢ LTG West is dual-hatted as Surgeon General of the Army and Commander of the Army Medical
Command. In these roles she provides advice and assistance to the Chief of Staff, Army (CSA)
and to the Secretary of the Army (SECARMY) on all health care matters pertaining to the U.S.
Army and its military health care system.
▪ OTSG/MEDCOM develops policy and manages the Army health system; medical materiel
developer for the Army

● Duties include formulating policy regulations on health service support, health hazard
assessment and the establishment of health standards.
➢ Army Medical Command (MEDCOM) - the second largest Army Command, is headquartered at
Joint Base San Antonio, Texas.
▪ DSG dual hats as DCG-Support: Focus is on
● Joint Health Services / ASD(Health Affairs) / Military Health Services (MHS) / Defense
Health Agency (DHA)
● Provide oversight of AMEDDC&S Health Readiness COE and MRMC
▪ DCG-Operations focused on ASCCs/FORSCOM/CORPS/and Regional Health Commands
providing for the Health Readiness of Army down to the installation level.
▪ All staff elements are aligned under the Chief of Staff (COS) who provides the critical
coordination, integration and synchronization of the Onestaff
➢ DCGs leverage the staff through matrix Work Groups orchestrated by COS
❖ Regional Alignment
➢ MEDCOM transforms to four multi-disciplinary Regional Health Commands that regionally align
with Corps in CONUS and Army Service Component Commands OCONUS.
➢ MEDCOM transforms from 20 to 14 subordinate Command HQs
❖ Provisional Boundaries and Alignments
❖ Army Medicine at a Glance - refer to slide

❖ CONUS AHS EAB TOE Units - refer to slide
➢ Korea & Germany - OCONUS MEDBDEs
➢ 5 other MEDBDEs CONUS
❖ Manning Documents
➢ Table of Organization and Equipment (TOE) Units: A TOE prescribes the normal mission,
organizational structure, and personnel and equipment requirements for a military unit and is the
basis for an authorization document. Units are constituted and activated in accordance with an
approved TOE or modified TOE (MTOE). All personnel are military, and the unit can be deployed
anywhere in the world. Ex: Combat Support Hospital (CSH)
➢ Tables of Distribution and Allowances (TDA) Units: TDA units are organized to perform
specific missions for which there are no appropriate TOEs. Unlike TOE units, TDA organizations
are considered non-deployable, even when organized overseas, as their missions are normally
tied to a geographic location. The personnel of TDA organizations can be military, civilian, or a
combination of both. Ex: Outpatient Clinic
AO220.2 ARMY MEDICINE CAMPAIGN PLAN

❖ Discuss:
1. List three factors influencing the AMEDD Strategic Environment.
➢ Cost rise of healthcare; Rising Obesity; Government Action;
2. What are the four Lines of Effort in the 2017 Campaign Plan?
➢ Readiness and Health; Healthcare Delivery; Force Development; Take Care of Ourselves, our
Soldiers for Life, DA Civilians, and Families
3. These will be accomplished through use of the __________, Ways, ___________.

➢ Means, [Ways], Ends

4. Why is Readiness and Health the Decisive Operation?
➢ AMEDD primary mission is supporting Warfighter’s readiness
5. List the three components of the Performance Triad.
➢ Sleep, Activity, Nutrition
6. List three of five components of the OC Model.
➢ Process Culture; Organizational Structure; Culture; Performance Metrics/Accountability;
Governance and Decision-Making
7. What is the focus of the System for Health?
➢ Prevention of injury, disease and disability
❖ Introduction
➢ Purpose: The Army Medicine 2017 Campaign Plan (AMCP 17) operationalizes the vision of the
Commanding General, United States Army MEDCOM for 2017. It also establishes the framework
through which the Army Medical Department (AMEDD) will achieve its 2025 end state
➢ Mission: Army Medicine provide sustained health services and research in support of the Total
Force to enable readiness and conserve the fighting strength while care for our Soldiers for Life
and Families
▪ To Conserve the Fighting Strength
➢ Vision: Army Medicine is the Nation’s premier expeditionary and globally integrated medical
force ready to meet the ever-changing challenges of today and tomorrow.
➢ Campaign Plan Endstate: Army Medicine of 2025 and beyond, as an integrated system for
health, is the Nation’s first choice for prompt and sustained expeditionary health services.
➢ Lines of Effort:
▪ Readiness and Health (Decisive Operation)
▪ Healthcare Delivery (Shaping Operation)
▪ Force Development (Shaping Operation)
▪ Take Care of Ourselves, our Soldiers for Life, DA Civilians, and Families (Sustaining
Operation)
❖ Strategic Environment and Risk
➢ Refer to slides
❖ Previous Key Concepts
➢ Emulates, nests, and aligns with Army Strategic Planning Guidance (ASPG) Vision and Army
Campaign Plan (ACP) end state: Prevent, Shape, Win – Framing What the Army Provides to the
Nation
➢ Provides consistency and aligns with previous published Army Medicine strategy documents and
discussion(s).
❖ Operational Approach

❖ Readiness and Health (Decisive Operation)

➢ CSA Priority is Readiness
➢ AMEDD primary mission is supporting Warfighter’s readiness
➢ We must remain agile, adaptive, flexible and responsive to Warfighter’s requirements
➢ We must remain ready, relevant, and Reliable
❖ Healthcare Delivery (Shaping Operation)
➢ AMEDD’s fundamental task is promoting, improving, conserving, or restoring the behavioral and
physical well-being of those entrusted to our care
➢ Meet this demand in operational and garrison environment
➢ Ensure healthcare support of Combatant Commanders’ operational requirements
➢ Healthcare delivery to families allows Warfighter to remain focused on mission
➢ Ensure our MTFs as Health Readiness Platforms are properly staffed
❖ Force Development (Shaping Operation)
➢ The future of Army Medicine is being determined today
➢ Develop scalable and rapidly deployable medical capabilities to support operational needs in a
Joint/Combined environment with minimal, if any established healthcare infrastructure
➢ Incorporate lessons learned
➢ Develop Agile and Adaptive Leaders who can achieve success in an environment in a constant
state of flux
❖ Take Care of Ourselves, our Soldiers for Life, DA Civilians & Families (Sustaining Operations)
➢ The patients we care for are the strength of our force
➢ We must provide care to Families, Retirees, Civilians and Ourselves with dignity and respect
➢ This care allows our operational forces to complete the mission without distraction, knowing we
will care for those they left at home
❖ Ends, Ways, & Means
➢ Ends
▪ Quality, Outcomes-Based Care for All We Serve
▪ Responsive Medical Capabilities
▪ Medical Readiness of the Total Army
▪ Health & Satisfied Families & Beneficiaries
➢ Ways
▪ IP1 - Optimize Soldier Protection in all Environments
▪ IP2 - Improve Joint & Global Health Partnerships & Engagements
▪ IP6 - Improve Care, Quality and Safety in a High Reliability Organization (HRO)
▪ IP7 – Manage the Direct Care System
▪ IP8 – Improve Primary & Specialty Care
➢ Means
▪ F1 – Optimize Financial Resources & Improve Fiscal Accountability in Support of Strategic
Priorities
▪ OC1 – Improve & Empower Highly effective Work Teams
❖ System for Health
➢ System for Health (SFH) means shifting the focus to prevention of disease, injury, and disability
➢ Culture shift to Soldiers and beneficiaries by encouraging them to develop a mindset that drives
them to optimize their own health
➢ Supports:
▪ National Prevention Strategy
▪ DOD Total Force Fitness Strategy
▪ Army Human Dimension Concept
▪ Army Ready & Resilient Campaign
➢ Integrates
▪ MTF
▪ Army Wellness Centers
▪ Community Health Promotion Council
▪ Operational Healthcare Capabilities
❖ Performance Triad

➢ Ensure the endurance of Army Medicine by creating economic and political stability;
organizational resiliency, and health and healthcare relevancy and essentiality for the Army and
the Nation.
➢ End state: Improve individual and organizational stamina to increase organizational depth,
resiliency and endurance
➢ Sleep, Activity, Nutrition
❖ Operating Company Model (OCM)
➢ Model Components:
▪ Process Structure
▪ Organizational Structure
▪ Governance and Decision-Making
▪ Performance Metrics and Accountability
▪ Culture
➢ Organizational methodology that will enable Army Medicine to move toward a SFH
➢ The OC framework is designed around integrated, standardized processes across the
organization; performance metrics and decision-making
➢ High focus and priority is given to process quality, repeatability, and standards
AO221.1 MEDCOM
Discuss:
1. T/F. The Military Health System (MHS) is a joint medical command that oversees service specific
medical departments
2. U.S Army Medical Command is a direct reporting unit to? [Department of the Army]
3. T/F. Enhanced Multi-Service Markets (eMSM) direct operations within their markets?
4. T/F. MEDCOM is comprised of 5 Regional Medical Commands? [4]
5. A _____________ is a medical mission command unit that provides oversight for at least one ACH or
clinic. [MEDDAC]
❖ Military Health System (MHS)

➢ MHS is led by office of the Assistant Secretary of Defense for Health Affairs (ASD[HA]) under the
Office of the Undersecretary of Defense for Personnel and Readiness (USD [PSR]).
➢ The MHS is a global, comprehensive, integrated system
➢ The fundamental mission of the MHS is to provide medical support to military operations
➢ The operational aspects of the MHS are divided among the:
▪ Department of the Army
▪ Department of the Navy
▪ Department of the Air Force
▪ Defense Health Agency (DHA)
➢ MHS Scope
▪ One of the largest health care providers in the US
▪ Combines resources from both direct and purchased care
▪ Purchased care component includes civilian network hospitals and providers operated
through TRICARE regional contracts
▪ $48.8 billion annual budget
▪ 9.4 million beneficiaries
▪ 60,389 civilians employees
▪ 86,051 military personnel
▪ Direct care facilities include:
● 56 hospitals, 361 ambulatory care clinics, and 249 dental clinics
❖ Defense Health Agency (DHA)
➢ DHA & Military Services
▪ The DHA reports the Assistant Secretary of Defense for Health Affairs (ASD[HA]) and
provides support to the three Military Services, no direct line of authority exists between DHA
and service medical commands
▪ DHA is a joint, integrated Combat Support Agency
▪ Enables the Army, Navy, and Air Force medical services

▪ Supports the delivery of integrated, affordable, and high quality health services to MHS
beneficiaries
▪ Responsible for driving greater integration of clinical and business processes across MHS
▪ Manages 10 shared services, including TRICARE Health, Medical Education & Training, and
Medical Research & Development
▪ Discontinued Tricare Management Activity (TMA)
➢ Nation Capital Region Medical Directorate
▪ National Capital Region (NCR) Medical Directorate reports DHA
● Also known as, Joint Task Force National Capital Region Medical (JTFCAPMED)
▪ Joint Directorate
▪ Responsibilities, include:
● Management of the NCR Enhanced Multi-Service Markets (eMSM)
● Walter Reed National Military Medical Center (WRNMMC) (Joint)
● Fort Belvoir Community Hospitals (Joint)
● Joint Pathology Center (JPC) (Joint)
❖ Enhanced Multi-Service Markets (eMSM)
➢ Component of MHS governance reforms
➢ Six enhanced Multi-Service Markets (eMSM):
▪ Tidewater
▪ Hawaii
▪ Puget Sound
▪ San Antonio (integrated)
▪ Colorado Springs
▪ National Capital Region (Joint)
➢ Six market managers provided additional authorities to assist in managing the entire market
regardless of Service affiliation, to include:
▪ Manage the allocation of the budget for the market
▪ Direct the adoption of common clinical and business functions
▪ Optimize readiness to deploy medically ready forces and ready medical forces
▪ Direct the movement of workload and workforce among market MTFs
▪ Major General or Rear Admiral joint command position, reports to ASD(HA)
▪ Six eMSMs: Represent 35% of the Direct Care Costs ($2.5B/$8.1B)
➢ eMSM are markets with:
▪ 1. Treatment facilities from more than one Service
▪ 2. Large eligible populations (greater than 65K)
▪ 3. High patient workloads
❖ U.S. Army Medical Command (MEDCOM)
➢ Direct reporting unit of the U.S. Army that provides command and control of the Army's fixed-
facility medical, dental, and veterinary treatment facilities, providing preventive care, medical
research and development and training institutions
➢ Divided into 4 Regional Health Commands (RHCs) that oversee day-to-day operations:
▪ Regional Health Command – Europe (RHC-E)
▪ Regional Health Command – Atlantic (RHC-A)
▪ Regional Health Command – Central (RHC-C)
▪ Regional Health Command – Pacific (RHC-P)
❖ Health Readiness Platforms (HRPs)
➢ Army Medical Centers (MEDCEN)
▪ Offer tertiary care (sophisticated diagnosis/treatment of any ailment) as well as primary and
secondary care
▪ A MEDCEN has a hospital plus other services (blood bank, etc.).
▪ MEDCEN hospitals are larger than ACHs, have more sophisticated equipment and more
specialized staffs, and wider arrays of specialty care
▪ All MEDCENs offer graduate medical education (GME)
▪ 8 Worldwide
➢ Hospitals & Clinics
▪ Army Community Hospital (ACHs) - offer complex, resource-intensive secondary care
(e.g., inpatient care, surgery under general anesthesia) at major posts, 14* ACHs Worldwide

▪Army Clinics - outpatient facilities offering primary care or simple specialty care, i.e., routine
exams, tests and treatments
● Also know as a Troop Medical Clinic (TMC), Clinic Activities, or Army Medical Homes
(AMHs)
➢ Medical Department Activity (MEDDAC)
▪ Medical mission command headquarters at a given post.
● A typical MEDDAC includes one ACH or clinic plus non-hospital elements (preventive
medicine, blood bank, etc.)
▪ Not all ACHs belong to MEDDACs
▪ MEDDAC is smaller than a MEDCEN and offers a limited range of services
▪ Major Service differences:
● MEDDAC does not have IG, JA, or Chaplain services
● Limited pediatric and OB/GYN capabilities
● Limited Lab Services
▪ MEDDAC has Occupation Therapy (OT), Physical Therapy (PT), Orthopedics
● MEDCEN has Physical Medicine and Rehabilitation (PMR)
AO221.4 MHS FUNDING

Discuss:
1.___________ is the utilization of resources appropriated by Congress to execute the
Department/Agency’s approved mission.
● Releases
2. A majority of MEDCOM funding for the operation of HRPs is allotted by ____________________.
● Assistant Secretary of Defense for Health Affairs
3. Defense Health Program (DHP) appropriation funds what three major activities?
● O&M (day to day operation); RDT&E; Procurement
4.T/F. RVU generation has no effect on an HRPs budget allocation.
❖ Why should we care?

➢ Army Medicine’s Strategic Environment
➢ Competition with the “network”
➢ Congress is asking:
▪ Can the MHS provide the best care?
▪ Can the MHS provide the most cost effective care?
➢ Army Medicine is being scrutinized and constrained:
▪ How we provide services
▪ How much we spend to provide services
❖ Specific MHS Funding Sources
➢ Medical Military Personnel (MilPers): funded by the Services’ MilPers appropriations
➢ DHP Appropriation: Operation & Maintenance (O&M), Procurement and Research,
Development, Test & Evaluation (RDT&E) funds
➢ Medical Military Construction (MilCon): included in Services, MilCon, Defense-Wide
appropriation
➢ Medicare Eligible Retiree Health Care Fund (MERHCF): accrual-type fund that pays the
Department’s health care costs for Medicare eligible retirees, retiree family members and
survivors
➢ Emergency Supplemental Appropriations: required for non-budgeted items such as the
Overseas Contingency Operations (OCO), Pandemic Influenza, Traumatic Brain
Injury/Psychological Health, and Wounded, Ill and Injured initiatives.
➢ Foreign Currency Fluctuation: funds provided by OUSD (Comptroller) to mitigate differences
between budgeted and actual foreign currency expenditures
➢ Special Program funding resources initiatives, i.e. VA-DoD Joint Incentive Fund
❖ Defense Health Program Appropriation
➢ Operation and Maintenance (O&M), day to day operations
▪ Medical, Dental and Veterinary Services (In-House Care and Private Sector Care)
▪ Medical Readiness not funded by Service “Line” appropriations
▪ Medical Education & Training

▪ Management Activities (Medical Headquarters)

▪ Occupational and Industrial Health Care
▪ Medical, Dental and Veterinary Facilities and Medical Installations
▪ Information Management/Information Technology (IM/IT)
➢ Research, Development, Test & Evaluation (RDT&E)
▪ Funds some medical research, Central IM/IT Projects, Navy Medical laboratories, and some
Air Force initiatives (disease surveillance and pilot vision enhancements)
➢ Procurement
▪ Funds initial outfitting and replenishment of medical equipment and information
processing system purchases ≥ $250,000
❖ How much?
➢ MEDCOM ~$11B
❖ Prospective Payment System (PPS)
➢ Creates a financial mechanism for the direct care system that will emphasize value measures for
outcomes and customer satisfaction in a balanced fashion with outputs
▪ Bases HRP budgets on outputs, not inputs
▪ Provides incentives for productivity
▪ Tied to Integrated Resource and Incentive System (IRIS)
▪ Drives core budget estimate
➢ Value HRP business plans/workload
▪ Fee for Service (FFS) rate for workload produced (Relative Value Units)
➢ Rates based on market price at which care can be purchased
➢ Computed at HRP level but allocated to Services/Branch
▪ Rolled up to Services
▪ Adjust Service allocation based on changes in workload
▪ Allows Services to manage resource allocation (i.e. IRIS)
➢ Considers total cost (O&M plus MilPers) of HRP workload unit produced
➢ IRIS moves primary care away from core funding to a capitation model
❖ HRP Budget Activity Groups (BAGs)
➢ BAG 1: In-House Care
▪ Medical Care in HRP
➢ BAG 2: Private Sector Care
▪ TRICARE Health Care Contracts
➢ BAG 3: Consolidated Health Support
▪ Military Unique Medical Activities (Blood Program)
➢ BAG 4: Information Management
▪ Service Specific Medical IM/IT programs
➢ BAG 5: Management Activities
▪ Regional Medical Commands or Major Subordinate Commands
➢ BAG 6: Education & Training
▪ Health Professions Scholarship Programs
➢ BAG 7: BASOPS & Communication
▪ Sustainment, Restoration, & Modernization
❖ HRP Budget Management
➢ Director of Resource Management → DCA → Hospital Commander
❖ Challenge with Financial Resources
➢ There never seems to be enough
➢ Many restrictions and directives associated with public funds
➢ Cannot exceed ceilings, limitations, targets, etc.
➢ Cannot shift funds between programs
➢ Cannot use an appropriation for other than its stated purpose
➢ Must have explicit authority -- versus prohibition
HA250.2 TECHNOLOGY ACQUISITION PROGRAMS (TAP)

Discuss:
1. What is the dollar threshold for a MEDCASE request _____________? > $250K
2. What is the dollar threshold for a SuperCEEP request _____________? $100K to $249,999

3. What is the dollar threshold for a CEEP request _____________? <$100K

4. T/F. MEDCOM manages CEEP funds?
5. What does TARA provide to the HRP Commander?
ID resource needs; management tool that provides unbiased review of clinical requirements and
operations for medical treatment facilities
6. T/F. The cost of transporting of a piece of medical equipment central funded through the MEDCASE
program will be charged to the HRP?
❖ Technology Acquisition Programs

➢ Technology Acquisition Programs (TAP), include:
▪ Medical Care Support Equipment (MEDCASE) Program
▪ Super Capital Expense Equipment Program (SuperCEEP)
▪ Capital Expense Equipment Program (CEEP)
➢ TAP designed to fund routine modernization/replacement equipment
➢ MEDCASE/SuperCEEP are for fixed equipment of a movable nature
➢ TAP funded by the Defense Health Program Appropriations (MHS)
➢ Not Army funded (e.g., Operations and Maintenance, Army)
❖ MEDCASE Overview
➢ Centrally managed, DA-level program (MEDCOM)
▪ Manages the approval and acquisition of investment equipment requirements that are funded
by medical Military Construction (MILCON) funds for major medical construction projects
➢ Utilizes DHP Procurement funds (OPD) for the acquisition of capital investment equipment
➢ Funds are 3 year appropriation
➢ Funds equipment $250K+ unit price or $250K+ system price
➢ MEDCOM is the program manager and proponent of policy
➢ MEDCOM develops and defends the program budget (STCPC)
➢ Executes the program through USAMMA
❖ MEDCASE Responsibilities
➢ Strategic Technology Clinical Policies Council (STCPC)
▪ established under MEDCOM Memorandum 15-25, 7 November 2003
▪ Comprised of senior MEDCOM/OTSG leadership
▪ STCPC oversees the MEDCASE program
▪ Recommends approval/disapproval of program funding for the fiscal year
▪ Designate potential candidates for central procurement, i.e., Digital Dental and Digital
Imaging Network-Picture Archiving System (DIN-PACS)
➢ US Army Medical Materiel Agency (USAMMA)
▪ US Army Medical Materiel Agency (USAMMA) administers and executes the program for the
MEDCOM
▪ USAMMA determines the adequacy of the submission and eligibility
▪ USAMMA is the proponent for the MEDCASE requirements and execution (MRE) system
▪ MRE is the MEDCASE data entry and recovery system
▪ USAMMA controls and accounts for the funds
▪ Receives and processes requisitions to the appropriate sources and vendors
➢ Regional Health Commands (RHC) & HRPs
▪ RHCs manage the development and execution of MEDCASE within their command
● Review and approve or disapprove requirements before forwarding to USAMMA
● Monitor and ensure program execution in accordance with MEDCOM guidance and
command goals
▪ HRP MEDCASE program participants develop equipment requirements consistent with
mission needs
● Activity commander reviews and approves or disapproves requirements; ensuring the
information provided is complete and accurate.
▪ MEDCASE is a Logistics, not a Resource Management, program
❖ MEDCASE Eligibility
➢ Must be classified as capital investment type equipment with a unit/system price $250K+
➢ Required to accomplish or support a health care mission at a fixed (TDA) activity
➢ Not centrally managed or funded through another DA-level program
➢ Not required to accomplish a Base Operation function

➢ Not required to provide back-up to existing equipment

❖ MEDCASE Approval Process
1. HRP submits locally approved MEDCASE to RHC
2. RHC Commander reviews and either approves or disapproves and forwards to USAMMA or
returns to activity
3. USAMMA reviews for administrative errors and eligibility. USAMMA forwards to applicable
Surgeon General (TSG) consultant for review and approval/disapproval
4. MEDCOM retains the prerogative to review and override approvals on an exception basis
5. Approval is based upon propriety of need, and not related to the present or the anticipated
availability of funding
6. STCPC convenes in October to review and prioritize for funding all MEDCASE submissions.
7. STCPC Chairperson presents to TIGOSC, the CoS and finally TSG
8. Upon approval by TSG, and funds are received, funds are distributed per TSG guidance
❖ MEDCASE Justification
➢ MEDCASE packets should state the minimum essential characteristics of the item and provide a
clinical or functional reason for purchase.
➢ Must be supported by facts, not general statements
➢ Must relate the capabilities requested to the requirements of the activity – not what the equipment
does, what it can do for your HRP
➢ Technology Assessment and Requirements Analysis (TARA) teams assist HRP commanders in
identifying resource needs
▪ TARA is a management tool that provides unbiased review of clinical requirements and
operations for medical treatment facilities.
▪ Focus is assistance NOT inspection
▪ Regionally based team, MEDCOM directed
▪ Addresses standards of care
➢ Justification must include responses to 7 questions:
● 1. What is the item requested to be used for? Why is it needed?
● 2. How will the item be used with other equipment?
● 3. What are the advantages of the requested item over equipment currently in use or
available on the market? Why are these advantages needed?
● 4. Have specific details been presented regarding cost-benefit, personnel savings, or
productivity, the enhancement or curtailment of services, frequency or duration of
breakdown, or other specific factors that may be relevant?
● 5. What will be the impact upon mission accomplishment if the requested item is not
acquired?
● 6. Is the anticipated workload provided?
● 7. Has consideration been given to the use of available excess assets to satisfy this
requirement?
❖ SuperCEEP
➢ Super Capital Expense Equipment Program (SuperCEEP) is an equipment acquisition program
for expense equipment items that are between $100K - $249,999.
➢ MEDCOM centrally manages these funds
➢ SuperCEEP mirrors the MEDCASE program
➢ Follows the same approvals and vetting procedures as MEDCASE
➢ Requirements are entered into MRE
➢ TARA teams will validate applicable requirements during site visits
➢ STCPC prioritizes and determines items to be centrally funded
➢ Urgent or unfunded requirements may be locally funded
➢ Locally funded reqs. are not eligible for central site-prep funding
❖ Capital Expense Equipment Program (CEEP)
➢ Non-expendable and durable equipment items that are < $100K each
➢ CEEP allows HRPs to purchase capital expense equipment for fixed facilities utilizing Operating
and Maintenance Defense (OMD) funds
➢ MEDCOM has developed guidance for the local CEEP programs
➢ MEDCOM established a ‘soft-fence’ target for each HRP
➢ Soft-fence is a TARGET for equipment purchases
➢ HRP develops an end-to-end prioritized CEEP list

➢ Prioritize through PBAC or other local committee

➢ HRPs must meet or exceed the ‘soft- fence’, but not under execute
❖ Site Preparation
➢ Prior to delivery and installation of the equipment, certain utility and/or facility modifications, may
be required
➢ Site prep must be planned and documented when the requirement is established in order to
receive central funding
➢ Site preparation provides only that work which is specifically required to make the equipment
operational
▪ Including: electrical, plumbing and mechanical interconnection between the components of
the system and the mounting of components to the existing structures
▪ Does not include: transportation, assembly, installation, calibration, and testing of equipment;
aesthetic or functional work; devices for connecting equipment
HA250.3 HEALTHCARE QUALITY & COST CONTROL

Discuss:
1) How do you measure quality? Structure, Process, Outcomes
❖ Quality
➢ No single, universal definition for good quality of care, any more than there is one for young or
distant
➢ Depends on who is defining:
▪ Clinicians
▪ Patients
▪ Payers
▪ Managers
▪ Society
➢ Technical Performance: how well apply medical knowledge and technology as expressed in:
▪ Timeliness and accuracy of diagnosis.
▪ Appropriateness of therapy.
▪ Skill performing medical interventions.
▪ Absence of accidental injuries.
➢ Patient Centeredness: empathy, responsiveness to patient’s needs, values, and expressed
preferences.
➢ Amenities: Characteristics of the setting.
➢ Access: Effort required to obtain needed services.
➢ Equity: Quality or Costs of care not affected by race, ethnicity, insurance, etc.
➢ Efficiency: How well resources are used to achieve a given result.
➢ Cost Effectiveness: How much benefit the intervention yields for a particular level of expenditure
➢ Measuring Quality
▪ Structure
● Capacity to provide high-quality services, reflected in costs, type, and qualifications of
individuals and facilities, i.e. board certification
● Good structure cannot guarantee high quality: necessary not sufficient
▪ Process
● What is done in the provision of care—appropriateness, skillfulness, and timeliness of
care, i.e. clinical practice guidelines
● Appropriate: doing the right things for the patient
▪ Outcomes
● Effects of care in relation to goals of care, such as patient health status, satisfaction, and
costs of care
● Causality between outcome and preceding process is crucial (efficacy)
▪ Criteria are evaluative characteristics, i.e. blood pressure
▪ Standards give criteria quantitative expression:
● >75% of treated hypertensive patients have diastolic pressure below 85mm
❖ Cost

➢ Relationship between Quality and Costs - not linear, S-shaped

▪ Quality costs money, but more $ does not necessarily buy more quality
▪ Some improvements in quality are not worth added cost
➢ Maximized Quality—keep expending resources until no additional benefits can accrue from it
➢ Optimized Quality—stop expending resources when marginal costs exceed marginal benefit
➢ Unnecessary care is always poor care—generates no health benefits to offset risks and costs
➢ Opportunity costs
➢ End of life care
❖ Lean Six Sigma
➢ Lean
▪ “Lean” is a systematic method for the elimination of waste within a process
● Waste created by non-value-adding work
● Waste created through overburden
● Waste created through unevenness in work loads
▪ Derived mostly from the Toyota Production System (TPS)
▪ Some or all components widely adopt by many US healthcare organizations
▪ Key concepts
● Waste, Value, and Flow
● Standardized Work
● Visual management
● 5 S’s
● Root Cause Analysis (A3)
● •“5 Whys”
➢ Six Sigma
▪ Six Sigma is a set of techniques and tools for process improvement
▪ Developed by Motorola in 1986
▪ Seeks to improve the quality output of process by identifying and removing the causes of
defects (errors) and minimizing variability in a processes
▪ Each Six Sigma project follows a defined sequence of steps and has quantified value targets,
for example: reduce process cycle time, reduce costs, or increase customer satisfaction
➢ Lean Six Sigma (LSS)
▪ Combines Lean and Six Sigma strategies
▪ Reduce Cost - reduce cost
▪ Improve Quality - reduce variations
▪ LSS Benefits:
● Prescriptive framework
● Trained experts leading trained project teams
● Execution pervades the organization
● Data-driven project selection and improvement
▪ Army LSS Guidance: to accelerate “Business Transformation” by creating a culture of
continuous, measurable improvement that eliminates non-value-added activities and
improves quality and responsiveness for Soldiers, civilians, Army families, and the Nation
▪ Army LSS Training - Yellow, Green, Black Belt
❖ Balanced Score Card (BSC)
➢ Strategic planning and management system
➢ Aligns strategy and execution
➢ Decision-making and communication tool*
➢ Provides disciplined framework for planning and measuring strategy
➢ Uses performance measures to monitor strategy execution
➢ Balance between:
▪ Financial and non-financial indicators
▪ External and internal constituents
➢ Lead and lag indicators of performance
➢ Army Medicine uses BSCs as its primary decision-making and communication tool.
➢ BSC Components
▪ Strategy Map: Quick look at strategic priorities in form of objectives
▪ Scorecard: developed from strategy map; translates objectives into set of performance
measures and targets

● provides framework for strategic measurement and management system

▪ Developed for each objective:
● Measures are how success or failure is monitored (criteria)
● Targets are the stated levels of performance desired (standard)
● Initiative is the action implemented to achieve the target
HA251.1 MED INFO SYSTEMS

❖ Discuss:
1.________________ is the principal advisor to the Assistant Secretary of Defense (Health Affairs) on
IM/IT affairs. OCIO
2._________________ integrates AMEDD information management operations US ARMY Medical
Information Technology Center (USAMITC)
3._________________ is the backbone of the MHS garrison IM/IT system
A.CHCS
B.ALTHA
C.Essentris
D.TMDS
4.Medical Information in Theater Medical Data Server (TMDS) is transferred to the _____________ for
inclusion a service member’s longitudinal medical record. Clinical Data Repository
5._____________ is an information technology system that provides IM/IT to hardware to deployable
units. MC4
❖ MHS Medical Information System Governance and Architecture

➢ MHS’s Office of the Chief Information Officer (OCIO) is the principal advisor to the Assistant
Secretary of Defense (Health Affairs) on information management and information technology
affairs.
➢ OCIO oversees:
➢ Defense Health Clinical Systems (DHCS),

▪Formerly Defense Health Information Management System (DHIMS)

▪Garrison, Theater, DoD/VA, and Wounded Warrior Systems
▪Provides MHS information management/information technology (IM/IT)
▪Manages the acquisition, development, deployment and maintenance of the systems that
comprise the military’s electronic health record (EHR).
▪ Supports the Theater Medical Information Program (TMIP).
▪ TMIP supports:
● Clinical care documentation
● Patient movement visibility
● Health surveillance
● Medical supply and equipment tracking
▪ TMIP data is consolidated into a database known as the Theater Medical Data Store (TMDS).
▪ Data is later transmitted to the military’s central database, the Clinical Data Repository, where
all service members’ longitudinal health records reside
➢ Defense Health Services Systems (DHSS)
▪ Builds or maintains more than 30 MHS IM/IT products, used in three areas:
▪ Clinical support
● CCQAS - Centralized Credentials Quality Assurance System
● Clinical Data Mart (CDM)
● TOL - Tricare Online
▪ Medical logistics
● DMLSS - Defense Medical Logistics Standard Support
● DCAM - DMLSS Customer Assistance Module
● PMITS - Patient Movement Item Tracking System
▪ Resources
● DMHRSi - Defense Medical Human Resource System Internet
● PEPR - Patient Encounter Processing and Reporting
● TPOCS - Third Party Collection System
➢ MHS Cyberinfrastructure Services (MCiS)
▪ Engineering, Design, Implementation, and Sustainment
➢ AMEDD Information Management
▪ Information Management operations are dispersed across three organizations:
● MEDCOM Headquarters
♦ Develops information management strategic plans
♦ Develops IM programs
♦ Identifies resource requirements
● AMEDD Center & School (AMEDDC&S)
♦ Develops information operations doctrine for AMEDD
♦ Gathers information requirements
♦ Provides information management training
● Medical Research and Materiel Command (USAMRMC)
♦ Acquires information systems – deploy and maintain the systems
▪ U.S. Army Medical Information Technology Center (USAMITC)
♦ Integrates AMEDD information management operations, designs, develops, deploys
and Sustains the AMEDD’s information management/information technology (IM/IT)
systems
♦ Executes the MHS IM/IT strategy on behalf of Army Surgeon General
❖ Garrison Medical Information Systems
➢ Composite Health Care System (CHCS)
▪ provides world-wide automated medical information system support to all Health Readiness
Platforms (HRPs) within the MHS
▪ One of the largest medical systems in the world
▪ Acts as the “backbone” for MHS IM/IT system
▪ System with which providers order labs, medications, imaging, and blood
▪ CHCS interfaces with 60 other clinical and administrative systems, including:
● VA Consolidated Mail Outpatient Pharmacy (VA CMOP)
● TRICARE Online (TOL)
● Pharmacy Data Transaction Service (PDTS)

● Defense Medical Logistics Standard Support (DMLSS)

● Third Party Outpatient Collection System (TPOCS)
● Defense Blood Standard System (DBSS)
● Defense Enrollment Eligibility Reporting System (DEERS)
➢ Armed Forces Health Longitudinal Technology Application (ALTHA)
▪ Electronic Health Record (EHR) system used by MHS providers
▪ Build on the CHCS “backbone”
▪ Provides the basis of the medical coding
▪ Provides 24/7 access to a beneficiary’s EHR anywhere in the MHS
▪ Primarily used for outpatient encounters
➢ Essentris
▪ AMEDD inpatient electronic health record system
▪ Allows for standardized usage across all Army RSPs
▪ Counterpart to AHLTA
❖ Deployable Medical Information Systems
➢ AHLTA-Mobile
▪ Previously Termed: BMIST-J (Battlefield Medical Information System Tactical – Joint)
▪ Enables medical professionals to record, store and transfer medical records to the Clinical
Data Repository (CDR) by synchronizing then imports into AHLTA-T
▪ Displays digital versions of the DD 1380 (field medical card) and SF 600 (chronological
medical record of care)
▪ Displays medical history, physical exam and disposition in structured data terms, including
ICD-10 codes associated with diagnoses
➢ AHLTA-Theater (AHLTA-T)
▪ Providers enter an Outpatient clinical encounter that is transmitted when signed through
Theater Medical Data Server (TMDS) to the JMeWS for collection of medical surveillance
▪ Providers can view clinical data via TMDS
▪ Commanders can view medical surveillance data via JMeWS
▪ Pushes Patient Demographics information to Theater Medical Information Program
Composite Health Care System Caché (TC2)
➢ Theater Medical Information Program, Composite Health Care System Cache (TC2)
▪ Primarily by Combat Support Hospitals (Role 3 facilities) to provide clinical inpatient and
ancillary service functionality
▪ Interfaces with AHLTA-T and TMIP Reports
▪ Offers expanded capability for documenting care and improved patient visibility
▪ Produce clinical notes, including a patient’s pre and postoperative information, anesthesia
progress, as well as admission, treatment plans and discharge summaries
▪ Upload monthly standard inpatient data record (SIDR) reports to patient administration
system bio-statistics activity (PASBA) to track all inpatient visits
➢ Joint Medical Workstation (JMeWS)
▪ The Joint Medical Work Station (JMeWS) is a theater medical surveillance system that
integrates information from three separate health data collection systems for the Army, Navy,
and Air Force
▪ JMeWS provides medical situational awareness, medical surveillance and force health
protection decision support
● Leads to new protective equipment and medical procedures
● Improves medical care at the point of injury and in treatment facilities
● Reallocate human and material resources based on needs and requirements
● Uses geographic data to determine sources of illnesses or injuries
▪ Feeds MSAT (Medical Situational Awareness Tool): Multi-tab interface of which the traditional
JMeWS interface is one of 6 tabs that provide medical Surveillance data
➢ Medical Communications for Combat Casualty Care (MC4)
▪ The DHCS’s software is integrated onto MC4 hardware
▪ MC4 fields and provides New Equipment Training (NET) on its systems
▪ MC4 supports their systems at home and in Theater
▪ Seven different hardware configurations approved by AMEDD C&S
▪ Approved configurations tailored to unit mission
▪ MC4 adjusts equipping levels dependent upon mission

▪ Hardware includes:
● Servers
● Laptops
● Handhelds
● Printers
● Peripherals
HA252.1 MTF MEDICAL LOGISTICS

Discuss:
1. A HRP’s Logistics Division is primarily responsible for ___________, supplies, and services.
Equipment
2. A Logistics Division has _______ branches. 4
3. The _____________ branch receives, stores, issues and inventories medical materiel. Supply chain
Management
4. The _____________ branch manages the Technology Acquisitions Program (TAP). Equipment
Management
5. The _____________ branch is responsible for enforcing TJC standards for housekeeping services.
Environmental services
6. The _____________ branch is responsible for developing the facilities operating budget.Facilities
management
7. What two branches work together to coordinate the collection, storage, and disposal of Regulated
Medical Waste (RMW). Supply chain mgmt & environmental services
8. T/F. The Logistics Division is a subordinate of Resource Management
❖ MEDLOG
➢ Objectives
▪ Provisioning of highly responsive medical materiel and support services to MEDLOG
customers.
▪ Satisfying the needs of each patient and health care provider on immediate basis.
▪ Planning for a wide range of demands based on varying missions, clinician’s preferences,
service focus, and susceptibility to rapid changes in technology
▪ Implementing intensive management controls for medical materiel, particularly for highly
sensitive items and services such as: temperature sensitive medical products (TSMP);
controlled substances; high tech, high dollar value, pilferable items; hazardous materiel;
hospital linen; and medical equipment maintenance services.
▪ Fostering an environment for attaining consistent levels of high performance in MEDLOG
areas
❖ HRP Logistics Division
➢ Mission: provide or arrange for the equipment, supplies, and services necessary to support the
health care delivery mission of a Health Readiness Platform (HRP) and the requirements of other
activities as authorized
❖ Chief, Logistics Division (generally 70K)

➢ Coordinates, monitors, and evaluates user consumption of supplies and care of equipment
➢ Coordinates with the HRP and installation staff
➢ Oversees four functional branches:
▪ Supply Chain Management Branch

▪ Environmental Services Branch

▪ Equipment Management Branch
▪ Facilities Management
➢ Chairs Environment of Care Committee
▪ Joint Commission’s Environment of Care (EC)
▪ standards require organizations to develop management plans in six functional areas*:
● 1. Safety
● 2. Security
● 3. Hazardous materials and waste
● 4. Fire safety
● 5. Medical equipment
● 6. Utilities
▪ * An organization is also required to have a written Emergency Operations Plan and a current
Statement of Conditions
➢ Serves as the Chairperson of other committees:
▪ Space Committee and Standardization Committee
❖ Supply Chain Management Branch
➢ Supply Section
▪ Management of Medical Materiel
▪ Maintenance of formal stock records
▪ Computation of requirements
▪ Dissemination of Quality Control messages
➢ Purchasing Section
▪ Coordinates local procurement with regional contracting office.
▪ Monitors prime vendor program
▪ Coordinates disposal of hazardous wastes (over sees contract for disposal site)
➢ Distribution Section
▪ Receives, stores, issues and inventories medical materiel.
▪ Delivers for internal customers
▪ Operates unit of sale distribution system for internal customers
▪ Quality Control / Quality Assurance
❖ Equipment Management Branch
➢ Equipment Maintenance Section
▪ Medical equipment repair
▪ Technical inspections
▪ Medical equipment preventive maintenance
▪ Medical equipment calibration
▪ Historical medical equipment records
▪ Medical equipment repair parts and maintenance float
▪ Safety inspections and testing
➢ Property Management Section
▪ Development and implementation of policies to ensure property control.
▪ Maintains a centralized property book using DMLSS
▪ Manages Technology Acquisitions Program (TAP)
▪ Quality Control / Quality Assurance
❖ Environmental Services Branch
➢ Housekeeping Section
▪ Enforce the Joint Commission (TJC) standards for housekeeping services
▪ Coordination of transportation services (does not include ambulance services)
➢ Linen Management Section
▪ Operate linen management program.
▪ Coordinate collection, storage, and disposal of Regulated Medical Waste (RMW
❖ Facilities Management Branch
➢ Facility Maintenance Section
▪ Coordinates with PWBC for new construction and maintenance repairs
▪ Manages the real property maintenance fund
▪ Develop facilities operating budget

▪ Maintain documentation for Joint Commission Plant, Technology, and Safety Management.
➢ Project Management Section
▪ Develop facilities operating budget
▪ Maintain documentation for the Joint Commission Plant, Technology, and Safety
Management
▪ Monitor the Presidential Energy Conservation Executive Order
AO221.3 HIGH RELIABILITY ORGANIZATIONS (HRO)

Discuss:
❖ HRO Definition
➢ A high reliable organization is a place where…
➢ “All workers look for, and report, small problems or unsafe conditions before they pose a
substantial risk to the organization and when they are easy to fix…they prize the identification of
errors…”
❖ HRO Focuses
➢ Where we acknowledge
➢ Human error is possible
➢ Accidents can occur due to risk factors (probability or consequence) and complexity.
➢ Focus of “Zero Preventable Harm”
➢ Manage unexpected events through “mindfulness”
➢ Safe reliable performance
➢ Leaders build expectations into routines and strategies
➢ Order and predictability around processes and practices
➢ Core characteristics embedded into organizational ethos
➢ Adopt “Collective Mindfulness”
❖ Preventable Harm
➢ Preventable Adverse Events = Preventable Harm
❖ System for Health (SfH) & HRO
➢ Transition from a Military Healthcare System (MHS) to a System for Health (SFH)
▪ Not a NEW initiative or our NEW #1 priority
▪ HRO is next phase along the continuum to the System for Health
➢ Phase 1: (Set the conditions/build the foundation)
➢ Phase 2: (Establish enabling framework)
➢ Phase 3: (Educate & Train)
➢ Phase 4: (Implement)
➢ Phase 5: (Sustain/Engrain)
❖ HRO Imperatives:
➢ Leadership
▪ Leadership commitment is critical in driving an organizational change to succeed
▪ Leaders focus on the journey by making it their highest priority
▪ Garner commitment that includes all organizational members
▪ Lead a cultural through their example and actions
▪ Parallels the Army’s Leadership Requirements Model
➢ Culture of Safety
▪ Trust
● Create mutual trust through shared understanding among the healthcare team
● Open communication amongst all stakeholders
▪ Improve
● Process focused on continuous improvement with a goal of achieving zero preventable
harm
● Implementation of systematic safety programs
● TeamSTEPPS
● Patient Caring and Touch System (PCTS)
▪ Report
● Reprisal free reporting
● Anyone can call timeout

➢ Robust Process Improvement

▪ A systematic approach using Lean Six Sigma and change management principles to dissect
complex safety problems and guide organizations to deploy highly effective solutions
❖ HRO Principles
➢ #1 Proactive to Preventing Errors
▪ HROs do not ignore any failure, no matter how small, because any deviation from the
expected result can snowball into tragedy. It is necessary, therefore for HROs to address any
level of technical, human or process failure immediately and completely.
● Also important to be somewhat fixated on how things could fail, even if they have not.
➢ #2 Reluctance to Simplify
▪ High Reliability Organizations are complex by definition and they accept and embrace that
complexity. HROs do not explain away problems, instead they conduct root cause analysis
and reject simple diagnoses.
➢ #3 Sensitivity to Operations
▪ HROs understand that the best picture of the current situation, especially an unexpected one,
comes from the front line. Because front line employees are closer to the work than executive
leadership, they are better positioned to recognize failure and identify opportunities for
improvement.
➢ #4 Commitment to Resilience
▪ Resilience in HROs means the ability to anticipate trouble spots and improvise when the
unexpected occurs. The organization must be able to identify errors for correction while at the
same time innovating solutions within a dynamic environment.
➢ #5 Deference to Expertise
▪ Expertise, rather than authority, takes precedence in an HRO. When conditions are high-risk
and circumstances change rapidly, on-the-ground subject matter experts are essential for
urgent situational assessment and response.
➢ These five principles form the foundation for the continuous improvement mindset of High
Reliability Organizations. Even if your business doesn’t deal in life and death affairs, there are
lessons to be learned from those that do. It might make sense to consider adding these principles
to your own approach to improvement
HR241.1 INTEGRATED DISABILITY EVALUATION SYSTEM (IDES)

Discuss:
1) T/F: MEB determines a service member’s ability to continue serving in full duty capacity in his/her
office, grade or rank
2) T/F. If a PEB determines a Soldier’s fit for duty the next step in the process is a Preliminary Rating
Board
3) T/F The chain of a command recommends a Soldier for MEB
❖ Overview
➢ Used to determine if SM coping with illness, wounds or injury is preventing them from performing
their duties or able to continue to serve
➢ Previously- SMs had to navigate 2 evaluation systems
▪ DoD
▪ Dept of VA

➢ Now: streamlined system, SMs receive one medical examination (conducted by VA-certified
medical providers) that determines both physical & psychological fitness-for-duty for DOD and
disability ratings for VA benefit claims
❖ Terminology
➢ IDES - Integrated Disability Evaluation System
➢ MEB - Medical Evaluation Board
➢ PEB - Physical Evaluation Board
➢ PEBLO - PEB Liaison Officer, admin for the Army portion. Follows the Soldier through the entire
process
➢ PEBLO Supervisor - Your best friend and Regs Guru
➢ VA MSC - Military Service Coordination, admin for the VA, Claims
➢ MRDP - Medical Retention Determination Point (Tx/MEB Providers)
➢ MAR2 - MOS Administrative Retention Review
❖ IDES Summary (Timeline)
❖ IDES Entry
➢ First: Treating Physicians may consider MAR2, (retainable but need to change MOS)
➢ Treating Physician Determines MRDP per AR 40-501:
▪ If apparent that a Soldier’s condition may permanently interfere with his/her ability to serve on
active duty
▪ Has tried all treatments for 1 condition without being able to RTD
▪ Service member treatment exceeds one year (T3/4 profile)
▪ Chain of command may request a fit for duty examination
➢ The treating physician issues an P3/4 profile recommends Medical Evaluation Board
❖ MOS Administrative Retention Review (MAR2)
➢ Treating Physician, (or the MEB) will check this option on profile (DA 3349)
➢ Installation Retention Office and BN/BDE career counselor (SME) will review the profile counsel
the Soldier (enlisted)
➢ Packet forward to HRC
▪ Review packet (profile, Soldier’s statement, CDR statement)
➢ Determination
▪ Retain in current PMOS/AOC
▪ Reclassify to another MOS/AOC
▪ Refer to MEB
❖ Medical Evaluation Board (MEB)
➢ MEB is an informal board comprised of at least two physicians at local installation (typically
senior physician of HRP (CMO), and MEB physician)

▪ Evaluate the Soldier’s medical history, condition, and extent of injury or illness. (Confirms SM
has met MRDP per AR 40-401, CH3 Retention standards)
▪ Recommends whether or not the Soldier’s medical condition will impede his/her ability to
continue serving in full duty capacity in his/her office, grade or rank, may recommend MAR2
➢ MEB process is usually complete within 90-100 days, during this time the VA will conduct their
examination and disability evaluation
❖ Medical Providers Role
➢ Treating physicians: determine SM at MRDP, initiate Perm 3 profile
➢ PCM continues to treat Soldier through MEB process
➢ MEB provider reviews case for disability standards (AR 40-501)
▪ Confirms SM has met MRDP
▪ The ability to perform military duties or not
▪ The service member has an illness or injury that requires referral
➢ MEB provider composes a Narrative Summary
➢ MEB provider and a second physician, usually CMO, review Narrative Summary to determine if
SM should be RTD or forwarded to the Physical Evaluation Board (PEB) or MAR2.
❖ Physical Evaluation Board (PEB)
➢ If the MEB finds the Soldier unfit to return to duty in his/her MOS, the Soldier is referred to the
PEB.
➢ The informal PEB evaluates the Soldier’s medical information, MOS, and other factors to
determine the Soldier’s:
▪ Fit or Unfit to continue military service
▪ Eligibility for disability compensation
▪ Disability codes and percentage rating
▪ Case disposition
▪ Whether or not the injury or illness is combat-related
➢ Soldier may request a formal PEB if they disagrees with the informal PEB fitness determination
➢ Eligibility for disability compensation
➢ Disability codes and percentage rating for UNFIT condition:
▪ 20% or less, receive disability severance pay (2 months’ base pay x yrs service)
▪ >30% Temporary compensation – requires re-evaluation of medical condition in the next 5
yrs.
▪ >30% Permanent compensation (2.5% x yrs. service x highest avg. 36 months pay)
➢ Whether or not the injury or illness meets combat-related criteria
➢ PEB appeal: Physical Disability Appeal Board (APDAB); Board for the Correction of Records
(ABCMR)
❖ Transition & Reintegration
➢ Final phase - SMs either transition to civilian life or reintegrate into military service. While
service members will receive ongoing medical care during transition and reintegration, medical
providers are normally not tasked with any IDES-related roles during this phase
CO 230.2 HRP CLINICAL OPERATIONS

❖ Discuss:
1.What type of care is provided without having to admit the patient to the hospital? Outpatient
2.Outpatient Medicine consists under which two deputies? Deputy of Commander of Medical Services,
Deputy Commander of Surgical Services
3. T/F Patient can be admitted to inpatient status from the clinic, subspecialty clinic, or the emergency
department?
4.T/F Patients who require care over a 24 hour period or longer are considered inpatients?
5.The two types of supervision are _________ and __________? Clinical and Military
❖ Outpatient Care
➢ Most hospital departments have outpatient and inpatient services
➢ Outpatient care is care that can be provided without the patient admission to hospital
➢ Care can be either routine or urgent
➢ The outpatient services available depend on the size of the facility

➢ Some specialty care (i.e. dermatology) requires referral

➢ Sometimes referred to as Ambulatory Care
❖ Outpatient Structure
➢ falls under the direct responsibility of two different deputy commanders:
▪ Deputy Commander of Medical Services
▪ Deputy Commander of Surgical Services
❖ Outpatient Staffing
➢ Department Leadership
▪ Medical Director
▪ Nursing Director
▪ NCOIC
➢ Outpatient Clinic
▪ Group Practice Manager
▪ Clinic Administrator
▪ CNOIC (head nurse)
▪ NCOIC
▪ Nursing Staff
▪ Ancillary Staff (varies)
➢ Case Management
➢ Pharmacy
❖ Accessing Care
❖ Inpatient Care
➢ Provides care for patients whose condition requires admission to a hospital for over 24 hours.
➢ Patients are generally only admitted to a hospital when their care cannot be provided in an
outpatient setting:
▪ Serious illness or injury
▪ Nursing care needed to accomplish basic daily activities
▪ Close monitoring due to unstable/unclear condition
➢ Inpatient care available depends on the size of the facility
➢ Larger facilities will have more specialties available
❖ Inpatient Structure
➢ Falls under direct responsibility of the Deputy Commander of Inpatient Services
❖ Inpatient Staffing
➢ Department Leadership
▪ Medical Director
▪ Nursing Director
▪ NCOIC
➢ Inpatient Unit
▪ CNOIC (head nurse)
▪ NCOIC
▪ Nursing Staff – mainly RNs
▪ Medical Technicians – 68W and Certified Nursing Assistants
▪ Ancillary Staff (varies)
● Case Management
● Pharmacy
● Dietary
❖ Other Hospital Services
➢ Radiology
➢ Pharmacy
➢ Lab
➢ Physical Therapy
➢ Occupational Therapy
➢ Nutrition Services
➢ Infection Control
➢ IMD Information Management Division
➢ Logistics
➢ Education and Training

❖ Clinical and Military Leadership
CO231.1 HEALTHCARE EDUCATION & REGULATION

Discuss:
1.T/F. Medical school is two years in length?
2.T/F. All Advanced Nurse Practitioners must operate under the license of a physician?
3.Name one characteristic of a dominant profession. tells others what to do (not vice versa); exclusive
control over training; self-regulating
4.Medicine self regulates by _______________________.
A. Encouraging continuing education
B. Instituting practice guidelines
C. Creating self-governing accreditation bodies
D. Incentivizing board certification
E. All of the above
5._______________ is the process of establishing the qualifications of licensed professionals,
organizational members or organizations, and assessing their background and legitimacy.
[credentialing]
❖ Education
➢ Physicians
▪ Medical School - 4 years
▪ Internship - 1 year
▪ Residency - 3 to 8 years
▪ Fellowship - 1 to 3 years
➢ Physician Assistants
▪ PA School - 29 months
● Military applicants complete 2-3 yrs of “pre-med” courses prior to PA school
● divided into two roughly equal components:
♦ 16 months of pre-clinical didactic courses in Ft Sam Houston, TX
♦ 13 months of clinical rotations. This model closely follows the M.D. education
system. Civilian programs can grant a Bachelors, or Masters (most programs).
▪ Can enter Military via:
● Interservice Physician Assistant Program (IPAP) +/- 95% of Army PAs
● Prior Service Enlisted, NCOs (majority), and Officers (Avg. +/- 8 years TIS)
● As a practicing Physician Assistant via Direct Accession (< 5%)
▪ Optional Residency - 18 months
➢ Nurses
▪ Certified Nurses’ Assistant (CNA)
● 6-9 months of training on basic nursing technical skills (i.e. vital signs, data collection)
● Likely will be seen on inpatient nursing units and specialty clinics
▪ Licensed Vocational Nurses/Licensed Practical Nurses (LVN/LPN)
● 1 ½ years training on basic nursing skills with an emphasis on skill performance
● Skills they are allowed to perform are controlled by state practice acts
● Licensed through National Council Licensure Exam (NCLEX)
▪ Registered Nurses (RN)
● Diploma – No remaining diploma programs. Some RNs started with these programs

● Associate Degree – Focused on the technical nursing skills required to be an RN

● Bachelor’s Degree – Expands education to include theory, management, and research
● Master’s Degree – Focuses more on theory, management, and research with an
emphasis on education or administration
● PHD/DNP – Expands on Master’s program with an emphasis on research in the field of
nursing
▪ All Active Duty Army Nurse Corps Officer have at least a Bachelor of Science in Nursing
▪ Depending on specialty and the state in which their licensed, some APNs can operate
independent of a physician license
➢ Veterinarians
▪ Vet school - 4 years
▪ Internship - 1 year (optional)
▪ Residency - 3 years
▪ Fellowship - 1 to 3 years
➢ Dentists
▪ Undergrad degree - 4 years take the DAT for admission into dental school
▪ DDS or DMD - 3 to 6 years
▪ Specialty training - 1 to 6 years
● Fellowship
❖ Regulation
➢ Dominance & Self Regulation
▪ Professional dominance entails:
● Exclusive control over training and content of work
● Tell others what to do, but not vice versa
● Hence evaluation of work can only be done by peers → self-regulation
▪ Self-regulation is a “professional” system of control, and therefore collegial
▪ Distinguished from “bureaucratic” systems of control, which are hierarchical
▪ Self-regulating professions, include: Medicine, Law Enforcement, Military, Clergy, and
Academia
➢ Continuing Education
▪ Professional systems of control rely heavily on educational programs; recertification and
relicensing require, i.e. Continuing Medical Education (CME) and Continuing Education Unit
(CEU) credits
▪ CME refers to a specific form of continuing education (CE) that helps those in the medical
field (physicians) maintain competencies
▪ CEUs are used in the field of nursing to manage CE requirements
▪ As a strategy to address specific deficiencies in care, CME, by itself, has been found
ineffective in achieving lasting changes in clinical behaviors
➢ Practice Guidelines
▪ Practice guidelines are important to the medical profession
▪ Can be used to either preserve or undermine the autonomy and control
▪ Hence medical profession favors practice guidelines that are:
● Developed by respected members of the profession
● Disseminated in an educational, non-coercive context
▪ Medical profession’s preferences clash with:
● Increasing sophistication of, and demand for, evidence-based medicine
● Use of profession’s own guidelines to deny payment for “inappropriate” care
➢ Accreditation & Certification
▪ Professional self-regulation is most directly expressed in accreditation and certification,
where quality is evaluated by bodies created by the profession using profession-generated
criteria and standards
▪ Among organizations that accredit and certify health care providers, the most prominent are:
● The Joint Commission (TJC)
● National Committee for Quality Assurance (NCQA)
● Medical Specialty Boards
➢ Credentialing & Privileging
▪ Credentialing is the process of establishing the qualifications of licensed professionals,
organizational members or organizations, and assessing their background and legitimacy

▪ Once a practitioner is credentialed, the hospital will take further steps to assess the
practitioner’s competence in a specific area of patient care, through a process known as
privileging
● Hospital specific
● Specialty, practice, and procedure specific
● Conducted by the Credentialing Committee
● Meets monthly
● Individual provider’s credentials and privileges are renewed every 1-2 years
CO231.2 CLINICAL QUALITY MANAGEMENT

Discuss:
1. T/F. Evidence Based Medicine is based on experience and provider intuition?
2. T/F. There is a single standard for the quality of clinical research?
3. T/F. There is a single national standard for Clinical Practice Guidelines?
4. Give an example of a CPG? [asthma, chronic heart failure, mTBI]
5. Team Strategies and Tools to Enhance Performance and Patient Safety is an evidence-based
framework and results in _________________ .
a.Improved communication
b.Reduced errors
c.Improved clinical quality
d. All of the above
6. List the five elements of the Patient Caring and Touch System (PCTS).
Enhanced Communication; Patient Advocacy; Capability Building; Evidenced-based
Practices; Healthy Work Environments
❖ Background
➢ To Err is Human: Building a Safer Health System*
➢ NOV 1999 Publication by the US Institute of Medicine (IoM)
➢ Estimated that ~100,000 hospital deaths per year in the US were attributable to human error
➢ Political Fallout Led to:
▪ Increased focus on patient safety, quality of care
▪ Renewed scrutiny of how medicine was practiced
▪ Increased emphasis on outcome measurement
▪ Accelerated the adoption of information systems
❖ Recent Events
❖ Evidence Based Medicine (EBM)
➢ Begins with a clinical question (PICO question)
▪ Population of interest
▪ Intervention in question
▪ Comparison
▪ Outcome of interest
➢ Utilizes external research to answer this question
➢ Designed to maximize quality of care
➢ Ensures that we can provide current, effective treatments
➢ How is it applied?
▪ ASK – equate to identifying the mission, what are we trying to accomplish [PICO Question]
▪ ACQUIRE/APPRAISE – part of Mission analysis.
● IPB = Acquire – gather all available data
● Appraise – critically look at the data, see if it applies to the mission (facts/assumptions
etc)
▪ APPLY – once you determine that the data is applicable to the problem, chose the
best/evidence method of treatment
▪ Analyze and Adjust – self explanatory, OPS process
● Information changes over time
● Determine if what we are doing makes sense
● Avoid anecdotal evidence

❖ Clinical Practice Guidelines (CPGs)

➢ Patient management recommendations based on recent medical literature
➢ Evidence-based stepwise/algorithmic format with attempts at standardization of medical practice
➢ Over two dozen Veterans Affairs (VA)/DoD CPGs currently ratified including: asthma, chronic
heart failure, concussion/mTBI, major depressive disorder, PTSD
➢ Outcomes can be monitored by various metrics such as Healthcare Effectiveness Data and
Information Set (HEDIS)
➢ Other examples of guidance includes Joint Trauma System (JTS) CPGs derived from the DoD
Trauma Registry: http://www.usaisr.amedd.army.mil/10_jts.html
❖ Healthcare Effectiveness Data and Information Set (HEDIS) Measures
➢ Established in 1991 to collect Health Maintenance Organization (HMO) data
➢ Developed and maintained by National Committee for Quality Assurance (NCQA)
➢ Used by >90% of US commercial health plans to measure performance on dimensions of care &
service
➢ Some plans utilizing HEDIS data to meet Centers for Medicare & Medicaid Services (CMS)
requirement to receive payment for some Medicare patients
➢ Consists of over 80 measures across 5 domains of care including:
▪ Childhood Immunization Status
▪ Lead Screening in Children
▪ Breast Cancer Screening
▪ Cervical Cancer Screening
➢ Affords comparison of healthcare facilities based on these detailed parameters
➢ Adopted by MEDCOM – used as part of IRIS
➢ Additional info available at NCQA & AMEDD Office of EBP: https://www.qmo.amedd.army.mil/
❖ Advocacy Organizations
➢ Agency for Healthcare Research and Quality (AHRQ), a U.S. Department of Health and Human
Services (HHS) Division
➢ National Guideline Clearinghouse (http://www.guideline.gov/ &
http://www.qualitymeasures.ahrq.gov/)
➢ U.S. Preventive Services Task Force (USPSTF)
➢ The Joint Commission: National Patient Safety Goals:
http://www.jointcommission.org/standards_information/npsgs.aspx
➢ Department of Veterans Affairs (VA)
➢ Designated as a CPG leader by IoM: http://www.healthquality.va.gov/
➢ National Committee for Quality Assurance (NCQA): HEDIS
❖ TeamSTEPPS
➢ TeamSTEPPS is an evidence-based framework to optimize team performance across the health
care delivery system championed by AHRQ
➢ Designed to improve communication and reduce errors in the name of improving clinical quality
▪ Two-Challenge Rule
▪ Call-Out
▪ Handoff
❖ Patient Caring and Touch System (PCTS)
➢ Enhanced Communication
➢ Patient Advocacy
➢ Capability Building
➢ Evidenced-based Practices
➢ Healthy Work Environments
❖ Clinical Decision Support (CDS)
➢ Healthcare must leverage “the use of the computer to bring relevant knowledge to bear on the
health care and well” (Greenes, p.6)
➢ System-based rules and functionality in information technology platforms that enables healthcare
providers to effectively leverage “big data” inherent in medicine and the expanding tome of
medical knowledge
➢ Allows computers & inherent mistake-resistant systems to perform actions that humans are
susceptible to err in secondary to fatigue/sleep deprivation/other human limitations
▪ Examples:

● Duplicative Medications Ordered

● Dosage Limit Reached/Exceeded Based on Patient Age/Weight/Diagnosis/Ancillary
Study Results
● Patient Allergies
● Drug-Drug Interactions
● Utilization Management
CO230.1 HELOS
Discuss:
1. T/F. HELOS re-structure increased authorizations on TDA for manpower.
2. T/F. HELOS re-structure increased executive leadership opportunities for Nurse and Medical Corps.
3. T/F. HELOS re-structure provides scalable executive positions for various sized Health Readiness
Platforms (small clinic to MEDCEN).
4. Which of the following is NOT the a key objective to HELOS restructure.
a. Health Readiness
b. Alignment
c. Quality and Safety
d. Simplicity
5. For a large clinic, all DCIS, DCSS, DCMS capabilities merge, the DMCS is retitled to
_______________. DCCS
❖ Strategic Drivers
➢ MEDCOM Headquarters recently restructured
➢ The Army Campaign Plan Section IV: Ready and Resilient Soldier
➢ AMEDD Campaign Plan 2020 published for a System for Health (OCM)
➢ Defense Health Agency about to be formed in October 2013
➢ Looming Department of Defense End-strength Reductions
➢ TSG Problem Statement: What is the right structure for the U.S. Army Medical Command
(MEDCOM) to best enable health readiness and support the Future Army?
❖ Purpose
➢ Best structure to support Army Medicine transformation to System for Health (SfH), operating
company model (OCM), synchronizes with the re-alignment of RMC to RHC {and high reliability
organization (HRO)}.
➢ Enhance Health Readiness, Quality safety, patient experience, productivity, staff and leadership
development
➢ Expand Executive Leadership opportunities for all AMEDD Corps
❖ Historic Executive Leadership Structure
➢ Historic executive leadership structure:
▪ Commander
▪ CSM
▪ Deputy Commanders (3):
● Deputy Commander for Administrative (DCA) serves as senior Health Administrator
● Deputy Commander for Clinical Services (DCCS) dual hats as Chief Medical Officer
● Deputy Commander for Nursing (DCN) dual hats as Chief Nursing Officer
▪ *WTUs and Troop Command found at MEDCENs, Hospitals and Large Clinics
➢ Issues
▪ CDR has no second in command or Chief of Staff for integration & synchronization
▪ High variability within various HRPs regarding roles/responsibilities of deputies
▪ Same structure in ACHs and MEDCEN – variation of workload on the deputies
▪ Clinics executive structure does not align with hospital
❖ Historic Role and Workload Variability
➢ Surveys of HRPs reflected high variability in terms of duty titles and positions and assignment of
senior deputy varied based off CDR preference.
➢ Variability and lack of consistency from HRP to HRP can negatively impact staff development,
potentially creates confusion and leads to numerous vulnerabilities:
▪ (example) 34 departments/divisions

▪ Excessive DCCS responsibilities

▪ High variance
▪ Does not account for:
● SFH
● HRO
● Service Lines
● Futures Integration
❖ Mission and Commander’s Intent
➢ Mission
▪ No later than 30 December 2015, USAMEDCOM implements the AMEDD HELOS model
within the Provisional Regional Health Commands (RHC) to improve the health readiness of
the Future Army through new standard organizational structures that enhance executive
leadership oversight of quality, safety, the patient experience, staff development, and
productivity within U.S. Army MEDCENs, Hospitals, and Clinics.
➢ Commander’s Intent
▪ To improve the health readiness of the Future Army, USAMEDCOM’s Health Readiness
Platforms will immediately transition to the new AMEDD HELOS model to enhance executive
leadership oversight of quality, safety, the patient experience, staff development, and
productivity within U.S. Army MEDCENs, Hospitals, and Clinics.
▪ This will be done through a standardized redistribution of executive work that provides better
span of control and creates more executive leadership opportunities for all AMEDD
Branches.
▪ MEDCOM will implement an orderly and systematic transformation in a phased approach that
begins with the MEDCENs, followed by Hospitals, and ends with the reorganization at the
Clinic level. This will be accomplished with no aggregate growth in manpower
authorizations.
❖ HELOS Functional Realignment
➢ Step 1: Functional Group Alignments
➢ Step 2: Three categories of Executive Leaders:
● Command-Focused
● Staff-Focused
● Service-Focused
▪ Governance: 12 executive leaders makes up the governing body for the HRP. Additionally,
non-staff advisors from PH and Dental are included. The executive leaders form various
committees within the HRP such as credentials, labor relations, risk mgmt, patient safety etc.
▪ CMO and CNO
● CMO: serves as the Commander’s principal physician advisor for the entire organization at
the executive level. Provides clinical expertise, leadership and accountability for all
healthcare practice within the Command, and is fully involved in the strategic and operational
decisions impacting the organization as part of the governing body. Reports directly to the
Commander
● CNO: serves as the Commander’s principal nurse advisor for the entire organization at the
executive level, having full involvement in the strategic and operational decisions impacting
the organization as part of the governing body, and provides leadership and accountability for
all nursing practice within the Command. Reports directly to the Commander
➢ Step 3: MEDCEN/Large Hospital Functional Group Alignments
▪ Difference between MEDCEN and Large Hospital functional group alignments: No Significant
Change; Functional capabilities similar to MEDCEN but reduced in scope. Enough depth in
capabilities to justify full complement of Executive Leaders
➢ Step 4: Functional Alignment Step Down
▪ MEDCEN → Hospital → Clinic
❖ HELOS Structure by HRP Type
➢ Refer to Slides & Below summary
❖ Summary Executive Leadership Structures
➢ RHC HQs: CG, CSM, DCG, 11 x Assistant Chiefs of Staff
➢ MEDCEN (O6/CSL II): CDR, CSM, DCO, 7 x Deputy CDRs, CMO & CNO
➢ Large Hospital (O6/CSL II) : CDR, CSM, DCO, 7 x Deputy CDRs, CMO & CNO
➢ Small Hospital (O6/CSL I): CDR, CSM, DCO, 6 x Deputy CDRs, CMO & CNO

➢ Large Clinic (O6/CSL I): CDR, CSM, DCO, 5 x Deputy CDRs, CMO & CNO
➢ Medium Clinic (O6-O5/CSL I): CDR, SGM, 4 x Deputy CDRs
➢ Small Clinic (O6-O5/CSL I): CDR, MSG, 2 x Deputy CDRs
HR242.2 PROFIS
❖ Professional Filler System (PROFIS)
➢ PROFIS designates qualified Active Army AMEDD personnel in (TDA) units to fill operational
(TOE) units of major commands across the spectrum of the operating force, when:
▪ 1. Required, Not Authorized on TOE
▪ 2. Required, Authorized but MEDCOM Human Capital Distribution Plan (HCDP) non-
supported (61J/61M)
▪ 3. Not Required, Not Authorized but Mission Essential (DCCS for CSH)
▪ 4. Worldwide Individual Augmentee System (WIAS) taskers validated by HQDA G3/5/7 for
special/unique missions
➢ Competing requirements and not enough faces for the many spaces in the total inventory this
PROFIS process affords non-medical operational units (i.e. brigade combat teams) to be
resourced at a higher level.
➢ Even if there were enough to fill both MTFs and operating forces (TOE), it is imperative that the
Professional Deployers remain in the medical treatment facilities in order to maintain critical “Go-
to-war” life-saving medical skills
❖ Unit Responsibilities
➢ Losing Unit Responsibilities:
▪ Ensure fillers have completed BOLC/basic training and are appropriately privileged
▪ Ensure fillers are prepared to deploy in accordance w/AR 600-8-101
▪ Provide replacements when PROFIS fillers deemed non-deployable (loaded in MODS w/in 20
working days)
▪ Provide travel funds to and from the gaining MTOE
➢ Gaining Unit Responsibilities:
▪ Validate PROFIS requirements
▪ Welcome letter / orientation packet to fillers NLT 30 days following notification
▪ Organizational clothing and individual equipment (OCIE) available for issue
▪ Provide billeting and messing during unit training
❖ PROFIS Deployment System (PDS)
➢ The PDS is a MEDCOM internal selection system within the overall PROFIS framework
➢ Designed to help better manage low-density and high-criticality AOC/MOS/ASIs
➢ Enables MEDCOM to thoroughly plan for sustained long-term operational
➢ Provides deploying units with battle roster 6-9 months prior to their Latest Arrival Dates (LADs)
❖ Tier Level Management
➢ PDS requirements are broken down by AOC/MOS and classified for selection by Tier.
➢ Tier I requirements are AOC/MOS that have a very low-density population and require special
consideration during the selection process. Selected by consultants / MEDCOM by name.
➢ Tier II requirements are AOC/MOS that have a greater inventory than Tier I but still require a high
level of management. Tier II is managed at the RMC/MSC level.
➢ Tier III requirements are the AOC/MOS that have a healthy population and selections are made
at the MTF level.
➢ Unlike the PROFIS system, PDS requirements are locked at certain intervals to ensure HQ,
MEDCOM has visibility and the ability to scrutinize all change requests. This feature provides
stability and predictability not only for the Soldiers selected for PDS duty, but also for their gaining
unit --the deploying force
❖ PROFIS Integration
➢ PROFIS miss much of unit pre-deployment training
▪ Attend Combined Readiness Center (CRC)
▪ Affect unit cohesion
▪ May not be familiar with unit TTPs
➢ Leadership must actively engage PROFIS
▪ Create a sense of belonging
▪ Improve unit performance

▪ Improve provider amenability
HA250.1 BUSINESS OF HEALTHCARE

❖ Discuss:
1) What are the benefits of BCA? Analytical, Structured, compares multiple options, aligned with
organizational goals, focused on achieving end-state.
2) What are the BCA Components? Intro, methods and assumptions, business impacts, sensitivity-
risks-and contingencies, conclusions and recommendations
3) Assumptions that can be controlled or mitigated are defined as: contingencies
❖ Business Case Analysis (BCA): A business decision document that identifies alternatives and
presents convincing economic and technical arguments for implementing alternatives to achieve
stated organizational objectives.
❖ Purpose of a BCA
➢ Examples: Request resources for a new program; Evaluate on-going programs; Facilitate lease
or buy decisions; Make or buy decisions; New technology purchase options
➢ A good BCA should demonstrate an initiative has a strong likelihood of achieving a positive a
return on investment (ROI) within a 5-year period and show a positive Net Present Value (NPV)
❖ STEPS of BCA
➢ 1) Introduction
▪ Last to be written, 1st to be read - sometimes only part read
● Title and Subtitle
● Authors and Recipients
● Date
● Executive Summary - similar to an abstract, concise summation of BCA
♦ Proposed Action
♦ Business Objectives/Impacts
♦ Strengths, weaknesses, opportunities, threats (if any)
➢ 2) Methods
▪ Scope Statement
● Who, What, When, Where, How
▪ Review of Options
● Includes Status Quo (Current Process)
● Typically two other alternatives are reviewed (Must have at least one)
▪ ID and List Assumptions
● Assertion about some characteristic of the future
● Something we take for great or presuppose
▪ Cost Model/Financial Impact
● Cost savings - actions that lower current spending, debt levels or overall investments
● Cost avoidance - actions that avoid having to incur costs in the future
● Variable Costs - expenses that remain the same regardless of production value
♦ rent, machinery, structures

● Fixed Costs - vary with output

♦ i.e. wages, utilities, materials used in production
▪ Rationale of Benefits
● Establish basis and validity for assigning financial value
● Must support agreement by case audience
● Must be tangible
● Must be measurable
● Must show comparison scenarios fairly and without bias
▪ Metrics & Evaluation Criteria - ID all data sources with dates & sources of information
● Financial (MEDCOM’s BCA tool automatically calculates)
♦ Discounted Cash Flows (DCF)
♦ Net Present Value (NPV)
♦ Return on Investment (ROI)
● Performance
♦ Increase in productivity, reduce wait time, etc.
● Financial & Non-Financial
♦ Patient Satisfaction; reduce hassles; morale, quality
➢ 3) Projections
▪ Cash Flow Statement
● Workload
♦ Workload Increases/Avoidance
♦ Workload Performance Indicators
● Costs
♦ Capital Expense (E&F)
Equipment and Facility Costs
♦ Operating Expenses
♦ Cost Increase/Avoidance
♦ Marginal Supply Costs for increased workload
♦ GS Personnel increase
♦ Military Personnel increase
♦ Contract Personnel increase
● Benefits
♦ Capital Assets Reductions
♦ O&M reductions
♦ Revenue & Productivity
♦ GS Reductions
♦ Military Reductions
♦ Contract Reductions
♦ Purchased Care Savings
♦ Purchased Care Avoidance
➢ 4) Risks & Sensitivity
▪ Risk Analysis
● Identify Risk (Review Assumptions)
● Quantify Risk (Probability & Impact)
● Management of Risk/Mitigation Strategies
● Contingency Plan(s)
▪ Sensitivity Analysis
● What if assumptions change?
● What if values in Cash Flow change?
➢ 5) Recommendations & Conclusions
▪ Recommendations:
● ID the best option:
♦ Positive NPV?
♦ Positive ROI?
● Implementation Plan
● How will you measure success/monitor in the future?
▪ Conclusions:
● What does your analysis tell you?

● May find your initial assumptions were wrong - if so, say so

❖ Financial Terms and Formula
➢ Discounted Cash Flow (DCF) - cash flow summary adjusted to reflect the time value of money
▪ Discount rate - an interest rate used for computing the present value of future cash flows
● Means a certain amount of money has different values at different points in time
▪ with DCF, funds that will flow in or flow out at sometime are viewed as having less value
today than an equal amount that flows today
● Discounting - having the use of money for a specific period of time has value that is
tangible, measurable, real
▪ 3 reasons:
● 1. Opportunity. Money you have now could (in principle) be invested now, and gain
return or interest between now and the futuretime. Money you will not have until a future
time cannot be used now.
● 2. Risk. Money you have now is not at risk. Money expected in the future is less certain.
A well known proverb states this principle more colorfully: "A bird in hand is worth two in
the bush."
● 3. Inflation: A sum you have today will very likely buy more than an equal sum you will
not have until years in future. Inflation over time reduces the buying power of money.
▪ Discounting in the Army
● OMB Circular A94 shows what discount rates to use in the federal government.
● OMB rate close to interest rate on federal debt
● Interest rate used to discount or calculate future costs/benefits to arrive at their present
values
● Also known as “The opportunity cost of capital investment.”
➢ Present value (PV)
▪ Discounting - way to a compute the present value of future money
▪ Compounding - method used to know the future value of present money
▪ PV: what future cash flow is worth today
●
➢ Future value (PV)
▪ Future value (FV) - value that actually flows in or out at a future time
●
➢ Net present value (NPV)
▪ The total discounted value (present value) for a series of cash flow events across a time
period extending into the future
➢ Return on investment
▪ A performance measure used to evaluate the efficiency of an investment or to compare the
efficiency of a number of different investments.

▪
Measures the amount of return on an investment relative to the investments cost.
▪
Return on Investment Formula:
ROI=(Gain form Investment – Cost of Investment)
▪
Cost of Investment
▪ To obtain average annual ROI you would need to divide ROI percentage by the duration of
investment:
● For example 40% ROI divided by 3 Years =13.33%
❖ MEDCOM BCA Tool
T111 - UNIT TRAINING MANAGEMENT 1
Discuss:
1) What regulation covers Army Training? FM 7-0
2) What tools exist to identify unit METLs? METL and CATS tool
3) Do CDRs dictate their unit METLS? No
❖ UTM Overview
➢ To achieve a high degree of readiness, the Army trains in the most efficient and effective manner
possible. Realistic training with limited time and resources demands that commanders focus their
unit training efforts to maximize training proficiency
➢ Army Principles of Training
▪ Train as you fight
▪ Training is commander driven
▪ Training is led by trained officers and NCOs
▪ Train to Standard
● Training and evaluation outlines which contain task, conditions, standards and
performance measures
▪ Train using appropriate doctrine
▪ Training is protected
● higher HQ ensures taskings and other distractors do not impact scheduled training
▪ Training is Resourced
▪ Train to Sustain
▪ Train to Maintain
▪ Training is Multi-Echelon and Combined Arms
➢ The Operations Process and Unit Training
▪ Uses Operations Process (plan, prepare, execute, assess) as training framework
▪ Unit commander begins training cycle with top-down training guidance from the higher
commander.

● Receipt of guidance begins process of determining the correct collective tasks on which
to train
● Commander then develops a Unit Training Plan (UTP) to conduct that training in the time
allotted.
➢ MDMP and Unit Training Management (Bn and above)
▪ MDMP - foundation to planning unit training (per ADRP 5-0)
● Determines the collective tasks to focus unit training
♦ What tasks must the unit train?
♦ How will the unit train to achieve task proficiency?
▪ Steps 1 and 2: Mission Analysis key inputs = higher commander’s mission and initial training
guidance
● Focuses on determining the mission essential tasks (METs) to train and gaining approval
from the higher commander via mission analysis back-brief.
▪ Step 3: Begin process of developing a strategy to train METs to proficiency
● Commander’s visualized end state + approved mission essential tasks to train →
sequentially lay-out the major training events (using backward planning)
▪ Step 4: War-gaming: work toward developing a COA that uses the time and resources
available to achieve the commander’s visualized end state
▪ Step 5: May be omitted or be the logical test to revisit that you have arrived at the most
effective LVC mix and sequence of Crawl-Walk-Run (C-W-R) training events
▪ Step 6: The results of training briefing with the higher commander is considered a ‘contract’
between higher commander & subordinate commander.
♦ This ‘contract’ is an agreement on the following:
Subordinate commander agrees to train the mission essential
tasks (METs)
Training conditions/OE to replicate
The senior commander agrees to provide the resources required
and to protect the training time
Training risk
Point in time when the unit will be proficient in the tasks to train +
level of training readiness to achieve
▪ Step 7: Higher commander’s approval of the plan → publishes the UTP as a five paragraph
field order (OPORD) to subordinates via DTMS
➢ TLPS and Unit Training Management (Co. and Below)
▪ What tasks does the unit need to train?
▪ How should the unit train (strategy)?
▪ Train (execute the plan
➢ Commanders Training Responsibilities
▪ Lead - through purpose + direction + motivation
● Understand: Commander’s intent & mission unit must execute
● Visualize: Training End State - what unit must be able to perform (tasks)
● Describe: How training will be accomplished (guidance + UTP)
● Direct: be present at training; conduct training meetings; operations process
▪ Assess
● Continually assess task proficiency to make accurate and timely decisions on training
readiness and quality of training
➢ Unit Leader & NCOs (FM 7-0, Para 1-21 thru 1-35):
● Train and develop subordinate leaders
● Develop cohesive and effective teams
● Develop and communicate a clear vision
● Personally engage in training
● Demand training standards be achieved
● Foster a positive training culture
● Limit training distractors
● Enforce a top-down/bottom-up approach to training
➢ Overlapping Responsibilities in Trainings
▪ Officers - collective training

▪ Noncommissioned officers (NCOs) - Soldier training (individuals, crews, small teams) to

support METs
▪ The commander is responsible to meld leader and Soldier training requirements into
collective training events using multi-echelon techniques
❖ Mission Analysis
➢ Training and Evaluation Outlines (T&EOs)
▪ Document is the Army's source for conditions and standards of collective tasks
▪ T&EOs are developed and approved by the Army proponent responsible for the task
publication
▪ Composed of the major procedures (steps or actions) a unit must accomplish to perform a
task to standard
▪ Provide evaluators with an outline of task steps, measures, other evaluation criteria for
evaluating tasks to the Army standard
▪ Provide event planners resourcing guidance for developing events that train collective tasks
▪ Use T&EO to Plan and Prepare a Training Event
▪ Use T&EO to Evaluate Task Proficiency
➢ Unit commander conducts mission analysis to:
▪ Understand the guidance given by higher commander
▪ Determine how the unit can best support guidance
▪ Initiate collaborative and parallel planning processes within the command
➢ Mission Analysis - ID’s collective tasks that a unit’s training should focus on
▪ Commanders conducting mission analysis:
● Identify and understand potential Operational Environment (OE)
♦ conditions, circumstances, and influences that affect employment of capabilities
♦ planners evaluate an OE to consider how to replicate it in training environment
♦ effective training environment → achieve proficiency in collective tasks trained
♦ Proponents describe variables of OE in condition para. of T&EO
Operational Variables
▪ PMESII-PT
Mission Variables
▪ Mission, Enemy, Terrain and Weather, Troops and Support Available, Time
Available, and Civil Considerations (METT-TC)
● Determine METS to train
♦ Higher CDR states tasks to accomplish, not how to do it
♦ Determine specified, implied, and essential tasks
♦ Standardized and non-standardized METLs are published in DTMS

● Assess METs to train (MET proficiency)
♦ Commander assesses current MET proficiency:
T / T- / P / P- / U (Fully Trained/Trained /Practiced/Marginally Practiced/Untrained)
through:
Bottom-up feedback from subordinates
Personal experience and observations
Inspection results
AARs and training records from DTMS
♦ Commander determines projected MET proficiency for the beginning of the training
period
♦ A snapshot of the unit’s readiness at that point in time
● Identify long-range planning horizon
● Identify training readiness issues
♦ Personnel turnover
♦ New equipment fielding
♦ time available to train
♦ Unique or scarce resource

♦ Training Risk / Risk Management

Training Risk – any training risk the commander has identified
that puts the plan at risk because of:
▪ key resources required to train are not available
▪ insufficient time to train to the readiness level required
Risk Management - the process of identifying, assessing, and
controlling risks arising from operational factors and making
decisions that balance risk cost with mission benefits (JP 3-0)
● Conduct a back brief to higher commander (Commander’s Dialogue)
♦ Ensures both commanders agree with direction and scope of unit training
♦ Critical contents:
Mission analysis backbrief
Training briefing
Training Meetings
QTBs / YTBs
Before, during, and after EXEVALS
● Issue a WARNORD

Discuss:
1) T / F. The Unit Training Plan includes the UTP Calendar
2) T / F. Developing a UTP calendar is fundamental to graphically developing training of the COAs
3) Describe the components of a training standard.
Task, Condition, Standard, and desired task proficiency
4) What are some advantages of using TADSS (Training Aids, Devices, Simulators, and Simulations)?
TADSS enhance the realism of pre-Lane Training Exercises (pre-LTX) training; they increase
proficiency on prerequisite and LTX tasks through practice and repetition; they enhance the realism of
both force-on-force and force-on targeting LTX; and TADSS reduce safety and environmental hazards
❖ Introduction
➢ How are units able to schedule everything onto a training calendar?
➢ How does the commander/staff organize the training calendar for individual, collective training?
➢ How do we maintain balance between readiness and Soldier time?
➢ How do leaders discern what takes priority in the amount of training that needs to be
accomplished to reach a readiness state?
❖ Course of Action Development
➢ Output of the mission analysis backbrief → commander determines the single, most effective
course of action (COA) to train the unit in the time available
➢ Creating a COA - primary goal is to develop a Unit Training Plan (UTP) that progressively
develops MET proficiencies to an end statf
➢ Explain why the Decisive Action Training Environment (DATE) is used to replicate the operational
environment:
▪ DATE is a composite model of the real-world environment produced by TRADOC
● Provides a useful training planning tool to replicate an operational environment for
training when one is not specified
➢ CoA Development Planning Concepts:
▪ Prepare the UTP calendar - visually defines time available to train
● Simple calendar format & CATS planning tool - showing planning horizon (good start
point)
● Planners apply the actual days available to train a COA → time is greatest restricting
factor to planning unit training
● Planners contend with
♦ Installation or command time management cycles, resource and facility constraints,
limited classes of supply, competing with other units on the installation for the same
limited resources
▪ Apply the command or installation time management cycle

● Time management cycles create prime time training periods for subordinate units to
achieve battle focus in training.
♦ There are multiple time management cycles
♦ The Green-Amber-Red cycle is used throughout the Army
Green - Training focused on multi-echelon, unit collective tasks,
MET proficiency
Amber - Focused on individual, leader, crew, and squad levels
Red - Focused to maximize self-development and individual task
proficiency
● Help subordinate units identify, focus, and protect training periods and resources needed
to support unit training
▪ Post the higher unit (multi-echelon) training events
● Start by placing all multi-echelon training events directed by their higher HQ on the UTP
calendar
▪ Determine unit training events
● Broadly assess the number, type, and duration of training events that a unit may require
to train the METs to proficiency
● TOE Commanders identify training events using the CATS
● TDA Commanders carefully consider modifying a CATS
● Consider the Training Environment
♦ Determine how to best replicate the operational environment
♦ Mix live, virtual and constructive training environments
● Tailor the collective events to meet your unit’s needs and resources:
♦ Current and required proficiency (C-W-R)
♦ Operational Environment
♦ Desired mix of L/V/C training environments
♦ Participating and supporting units
♦ Resource availability (time, ranges, ammo, …)
▪ Identify training objectives for each training event
● Training objective - statement that describes the desired outcome of a training activity in
the unit
♦ TO’s identified for each multiechelon training event conducted in the long-range
planning calendar
♦ TO’s help chart how training events contribute to MET proficiency
♦ Describes the purpose (why) for each training event
▪ Use a backward planning approach using a crawl-walk-run methodology
● End state is point in time when the unit expects to be trained to standard in selected
METs
● Unit EXEVAL is the training event that normally culminates the end state
● Crawl-Walk-Run methodology sequences training events from simple to increasingly
complex
♦ Simple (crawl) events are scheduled on the front end of the UTP and progressively
increase in complexity
♦ Ensures that task proficiencies progressively build on each other
● Crawl - unit trains to first understand task requirements/standards (i.e. classroom, sand
table)
● Walk - Trains the task with added realism by changing conditions (i.e. Lane training
exercise)
● Run - Train collectively to achieve task proficiencies under increasingly realistic
conditions; work as effective and efficient teams (i.e. field training exercise)
▪ Consider the training environment
● Limited training time and resources → commanders use creative and innovative means
to conduct training in other-than-live training environments
● Realistic training → creative mix of live, virtual and constructive training
♦ Live training - executed in field conditions using tactical equipment
♦ Virtual training - executed using computer-generated battlefields in simulators with
the approximate characteristics of tactical weapon systems and vehicles

♦ Constructive training - uses computer models and simulations to exercise command

and staff functions
▪ Ensure time is programmed for subordinates to train
❖ CoA Analysis (War Game)
➢ Identify major resources that require immediate coordination and/or help from higher (includes the
major resources to replicate the OE)
➢ Identify possible resource shortcomings
➢ Identify and de-conflict scheduling issues
➢ Identify decision points for the commander
➢ Tools
▪ ATN website
▪ CATS - best starting point to understand the resources needed to train the METs
▪ T&EOs - provide additional detail regarding resource requirements to train specific collective
tasks
➢ Analyze with Screening Criteria
➢ Planners Consider:
▪ Land, facilities, and ranges
▪ Ammunition and TADDS
▪ Blended training environments and ITEs
▪ Classes of Supply
▪ OPFOR, role players and MSELs
▪ Resources not readily available at home station
▪ Unit availability (Green-Amber-Red)
❖ CoA Comparison
❖ CoA Decision Briefing
➢ Commander’s training guidance of the higher and next higher commanders
➢ Training status of the entire unit
➢ Current and projected proficiency rating of the METs (U, P-, P. T-, T)
➢ COAs considered, including
▪ Assumptions used
▪ Results of training estimates
➢ Summary of the war game for each COA
➢ Advantages and disadvantages (including risks) of each COA
➢ Recommended COA
❖ CoA Approval
➢ Selected COA - briefed to the next higher commander for approval
➢ Approved COA - basis for the Training Briefing to the next higher commander—their approval
sets a ‘contract’ between commanders to resource and protect approved training plans
❖ Training Briefing
➢ Brigade Commander’s Training Focus
➢ Operational Environment (OE)
➢ Battalion Command Training Guidance
➢ Concept of the Operations
▪ Decisive Operations
▪ Shaping Operations #1 (individual training)
▪ Shaping Operations #2 (leader development)
➢ Assessment Plans
➢ Key Resources Required to Train
➢ Training risk (time/resources to train)
➢ Training challenges
❖ Publish the Unit Training Plan
➢ DTMS provides easy dissemination
➢ Subordinate units have instant access to the OPORD
➢ Owner of the OPORD can edit/update the OPORD in the DTMS Document Library
➢ OPORD can be archived for future use


❖ UTM 1 & 2 Review
➢ Analysis of Training Guidance
➢ ID & Understand the OE
➢ Determine METs to Train
➢ COA Development Planning Concepts
➢ Determine Collective Training Events
▪ How do you determine collective training events?
● On the unit training calendar, display the higher HQ time management cycle, i.e., green-
amber-red cycle.
● On the unit training calendar, display the higher HQ multi-echelon training events and
EXEVAL in which the unit must participate.
● Identify periods of ‘white space’ on the calendar for subordinate units to conduct
collective training in preparation for unit major training events.
▪ Combined Arms Training Strategies (CATS) – use to report to identify the number, type, and
duration of training events that may be required to train to MET proficiency:
♦ Associate METs with training events using CATS Task Sets (TS).
♦ Identify events as crawl, walk, or run (C-W-R) events and array them accordingly on
the unit training calendar.
♦ Determine the right mix and sequence of live (to include gunnery), virtual, and
constructive (LVC) training events.
♦ Identify events that allow the unit to train in the identified operational environment.
♦ Identify the units that must participate in the training, to include supporting units.
➢ ID Training Objectives (TO)
➢ Consider the Training Environment
▪ Describes the purpose (why) for each training event
▪ Factors such as availability of resources, time and safety considerations cause commanders
to leverage all of the live, virtual and constructive (L-V-C) training environments
▪ Blended training environment (BTE)
● Unit training conducted concurrently within two or more training environments (L-V-C)
● Lacks the sophisticated integrating technologies that allow the different environments to
interact
▪ Integrated training environment (ITE)
● ITE uses consistent and continuous LVC training environments to stimulate mission
command information systems
● ITE uses correlated terrain databases
➢ Managing the Training Plan
❖ 8 Step Training Model

❖ Plan a Training Event

➢ Conduct Mission Analysis
▪ Develop Objectives for the event based on UTP
● Refine training objectives as necessary
➢ Evaluate the Operational Environment
▪ Determine how the OE will be replicated
● Structure the Event & Verify Venue
♦ Work through methods to stimulate training
♦ Maximize time and space
➢ Verify the Training Venue as Live, Virtual, or Constructive
▪ Develop event Concept
● Visualize the event with all pieces and develop concept for execution
● Maximize time and space - how many iterations can be accomplished?
▪ Determine the assessment plan
➢ Identify Resource Requirements
● Combined Arms Training Strategies (CATS) and historical data are start points for
identifying resources
● Event Planner:
♦ Confirms resources already planned
♦ Coordinates additional resources identified from concept development and refines:
Classes of supply not previously identified
TADSS
Additional OPFOR / OC/Ts / Role players not already identified
♦ DTMS can assist in tracking required resources for event
➢ Publish the Event Administrative Operations Order
▪ Using an OPORD, the Commander identifies:
● Tasks to be trained
● Training objectives
● Clear mission statement
▪ Commander defines:
● The scope of the training
● How the training will be conducted
● Which tasks will be trained
➢ Produce Separate Tactical and OPFOR orders
▪ Commander decides if the training event will require:
● A separate tactical order as opposed to a FRAGO
● An Opposing Force (OPFOR) specific OPORD
▪ Should be comprehensive and detailed to ensure that all leaders have a shared
understanding of the event’s expected outcome
▪ Tactical orders will usually require staff input to complete (i.e. Signal, Sustainment, Fires,
Intel, and other support requirements) - include those functional experts in the orders process
❖ Training meetings - ensures UTP remains on track
➢ Co-level: usually weekly; Bn and above: as directed by the commander
➢ Goals:
▪ Review and re-confirm training plan
● Modify and update the training as needed

▪ Ensure cross-communication between leaders

● Assess the previous weeks’ training
● Subordinate leaders provide assessments
● Ensure tasks are executed and assessed to standard
▪ Validate future tasks (collective and individual)
● Modify and update the training as needed
▪ Synchronize events and training plan
● Upcoming training events
● Training objectives
● Resource requirements and status of coordination
➢ Managing Training Events & T-Week
▪ T-Week concept - provides framework and backwards planning method that considers for
necessary planning and coordination for each training event
● Training event’s T-Weeks as it’s Planning Horizon, but tied to specific, required actions
for each week
● Assist in backward planning
▪ Training meetings - where T-week issues are reviewed, discussed, resolved
❖ Prepare for a Training Event
➢ Train and Certify Leaders
▪ **Commanders are the certifying official for their unit
▪ Qualified and competent leaders and trainers are critical in delivering quality, effective
training to the unit
▪ Ensure that trainers are prepared to conduct performance oriented training
▪ Provide adequate preparation time so the trainers
➢ Pre-Execution Checks
▪ Informal coordination conducted prior to conducting training events – these are not pre-
combat checks
➢ Rehearsals
▪ provide a mechanism for leaders and Soldiers to visualize what is supposed to happen, and
to correct deficiencies during subsequent rehearsals if necessary
● Identify weak points in the plan
● Coach the trainer until he/she feels comfortable
● Determine if leaders are tactically & technically proficient
● Determine how the trainer will evaluate Soldier, or unit performance
● Give subordinates confidence in their ability to train
➢ Complete Final Preparation
▪ Lock-in Resources
● Confirm all resources approved
● Final coordination complete
● Generally occurs 6 weeks out from execution
● Publish training schedules
▪ Publish Training Schedules
▪ Receive Resources
● Coordinate pickup and delivery to training site
● Pre-execution maintenance for TADDS and other equipment
● Trainers familiar with and trained to use TADDS
▪ Site Setup
● Training set as designed in OPORD
● Final Preparations / Rehearsals
❖ Execute a Training Event
➢ Train and Evaluate to the Army Standards using T&EOs
➢ Record Training Evaluation within the T&EO Performance Measures
➢ Conduct On-site, Informal AARs during Training Events
➢ Retrain Tasks in Order to Meet Training Standards
➢ Retry Tasks if time and resources permit
➢ Training must be executed utilizing established T&EOs to ensure that the Commander gets a true
assessment of the unit’s readiness
❖ Assess Training

➢ Aggregate completed T&EOs to enable the commander to assess unit training readiness
➢ Present all bottom-up feedback to the commander before final assessment is made and entered
into DTMS
➢ Enter assessments into DTMS using the objective assessment and recording of training
proficiencies of T, T-, P, P- or U.
➢ Honest bottom-up feedback is essential to the Commander’s ability to complete and submit the
final assessment
AS211.2 BCT MEDICAL READINESS AND TRAINING
Discuss:
1. How is medical readiness tracked?
MEDPROS
2. How often is Soldier’s Readiness checked?
At least annually
3. What is the difference between MODS and MEDPROS?
MODS - data entry system
MEDPROS - part of MODs; tracking & reporting system
4. What is the 68W sustainment training requirement? How is it tracked?
Requirement - Table VIII
Tracked in - MODS
5. T/F Medical provider training for integration to deploying BCT focuses on emergency treatment skills.
❖ Soldier Readiness
➢ Individual medical readiness Standards (AR 40-501)
▪ Classifications
● MRC 1 - Medically ready / Deployable
♦ Meet all requirements, dental class 1 or 2, Profile < 7 days
● MRC 2 - Partially Medically Ready / Deployable
♦ Temporary profiles 8-14 days; hearing class 4, vision class 4, require DNA / HIV/
medical equipment / immunization
● MRC 3 - Not Medically Ready / Non-Deployable;
♦ CDR determines deployability for
DL1 - Temp Profile > 14 days
DL 2 - Dental Readiness Class 3
♦ Non deployable for profile greater than 14 days, dental class 3, pregnant, permanent
profile who requires MAR 2, MED, non-duty related action, or have restriction code F
/ V / or X
● MRC 4 - Not Medically Ready / Non-Deployable and CDR determines Deployability
(Default non-deployable)
♦ Do not have current PHA or Dental Screening
▪ Individual Medical Readiness (IMR)
● Reflects unit’s required strength available for deployment, consists of:
♦ Health assessment (PHA) (12-15 months)
♦ Deployment limiting medical conditions (P3/P4 profile, MAR2, MEB/PEB)
♦ Dental readiness. (Cat 1-4)
♦ Immunizations (standard plus theatre specific)
♦ Deoxyribonucleic acid (DNA) on file
♦ HIV test current (annually)
♦ Hearing readiness (12 months, class 1-4)
♦ Vision readiness (Class 1-4)
➢ Medical Protection System (MEDPROS)
▪ Database of record for all medical readiness data elements
▪ Tracks all immunization, medical/dental readiness, and deployability data (profiles,
eyeglasses, blood type, medical warning tags, deployment medications, pregnancy, DNA,
HIV, hearing)
● Medical Personnel - data entry

● Commanders and Medical leaders - tracking

● Data - by individual, unit, task force
➢ Soldier Readiness Program (SRP)
▪ Check status of individual soldier readiness during inprocessing, at least once annually,
during out-processing, and within 30 days before an actual unit deployment date or the date
an individual soldier departs on a TCS move
▪ Commanders are responsible to maximize Soldier readiness
● Identify and correct non-deployment conditions
● S1 work with G1/AG (Chief, MPD) to coordinate installation/community agencies to
process Soldier readiness
▪ Soldier readiness is checked during:
● In-processing, out-processing
● Annually
● Within 30 days of actual unit deployment
● Per unit SOP
▪ All soldiers are required to process through the following stations:
● Personnel management station
● Medical facility, and Dental facility
● DEERS/RAPIDS/ID cards and tags
● Security office
● Military pay office
● Legal affairs
➢ Modification of Personnel Policy (MOD)
▪ AR 40-501 sets standards for Individual Medical readiness for deployment
▪ Each COCOM can/will set modification of deployment requirements specific to AOR or
theatre
▪ Modification of personnel policy for overseas deployment address medical deployability of
Soldiers, civilian employees and contractors
➢ Profiles
▪ PUHLES code - Physical, Upper, Hearing, Lower, Eyes, Sight
▪ Profile Codes
● “F” - no OCONUS assignment or where no definitive medical care available
● “S” - in MEB
● “V” - can deploy within certain parameters (waiver), i.e. OSA needs electricity for CPAP
▪ Profile writers:
● No restrictions (temp profile up to a year, 90 day increments) - Physicians, Dentists,
Audiologists
● Temp Profile up to 90 days, extra signature to extend to 180 days - Optometrists,
Podiatrists, Chiropractors, Physical Therapists, Occupational Therapists
● TP up to 30 days, reevaluate to extend up to 180 days without signatures; signature
required after 180 days - Nurse Practitioners, Nurse Midwives, Licensed Clinical
Psychologists/Social Workers, Physician Assistants
❖ Army Health System (AHS) Personnel Readiness
➢ 68W (Healthcare Specialist/Combat Medic) Sustainment
▪ 68W (Healthcare Specialist/Combat Medic) - 2nd largest MOS in the Army
▪ 16 weeks MOS initial entry training program - Trained in combat casualty care life-saving
interventions
● Advanced airway management
● Combat trauma management
● Medicine administration
● Advanced casualty movement
▪ Skills comparable to Advanced EMT or Paramedic
▪ Able to assist a provider in primary care/sick call
▪ TC 8-800 sets guidelines for required training and validation
▪ Biennial (Q2yrs) NREMT recertification
▪ Medics holding additional skill identifiers (ASIs) are no longer required to maintain NREMT,
including:

● Orthopedic, Practical Nursing, Dialysis, Physical therapy, Occupational therapy

specialists
▪ Specific 68W ASI MOSs are no longer required to be NREMT but should demonstrate their
medical skills annually IAW TC 8-800
▪ Minimum Requirements
● Basic Lifesaver certification at the healthcare provider level
● 24 hours of CE equivalency refresher training
● 48 hours of additional continuing education
● Verification of skills validation (Table VIII)
▪ Failure to meet requirements will result in re-classification

▪ DA 7442 R - proof for TC 8-800 course completion and Skills validation; copy kept at training
location for a minimum of 2 years
▪ Only document Army EMS will accept for proper MODS entry for CE equivalency and skills
validation
➢ Low Density Military Occupational Specialties (MOS) Training
▪ Medical Providers – require licensing and annual continuing medical education (CME)
annually
● Physicians
● Dentists
● Physician Assistants
● Nurses
● Physical Therapist
▪ After initial training certification non-68W enlisted medical MOSs must demonstrate of job
proficiency, i.e. 68K, 68J, etc.
▪ Reference AKO – Army career “Tracker Tab” for specific MOS career path guidance or DA
PAM 600-4 for AMEDD Officer Career Development
➢ Medical Operational Data System (MODS)
▪ An MHSS objective system that provides the Army Medical Department (AMEDD) with an
integrated automation system that supports all phases of Human Resource Life -Cycle
Management in both peacetime and mobilization
▪ On-line system provides commanders, staffs and functional managers of AMEDD
organizations a real time source of information on the qualifications, training, special pay and
readiness of Army Medical Department (AMEDD) personnel
▪ Applications include:
● 68W – Individual or Unit training status and Data entry option
● e-Profile – electronic record of temporary, permanent profiles and data entry option
● MEDPROS – previously discussed, view only
● MWDE –MEDPROS data entry system
● MHA – medical health assessment, PHA, consult tracking, and VA disability rating
tracking
➢ Provider Training
▪ Physicians and PA –
● BDE/Division Surgeon Course
● Combat Casualty Care Course (C4) {ATLS – advanced trauma life support}
● Tactical Combat Medical Care (TCMC)
● Tactical Combat Casualty Care Course (TC3)
▪ BDE Nurse
● Trauma Nursing Care Course
● TC3

▪ Brigade Health Care Provider course – in development (BDE Surgeon, nurse, dentist)
▪ Additionally, training is provided to create “physician extenders” within BCTs, i.e. Combat
Lifesaver and Field Sanitation Team training
L172 COUNSELING
Discuss:
1)
❖ Types of Developmental Counseling
➢ Event-Oriented Counseling
▪ Specific occasion of superior or substandard performance
▪ Reception / Assignment to a new position
▪ Crisis counseling
▪ Referral counseling
▪ Promotion counseling
▪ Separation counseling
➢ Performance and Professional Growth Counseling
▪ Leader conducts a review of the subordinate’s duty performance during a certain period
▪ The leader & subordinate establish objectives and standards for the next period.
▪ Leader should focus on the subordinate’s:
● strengths
● areas needing improvement
● potential
❖ Four-Stage Counseling Process
➢ 1. Identify the need for counseling
➢ 2. Prepare for counseling
▪ Select a suitable place
▪ Schedule the time
▪ Notify the subordinate well in advance
▪ Organize information
▪ Outline the components of the counseling session
▪ Plan the counseling strategy
▪ Establish the right atmosphere
➢ 3. Conduct the counseling session
▪ Open the session
▪ Discuss the issues
▪ Develop a plan of action
▪ Record and close the session
➢ 4. Follow-up
▪ Implement the plan of action
▪ Assess the plan of action
❖ Counseling/Evaluations
➢ Focus: Duties, responsibilities, and performance objectives
▪ Initial
▪ Quarterly
▪ NCOER Inflation
▪ Managing a rater profile for NCOERs
❖ Evaluation Reporting System
NCOER Training Video https://www.youtube.com/watch?v=JsAa537vD28

➢ Use of Support Form is mandatory for Colonel and below

➢ Aligns with the revised OER
➢ Focuses on Attributes and Competencies IAW ADRP 6-22
➢ Initiate and complete in the Evaluation Entry System
➢ Even though there are three different versions of the OER, there will only be one support form
because attributes and competencies are not limited by grade
➢ Online completion allows for admin data import to OER
➢ Supplementary review required when:
▪ the senior rater is 2LT-1LT, WO1-CW2, or SFC-1SG/MSG
▪ no uniformed Army-designated rating official in the rank of CSM/SGM, CW3-CW5, or CPT
and above exists in the rating chain for the rated NCO
▪ senior rater has directed the relief or when an individual outside of the rating chain has
directed the relief
➢ Performance Evaluation Guide
▪ Examples of attributes & competencies
● These examples are NOT to be used as excerpts for formal performance appraisals and
only serve as a guide in differentiating the level of performance.
▪ Example behaviors – ADRP 6-22
● Results of the 10 leadership competencies
HR240.1 OER
Discuss:
1) What references covers OERS? DA PAM 623-3
❖ The Army Evaluation System

➢ Purpose: Identify Army’s best performers and those with the greatest potential
▪ Requires candor and courage; frank and accurate assessment
▪ Leaders must guard against “word inflation”
➢ The OER is an assessment tool; the Support Form is a counseling tool
▪ OER is a forced distribution system
▪ Senior Rater top box (Most Qualified) restricted to <50%
▪ Rater Left Box (Excels) restricted to <50%
▪ Rater narrative focuses on quantifiable performance
▪ Senior Rater narrative focuses on potential (3-5 Years)
▪ Use the “top box” to identify your best officers and quantified narratives
▪ Commander is overall care-taker of all personnel systems
▪ COUNSELING IS KEY!
❖ Rating roles and responsibilities
➢ Rater Designation
▪ Commanders, Commandant, Organization leaders are responsible for rating schemes

▪ Rater will be immediate supervisor of rated Soldier

▪ “Normally” be senior to rated SM in Grade or Date of Rank (DOR)
● Exception – commanders can rate someone is senior in DOR (not Rank)
▪ Promotable Officers serving in position of next rank may rate the officer they supervise if after
promotion they will be senior to rated officer (i.e. not senior in DOR but selection promotion
earlier)
▪ Role of the Rater - Immediate supervisor of rated officer
● Develop a “Rating Philosophy” and communicate it to rated officers
● Clearly and concisely communicate most significant achievements
● Focus on narrative comments and performance
● Anticipate and project future evaluations
● Advocate Officer to the Senior Rater
● Keep senior rating officials informed of upcoming evaluations
● Track evaluations from submission to HRC thru completion
➢ Intermediate Rater Designation
▪ Only for specialty branches (AMEDD, Chaplain, JAG)
▪ Level of technical supervision (rater/senior rater does not have)
▪ Intermediate rater must be senior to rated officer in rank or DOR
▪ Be supervisor to rated officer, link between rater and senior rater
▪ Served in capacity for minimum 60 days
➢ Senior Rater Designation
▪ Senior Rater will be supervisor of Rater
▪ Minimum of 60 Days (unless they also served as Intermediate Rater (IR))
▪ Senior Rater will be senior in GRADE or DOR to rater and IR, and meet minimum grade
requirements per table 2-1, AR 623-3.
● CPT: Minimum SR rank MAJ(P)/LTC
● CPT(P) to MAJ: Minimum SR rank LTC(P)/COL
● MAJ(P) to LTC: Minimum SR rank LTC(P)/COL
▪ Exception for AMEDD AR 623-3, Appendix E
▪ Exceptions to SR being senior to IR – when IR is from a non-parent unit with dual
supervision:
● AMEDD Exception to AR 623-3. Appendix E
● GME (MC/DC) – Commander will designate to officers directly responsible for education
program to lowest practical level
♦ Rater – does not have to be senior in rank or DOR to rated SM
♦ Senior Rater – will be senior in rank or DOR
● Physician Assistants
♦ Primary clinical duty – MD/DO will be rater or senior rater
♦ Primary Administrative duty – no MD/DO required in rating chain
♦ Primary Admin and part time clinical – MD/DO as intermediate rater
● COLs in command can senior rate other COLs regardless of DOR
➢ Developing a Rating Philosophy
▪ Mission: Identify your best
▪ Counseling – ensure counseling is accomplished.
▪ Raters decide how to assess based on performance
▪ Senior Raters decide how to assess based upon potential
▪ Write well – quantify and qualify in narrative; correspond comments with box check as the
system allows. Use the narrative to paint the picture
▪ Plan ahead, think series of reports (number of times you will rate an officer)
➢ Rater Counseling Responsibilities
▪ Provide Rater’s and Senior Rater OER Support Forms
▪ Within 30 days after the beginning of the rating period discuss:
▪ Rated Soldier’s duty description and
▪ Performance objectives to attain
▪ Counsel the rated Soldier, give the rated Soldier a guide for performance while learning
new duties and responsibilities.
▪ Assess the performance of the rated Soldier, using all reasonable means, to include
personal contact, records and reports, and the information provided by the rated officer on.

❖ Assessing Leader Attributes and Competencies (Leadership Requirements Model)
➢ Attributes - What a Leader is

▪ Character, Presence, Intellect
➢ Competencies - What a Leader is
▪ Leads, Develops, Achieves
❖ OER Support Form
➢ Use of Support Form is mandatory for Colonel and below and
➢ Must be approved one level higher (up to 3 Star Level)
➢ Aligns with the revised OER
➢ Focuses on Attributes and Competencies IAW ADRP 6-22
➢ Initiate and complete in the Evaluation Entry System
➢ Use of the Electronic Entry System (EES) allows for data import to OER
➢ Three different versions of the OER, one support form
➢ The support form provides 3 pages of instructions that will assist raters
❖ Writing an OER
➢ Raters focus on specifics to quantify and qualify performance
▪ Raters and Senior Raters SHOULD comment on the rated officer’s abilities to execute
mission command in their narrative comments
➢ Senior raters need to amplify their potential box checks by using the narrative to clearly send the
appropriate message to selection boards
▪ Focus on potential (3 to 5 years; command, assignment, schooling and promotion)
▪ Cannot mention Box Check in the narrative
➢ Be careful with your narrative:
▪ What is not said can have the same impact as what is said
▪ Don’t say the same thing for all your people (Boards will detect repeated verbiage)
▪ Avoid using the same verbiage year to year for the same officer
▪ Accurately and fairly assess all officers regardless of branch and functional area
● SHARP must be discussed during counseling and assessed on the evaluation
➢ Rate Box Check Defined
▪ Excels: Results far surpass expectations. The officer readily (fluently/naturally/effortlessly)
demonstrates a high level of the all attributes and competencies. Recognizes and exploits
new resources; creates opportunities. Demonstrates initiative and adaptability even in highly
unusual or difficult situations. Emulated; sought after as expert with influence beyond unit.
Actions have significant, enduring, and positive impact on mission, the unit and beyond.
Innovative approaches to problems produce significant gains in quality and efficiency.
▪ Proficient: Consistently produces quality results with measurable improvement in unit
performance. Consistently demonstrates a high level of performance for each attribute and
competency. Proactive in challenging situations. Habitually makes effective use of time and

resources; improves position procedures and products. Positive impact extends beyond
position expectations.
▪ Capable: Meets requirements of position and additional duties. Capable of
demonstrating Soldier attributes and competencies and frequently applies them; Actively
learning to apply them at a higher level or in more situations. Aptitude, commitment,
competence meets expectations. Actions have a positive impact on unit or mission but may
be limited in scope of impact or duration.
❖ Company Grade OER
➢ Administrative data remains consist with the old OER (67-9)
➢ Highlights the need for a supplementary reviewer is required by updated AR / DA PAM 623-3
➢ Addresses the completion of the multi-source assessment feedback
➢ Rater’s comments pertaining to APFT move to page 1
▪ Performance block checks and the Rater’s overall performance assessment
▪ Focused on core attributes and competencies in ADP 6-22
▪ More prescriptive
▪ Performance based assessment
▪ Narrative only (4 lines per entry)
▪ Mandatory entry for each Attribute/Competency
▪ Encourages specific discussion with Rated Officer on desired traits
➢ Intermediate Rater if applicable
➢ Senior Rater block checks redefined to better identify leader potential
❖ Field Grade OER
➢ Administrative data remains consist with the CO Grade evaluation
➢ Raters have the opportunity to comment on possible broadening and operational assignments
➢ Attribute of Character is highlighted on the Field Grade Form
➢ Raters MAY recommend potential “Broadening,” “Operational”, and “Strategic” assignments
looking 3-5 years out.
▪ Will assist Assignment and Career Managers in selecting the right officer for the right
assignment
➢ Rater comments on the Officer’s performance against the Attributes and Competencies during
the rating period (5 lines of narrative text)
▪ Box checking philosophy remain consistent; less than 50% Excels
▪ Rater’s overall performance is further codified in the Comments section
❖ Box Checks
➢ Rater Box Check
▪ “Excels” is limited to no more than 49.9% (less than 50%) for each grade
➢ Senior Rater Box Check
▪ Four box profile remains consistent with current system; provides more options for senior
raters
▪ Highly Qualified and Qualified enable greater stratification
▪ Most Qualified becomes the control box (limited to less than 50%)
▪ No restart of profile; no close-out reports
▪ Continue to mask 2LT/1LT after promotion to CPT; WO1 after selection to CW2
▪ Senior Raters will receive a “Warning Label” if rendering a Most Qualified box will cause a
misfire
▪ An official misfire (going over 49.9% in that rank) will calculate the SR profile against the Most
Qualified box, but show a DA Label of Highly Qualified when the board reviews the OER
❖ Senior Rater comments
➢ Number of officer currently rate in this grade
➢ Narrative focused on potential
➢ Comment on future assignments, promotion, and education
➢ Future assignments should be successive (this is a change)
HR240.2 NCOER
❖ Rating Chains
➢ Must be established at the beginning of the rating period.

➢ Commanders, commandants and organizational leaders are responsible for rating schemes.
➢ Rating Chains must correspond as nearly as practicable to the chain of command and
supervision within an organization regardless of the component or geographical location.
➢ Evaluation of NCOs by persons not involved with their supervision is not authorized
➢ Pooling is not authorized
➢ Rater
▪ Must be immediate supervisor
▪ Designated as the rater for a minimum of 90 rated days
▪ SGT or above and senior to the rated NCO by either pay grade or DOR
▪ Commanders may appoint DOD Civilians (GS-6) and above when immediate military
supervisor is not available
▪ Recalled Retired Soldiers can serve as rating officials
▪ In rare instances members of allied armed forces may be serve as raters
➢ Senior Rater
▪ Will be the immediate supervisor of the rater
▪ Must be in the direct line of supervision
▪ Designated the senior rater (SR) for a minimum of 60 rated days
▪ Senior to the rater by either pay grade or DOR
● SGT/SGTP will have SR >=SFC
● SSG/SSGP will have SR>=MSG
● SFC/SFCP will have SR>=SGM
● MSG/1SG/SGM will have SR senior to rater
▪ Commanders may appoint DOD civilians (GS-9)
▪ USAR (Less AGR) - need not be senior by DOR, if Senior Rater is CDR
➢ Reviewer
▪ Must be a commissioned officer, warrant officer, CSM, or SGM
▪ Direct line of supervision
▪ No minimum time is required
▪ Senior in pay grade or DOR to the senior rater
▪ Every NCOER should be “reviewed” by 1SG, CSM or SGM
▪ Commanders may appoint officers in other US military services or DOD civilian (GS-12) or
above.
▪ Generally not Required, except:
● If SR is <CW2, 1LT, MSG
● Rater or SR not an Army SM
● Relief for Cause evaluation
❖ NCOER Support Form (DA Form 2166-9-1A)
➢ Mandatory for all NCOs, CPLs thru CSMs
➢ Rater develops duty description, objectives/tasks for Rated NCO
➢ Rater communicates performance standards and expectations
➢ Rater explains standards for success and discusses the meaning of values
➢ Shows rated NCO the rating chain and complete duty description
➢ Conducts Initial Face to Face Counseling within 30 days of:
▪ The beginning of the rating period
▪ Lateral Appointment to Corporal
▪ Promotion to Sergeant (SGT)
➢ Quarterly thereafter and at the end of evaluation period
➢ DA Form 2166-X-XX is maintained by Rater
❖ NCOER Forms (DA Form 2166-9-X)
➢ Three NCOER forms aligned with Army Leadership Doctrine (ADP 6-22)
▪ SGT (Direct) DA Form 2166-9-1
● Focuses on proficiency and is developmental in nature
● Aligns with Army Leadership Doctrine
● Rater – Bullet format (Met or Did Not Meet Standards)
● Senior Rater – Narrative format
● Unconstrained Senior Rater box check
▪ SSG-1SG/MSG (Organizational) DA Form 2166-9-2
● Focuses on organizational systems and processes


● Rater – Bullet format
● Senior Rater – Narrative format
● Unconstrained Rater Tendency
● Constrained Senior Rater Profile (limited to less than 25% for “MOST QUALIFIED”
selection)
● “Silver bullet” – only one of the first four reports may be “MOST QUALIFIED”
▪ CSM/SGM (Strategic) DA Form 2166-9-3
● Focuses on large organizations and strategic initiatives
● Rater and Senior Rater – Narrative format
● Unconstrained Rater Tendency
● Constrained Senior Rater Profile (limited to less than 25% for “MOST QUALIFIED”
selection)
● “Silver bullet” – only one of the first five reports may be “MOST QUALIFIED”
❖ Mandatory Areas of Emphasis
➢ Requires safety objective and/or task be developed for every NCO as part of their support
form/counseling requirements.
➢ Counseling will include a leader’s execution of training on prevention of sexual misconduct or
training on avoidance of sexual misconduct.
➢ Information Security Program
➢ Property Accountability
➢ Internal Controls
❖ Rater Tendency
➢ Key information includes the following:
▪ Rater’s assessment of Rated NCO
▪ Rater Tendency Label – the value below each box equals the overall history of those ratings
in this grade
▪ Rater Tendency (i.e., profile history) will be viewable within the Evaluation Entry System
(EES) by the Rater’s Rater and Senior Rater
▪ Applies to SSG-CSM/SGM
❖ Senior Rater Profile
➢ Key information includes the following:
▪ Senior Rater’s profiled assessment of Rated NCO
▪ Senior Rater’s total number of ratings
▪ Number of ratings for the Rated NCO by the current Senior Rater
▪ Applies to SSG-CSM/SGM
➢ Senior Rater Profile Calculation
▪ Senior Rater Profiles will be limited to less than 25% Most Qualified
▪ One “silver bullet” authorized for first four initial evaluations in a grade, thereafter silver bullets
is authorized every fifth evaluation
▪ Misfires are automatically downgraded to Most Qualified by HRC
❖ Writing an NCOER
➢ Place strongest bullet up front
➢ The rater will write the NCOER not the rated NCO
➢ Bullet comments should be past tense for contributions/achievements and present tense for
values
➢ Use action words and avoid using personal pronouns and names
➢ Paint clear and accurate portrait of rated NCO
➢ Reflect significant accomplishments during rating period on report
➢ Bullet comments should justify the rating in the checked box
➢ See lesson resource file for examples
➢ Evaluation Narrative
▪ Selection boards should understand what input the Rating Chain is providing without having
to guess
▪ Raters – focus on specifics to quantify and qualify performance
▪ Senior Raters – focus on potential
▪ Reserve exclusive and strong narratives for the very best NCOs

▪ Focus on the next 3-5 years (assignment, schooling, and promotion)

▪ “HIGHLY QUALIFIED” box checks will be the norm
❖ NCOER Counseling
➢ Evaluation should not be a surprise!
➢ Frequent counseling and NCOER Support Form sessions
➢ Be honest
➢ Don’t beat around the bush
➢ Refer to the support form:
▪ Duty Description
▪ Performance Objectives
▪ Goals vs Achievements
HR240.3 AWARDS
❖ Intent of Military Awards - AR 600-8-22, Ch. 1, Sec 1-1

➢ “The goal of the total Army awards program is to foster mission accomplishment by recognizing
excellence of both military and civilian members of the force and motivating them to high levels of
performance and service.”
❖ Purposes of Awards
➢ Acts of Valor
➢ Exceptional Service or Achievement
➢ Special Skills or Qualifications
➢ Acts of Heroism
❖ Awards Policies
➢ Time Limitation
▪ Two years of act, achievement, or service being honored (3yrs. for PH)
➢ Duplicate Awards
▪ Only one decoration awarded for same act or achievement
▪ Can receive recognition for a heroic act and for a period of service
➢ Interim Awards
▪ Given when awaiting final approval on recommendation for a higher award
▪ Revocation when higher award is approved
➢ DA 638 or permanent orders required for decorations and badges
➢ DA 638 not required service medals & ribbons
➢ Revocation
▪ Awards are revoked by awarding authority
▪ Announced via permanent orders
➢ Anyone can recommend someone for an award
➢ Army Awards may be awarded to other services
➢ Other services may award Soldiers service specific awards
➢ Based upon performance, not grade
❖ Types of Awards
➢ Decorations
▪ Heroism, meritorious achievement or service
▪ Based on performance, not grade
▪ Not to be used as prizes
▪ ARCOM & AAM not awarded to GOs
➢ Good Conduct Medal
▪ Awarded to Active duty enlisted Soldiers
➢ Service Medals & Service Ribbons
▪ Denotes honorable service within specified geographical area, for a specific time
▪ Normally awarded for active service only
▪ No orders published for service medals
▪ Appurtenances (subsequent awards)
▪ Worn to denote additional awards or participation in a specific act
➢ Badges & Tabs

▪ Provides public recognition for skills earned

▪ Combat & special skill badges
➢ Certificates & Letters
▪ Certificate presented with each award of military decoration
▪ Certificate of Achievement (COA)
▪ Letter of commendation
➢ Unit Awards
▪ May wear an award if you are assigned to the unit
▪ Remove award once you PCS, unless you were with the unit when it was given the award
➢ Appurtenances
▪ Oak Leaf Clusters
● 1 silver OLC = 5 bronze OLC
● Worn on decorations & unit awards
▪ Numerals
● Overseas Service Ribbon
● NCO Professional Development Ribbon
▪ V devices
● Denotes heroism when engaged with an armed enemy
● Worn on BSM, Air Medal, ARCOM & JSCM
▪ Clasps
● Worn on Good Conduct Medal
▪ Service Stars
● 5 bronze stars = 1 silver star
● Worn on campaign & service ribbons to denote additional awards
● Bronze stars worn on parachutist badge for combat jumps
❖ The Awards Process
➢ Things to consider when submitting an award:
▪ Type of Award you are submitting:
● Retirement
● Service
● Permanent Change of Station (PCS)
● Achievement/Impact
● Heroism
➢ Timeframe
➢ Approval Authority
❖ Approval Authorities
❖ Purple Heart
➢ Awarded to members of the Armed Forces of the United States who, has been wounded or killed,
or who has died or may hereafter die after being wounded.
➢ A wound is defined as an injury to any part of the body from an outside force or agent sustained
under one or more of the conditions listed above.
➢ A physical lesion is not required, however, the wound for which the award is made must have
required treatment by medical officer and records of medical treatment for wounds or injuries
received in action must have been made a matter of official record
❖ Other Military Awards
➢ Overseas Service Ribbon
▪ Normal OCONUS tour (1-3 yrs.)
▪ Tour length NOT established for combat tours (OEF/OIF)
● Table 3-2 guidelines (AR 614-30 Overseas Service)
● 9 consecutive months
● 11 cumulative months in 24 months period

➢ Combat Badge
▪ No time requirement (1 day)
▪ Must be in combat zone
❖ Civilian Awards
❖ DA Form 638
❖ Award Writing
➢ Stylistically awards are less stringent than evaluations
▪ With exception of citation recommendation
▪ Use unit template when possible for citation
➢ Only one achievement needed for an impact award
➢ Achievements should be quantifiable
➢ Same achievement cannot be cited in two awards
▪ For example: PCS and Deployment Awards
➢ Follow unit guidelines or use unit template
❖ Unit Award Programs
➢ The Awards program is a commander’s program
➢ Each unit is required to have a Awards program
➢ CDRs may convene an award board to ensure fairness
➢ Submit awards on deserving Soldiers
➢ Keep copies of all awards received
➢ If you need a replacement award contact the unit that presented the award
LE160 UNIT MAINTENANCE OPERATIONS

Discuss:
1. What are the two levels of maintenance support? Field & Sustainment
2. What is the purpose of Army Maintenance? to generate and regenerate combat power
3. Who is responsible for providing resources, assigning responsibility, and training their Soldiers to
achieve maintenance standards? Commanders
4. Where is field maintenance performed? On or near the system (as far forward as possible)
5. What is the single standard for maintaining Army equipment? TM XXX-10 or -20
6. What three publications contain the basic doctrine for Army Maintenance? ADP 4-0, ADRP 4-0
and ATP 4-33, FM 4-90 and FM 4-93.2
7. Which maintenance organization typically provides field maintenance and recovery support to
BCT operations? Brigade Support Battalion
8. Forward Support Companies typically provide what type of maintenance to the Battalions they
support? Field Maintenance
9. Providing maintenance support to units not supported by an FSC is the responsibility of which
type of maintenance organization? Field Maintenance Companies
10. What is the Army’s primary maintenance management information system? Global Command
Support System - Army (GCSS-A) (replaced SAMS-E)
11. In what type of Unified Land Operation is the focus of maintenance support enhancing
momentum by keeping the maximum number of weapons systems operational? Offense
12. Who coordinates all maintenance operations at the Brigade/Battalion level? Support Operations
Office (SPO)
13. Maintenance management at the Company (FSC/FMC) level is focused on what? Each job
❖ Purpose of Army Maintenance System

➢ To generate/regenerate combat power, and to preserve the capital investment of weapons

systems and equipment to enable mission accomplishment.
➢ Maintenance actions are divided into field and sustainment level tasks
❖ Principles of Maintenance
➢ Commanders are responsible for
▪ Establishing a command climate that ensures all assigned equipment is maintained in
accordance with appropriate TMs and AR 750-1
▪ Providing resources, assigning responsibility, and training their Soldiers to achieve
maintenance standards.
▪ Readiness and safety of equipment
➢ Preventive Maintenance Checks and Services (PMCS) are the foundation of materiel readiness
➢ Expeditious return of non-mission capable equipment back to operational status
➢ Use of field level maintenance forward/sustainment level maintenance at echelons above Brigade
❖ Core Maintenance Processes
➢ Performance observation - foundation of the Army maintenance program and is the basis of the
preventive maintenance checks and services that are required by all equipment technical
manuals in the before, during and after operation checks
➢ Equipment services - specified maintenance actions performed when required, where
equipment, components, and systems are routinely checked, adjusted, changed, analyzed,
lubricated, and so forth, in accordance with designer and engineer specifications.
➢ Fault repair - process used by operators and maintenance personnel to restore equipment to full
functionality as originally designed or engineered
➢ Single-standard repair - process that seeks to ensure a single repair standard is applied to all
end items, secondary items, and components repaired and returned to the supply system or by
exception directly to the using unit
▪ Assures high quality and establishes a predictable service life using the best technical
standard
❖ Two Levels of Maintenance
➢ Field Maintenance - rapid repair & return to user
▪ 1-13. Field maintenance is on-system maintenance, repair and return to the user, including
maintenance actions performed by operators
▪ Includes actions performed by the operator
▪ Achieved through
● Operator and Crew Maintenance (inspecting, servicing, lubricating, adjusting, replacing
minor components)
● Maintainer Maintenance (after operators have exhausted capabilities; used when shop
replaceable or line replaceable units require trained maintainer; items returned to user
after maintenance tasks completed)
➢ Sustainment Maintenance - performed “off system” and repair and return to supply system;
supports both operational force and Army supply system
▪ 1-17. Sustainment maintenance is off-system component repair and/or end item repair and
return to the supply system or by exception to the owning unit, performed by national level
maintenance provider
▪ Achieved through:
● Below depot sustainment maintenance
♦ Performed on a component, accessory, assembly, sub-assembly, plug-in unit or
other portion after it is removed from the system.
♦ Items are returned to the supply system after maintenance is performed.
♦ Can also be applied to end item repair and return to supply system
● Depot sustainment maintenance
♦ Accomplished on end items or components after they are removed from end items.
♦ Can be performed by depot personnel or contractor personnel when authorized by
Army Material Command.
♦ Items are returned to the supply system or by exception directly to the unit
❖ Brigade Support Battalion Structure
➢ Capabilities differ somewhat depending upon the type of brigade (e.g. Armored, Infantry, Stryker)
one of the core capabilities of all BSBs is maintenance.

➢ Support brigades such as Fires and combat aviation are supported by similar sustainment
organizations to those of the BCTs however, these units are tailored to support specific
capabilities
▪ BSB Medical Company (BMSO)
● Responsible for field level maintenance for the company and may provide emergency
equipment maintenance for medical platoons throughout the BCT.
● Can dispatch Field Maintenance teams to support organic BCT units who lack the
capability to repair or maintain their own medical equipment.
● ATP 4-02.1 Army Medical Logistics contains additional information on medical equipment
maintenance support
❖ Field Maintenance Company (FMC)
➢ Provides field level maintenance for:
▪ Units in the brigade not supported by an (FSC)
▪ Specialized low density field maintenance to the entire brigade
➢ Structure is tailored to the supported brigade’s mission
➢ Provides back-up support to FSC’s
➢ Provides maintenance management support to brigade BSB
➢ Serves as the central entry and exit point into the for all equipment requiring evacuation for repair
➢ Offers expanded capability in armament, electronics, allied trades and ground support equipment
❖ Forward Support Company (FSC)
➢ Organic to the BSB’s within the BCT
▪ Normally receive mission command from the BSB commander
▪ FSC’s may be attached or placed under the Operational Control (OPCON) of the supported
battalion.
▪ Attachment or OPCON is generally limited in duration.
▪ Location is determined by the supported battalion and normally in close proximity to the
supported battalion.
▪ May be divided in order to best support the maneuver brigade mission
➢ Provide direct logistics support to the supported (Combat) Battalion
➢ Complete the link between the BSB and the supported battalion
➢ Provide commanders the greatest flexibility for providing logistics support across the brigade
➢ Organization (sub-organizations vary per BCT type)
▪ HQ
▪ Maintenance Platoon
❖ Maintenance Management Information Systems (Ground)
➢ Automation greatly increases the ability of maintenance managers to manage the flow of
maintenance data.
➢ Force XXI Battle Command, Brigade and Below (FBCB2) system
▪ Supports lower-echelon battle command tactical mission requirements
▪ Displays a common picture of the battlefield
▪ Provides enhanced capability to request maintenance support
➢ Global Command Support System - Army (GCSS-A)
▪ Replaced the Standard Army Maintenance System – Enhanced (SAMS-E)
▪ Provides consolidated maintenance and repair parts data
▪ Generally located at the Forward Support Companies (FSC), Field Maintenance Companies
(FMC), Brigade Support Battalions (BSB), Combat Sustainment Support Battalions (CSSB)
▪ GCSS-A is the Tactical Enterprise Logistics System (TELS) used for maintenance
management – can be used from any computer with NIPR connectivity
❖ Fundamentals of Maintenance
➢ Maintenance Functions
▪ Inspect
▪ Test
▪ Service
▪ Adjust/Align
▪ Calibrate
▪ Remove/Install
▪ Replace

▪ Repair
▪ Overhaul
▪ Rebuild
❖ Maintenance Organizations (Brigade and Below)
➢ Brigade Support Battalion (BSB)
➢ Field Maintenance Company (FMC)
➢ Forward Support Company (FSC)
➢ Brigade Support Medical Company
➢ Brigade Support Battalion Distribution Company
❖ Maintenance Support to Unified Land Operations
▪ Offense
● If offensive momentum is not maintained, the enemy may recover from the shock of the
first assault, gain the initiative, and mount a successful counterattack.
● Priorities and requirements for support may change rapidly.
♦ Planners ensure maintenance operations support momentum and massing at critical
points.
● Operators, crews and maintenance personnel:
♦ Maximize momentum by fixing inoperable equipment at the point of malfunction or
damage.
♦ Enhance momentum by keeping the maximum number of weapon systems
operational.
♦ Perform maintenance and recovery personnel as far forward as possible
▪ Defense
● Priority of protection goes to those units preparing positions and obstacles.
♦ Positions are prepared → priority shifts to protection of the reserve, BSA/trains and
command post locations.
● Maintenance considerations for defensive operations include:
♦ Planning to reorganize in order to replace lost maintenance capability
♦ Use maintenance teams well forward at collection points
♦ Plan to displace often
♦ Emphasize recovery and retrograde of equipment that require extended repair time.
● FSC’s Field Maintenance Platoon (FMP) takes all required steps to place as many
weapon systems as possible in serviceable condition.
● Operators, crews, and Field Maintenance Teams (FMT) perform any necessary repairs
authorized at their level of repair.
● Once defensive operations begin the principles are the same as for the offense
▪ Stability
● Sustainment for stability operations involves supporting U.S. and multi-national forces in
a wide range of missions.
● Maintenance assets are allocated based on those requirements.
● The key to success with stability operations is interagency coordination.
● Host-nation support, contracting, and local purchase are force multipliers in many of
these operations
▪ DSCA
● Foreign Humanitarian Assistance
♦ locate maintenance operations away from dense population centers
♦ identify maintenance sites easy to secure and defend
♦ Secure lines of communication
♦ Coordinate engineer support
♦ Establish entrance and exit control points/ maintain perimeter security
♦ Consider impact on the environment
● Disaster Relief
♦ Identify commercial vendors for support
♦ Coordinate other agencies, contractors, and local maintenance resources
➢ Recovery operations
▪ Process of repairing, retrieving/freeing immobile, inoperative, material from the point where it
was disabled or abandoned.
▪ Dedicated recovery assets must:

● Be strategically located for optimal support

● Used only when necessary
● Returned as quickly as possible after use.
▪ Recovery managers must use resources carefully to ensure continuous support
➢ Battle Damage Assessment and Repair (DBAR)
▪ Procedure used to rapidly return disabled equipment to the operational commander by field
expedient repair of components.
▪ Battle Damage Assessment is used to appraise system status focusing on mission essential
components only.
▪ Repairs are conducted using field expedient methods in order to repair only the damaged
mission essential equipment to an operational status.
▪ FM 4-30.31, Recovery and Battle Damage Assessment and Repair, provides information and
procedures for BDAR
❖ Maintenance Management
➢ Managing Battlefield Maintenance
➢ Maintenance Management Processes
▪ Maintenance Management Functions
● Forecasting
● Scheduling
● Production control
● Quality assurance
● Technical assistance
● Resourcing repair parts
● Work loading/cross-leveling regional workload
● Developing reparable programs to meet local, regional, and national needs
➢ Brigade/Battalion Level Maintenance Management
➢ Company Level Management
➢ Maintenance Management Information Systems (Ground)
❖ Levels of Management
➢ Brigade/Battalion Level Management (CSSB/BSB)
▪ Brigade/Battalion Support Operations Office (SPO)
● Coordinates all maintenance operations.
● Provides guidance on maintenance priorities, and sets objectives for production.
● Coordinates and integrates the brigade’s field maintenance mission and is a key element
in maintenance data collection ensuring its units provide automated data and generate
appropriate maintenance reports.
▪ At battalion level, the SPO manages supported customer units.
● Supervise, control and direct the operation of battalion units for field maintenance,
recovery, repair parts supply, and technical assistance
▪ Advises the Sustainment Brigade on maintenance and repair parts supply matters
➢ Company Level Maintenance (FSC/FMC)
➢ Command Maintenance Discipline Program (CMDP)
O506 HOMELAND DEFENSE AND DSCA

Discuss:
1. Which of the following is a primary task in DSCA?
a. Provide support for domestic civilian law enforcement agencies & Provide support for
domestic disasters & Provide support for domestic CBRN incidents
2. The primary documents containing national preparedness doctrine are: NIMS and NRF
3. Which of the following is not an overarching purpose of DSCA?
a. Conduct Law enforcement (true purpose: Save lives, alleviate suffering, protect property)
4. T /F. Title 10 forces responding domestically may participate in law enforcement
5. Which of the following pieces of legislation is most important to DSCA? The Stafford Act
6. What 3 organizations moved to DHS since its inception in 2002?
a. FEMA, Secret Service, Coast Guard
7. How many FEMA regions are in the U.S.?
a. 10

8. What is the principal difference between Homeland Defense (HD) and DSCA?
a. HD focuses externally and DSCA only looks inward
9. If a state’s National Guard responds in T32 status, who is in command of those forces?
a. The governor of the state
10. What is the position of the Title 10/O6 Army officer organic to each FEMA Region?
a. Defense Coordinating Officer
❖ Homeland Defense and DSCA

➢ Homeland Defense: Protection of United States sovereignty, territory, domestic population, and
critical infrastructure against external threats and aggression or other threats as directed by the
President (JP 3-27). DOD is lead agency.
➢ Defense Support of Civil Authorities (DSCA): Support provided by U.S. Federal military forces,
DOD civilians, DOD contract personnel, DOD Component assets, and National Guard forces
(when the Secretary of Defense, in coordination with the Governors of the affected States, elects
and requests to use those forces in Title 32, United States Code, status) in response to requests
for assistance from civil authorities for domestic emergencies, law enforcement support, and
other domestic activities, or from qualifying entities for special events
❖ Characteristics
➢ What shapes command decisions in DSCA?
▪ State and federal laws define military support
▪ Civil authorities are in charge
▪ Military departs when civil authorities are able to continue without support
▪ Military must document costs of direct and indirect support
❖ Range of Response
▪ National Guard forces
▪ Reserve Forces
▪ Title 10 Active forces
➢ Two methods for providing support:
▪ Incident occurs and DoD support is requested
● DoD support:
♦ 1. Federal agency requests assistance
♦ 2. DOD executive secretary processes request
♦ 3. Assistant Secretary of Defense (Homeland Security) and Joint Director of Military
Support process orders
♦ 4. SecDef approves orders
♦ 5. JDOMS issues orders to combatant commander (NORTHCOM or PACOM) or
Services
▪ Commander responds under own authority
● Commanders can support local communities under two different authorities:
♦ Memorandum of Agreement or Understanding
♦ Commander’s Immediate Response Authority
Short term humanitarian effort (generally not exceed 72 hrs)
▪ No official policy for immediate responses
▪ Situation dependent
▪ Under immediate response, commanders are authorized to respond without
a disaster declaration
▪ After the first 72 hours, guidance/approval from higher headquarters is highly
encouraged
Coordinate with the county/city emergency manager
Funded by the installation
(Disengagement is the hard part)
❖ Core Tasks – Role of DoD in DSCA operations:
➢ Provide support for domestic disasters
➢ Provide support for domestic civilian law enforcement
➢ Provide support for domestic CBRN incidents
➢ Provide other designated domestic support
❖ Mission Command in DSCA
➢ Army Forces and Status

▪Governor - National Guard & Civil Support, National Guard in Title 32 duty status
▪President - Defense support of civil authorities (all Regular Army, Army Reserve, and NG in
Title 10 status)
➢ USNORTHCOM & NORAD - both located at CO Springs, CO; same commander
➢ USNORTHCOM - homeland security functions for DoD are the responsibility of USNORTHCOM
▪ has to anticipate requests for assistance and mission assignments and be in a position to
rapidly provide any and all assistance that our civil authorities require
▪ Has to anticipate requests for assistance and mission assignments and be in a position to
rapidly provide any and all assistance that our civil authorities require
➢ NORAD - Many of the functions for homeland defense are the responsibility of NORAD
➢ USPACOM & USSOUTHCOM - area of responsibilities include US territories, HI

❖ Unified Action in DSCA
➢ Slide 20
➢ FEMA - Coordinate the federal government’s response to emergencies and major disasters,
natural and man-made, including acts of terrorism: “all-hazards”
▪ Save lives, Protect Property, Ensure basic human needs are met
❖ Legal
➢ Stafford Act **
▪ Authorizes the President to issue major disaster declarations - authorizes federal agencies to
provide assistance to states overwhelmed by disasters
● Major Disaster – Issued after request by governor.
● Emergency – Similar to major disaster but may be issued without governor request – if
primary responsibility rests with the federal government.
● Fire Suppression – Assistance when fires threaten such destruction to warrant major
disaster.
● Defense Emergency – Request by governor – emergency work not to exceed 10 days –
limited to preservation of life and property.
● Pre-Declaration Activities – Preparedness and preliminary damage assessments,
coordination, employee alerts
▪ Responsibility for administering delegated to FEMA by Executive Order.
▪ Assistance available to individuals, families, state and local governments and certain non-
profit organizations.
▪ Funds provided through the Disaster Relief Fund
➢ Posse Comitatus Act
▪ Prohibits use of federal troops for law enforcement
▪ Air Force and Army identified
▪ Navy and Marine Corps included by DoD Policy
▪ Annual DoD Authorization Act allows use for drug interdiction
➢ Insurrection Act
▪ Coupled with the Posse Comitatus Act (Title 10 USC, Sections 331-335).

▪ Allows the President to use US military personnel at the request of a state legislature or
governor to suppress insurrections.
▪ Also allows the President to use federal troops to enforce federal laws when rebellion against
the authority of the US makes it impracticable to enforce the laws of the US
➢ Economy Act - Section 1535, Title 31 United States Code)
▪ Authorizes federal agencies to provide supplies and services to each other.
▪ Mandates cost-reimbursement
➢ Title 10, United States Code (reserve components)
▪ May order member, without consent, to active duty not more than 15 days a year. May
retain, with consent, on active duty anytime.
▪ May order to active duty for national emergency for not more than 24 consecutive months.
▪ Order to active duty other than during war or national emergency - No reserve units or
members may be ordered to active duty for a disaster, accident, or catastrophe.
▪ Exception: “Responding to an emergency involving use or threatened use of a weapon of
mass destruction.”
▪ National Guard in federal service: President may call into federal service whenever:
● (1) The United States, or any of the territories, commonwealths, or possessions, is
invaded or is in danger of invasion by a foreign nation;
● (2) There is a rebellion or danger of a rebellion against the authority of the government of
the United States; or
● (3) The President is unable with the regular forces to execute the laws of the United
States
➢ Policy
▪ Key Policy Documents
● Presidential Policy Directive 8 - Building and sustaining national readiness
● National Incident Management System (NIMS) - Template for managing incidents at all
levels of government
♦ http://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf
♦ Basic Concept: Flexibility, Standardization
♦ Components: Preparedness; Communications and Info management; Resource
Management; Command and Management; Ongoing Management and Maintenance
● National Response Framework (NRF) - Emphasis on response
♦ Functions:
● National Security Strategy - Develop, apply, and coordinate national power
AS215.1 AHS SUPPORT TO DSCA
Discuss:
1. How does the DoD support the National Disaster Medical System? Operate SCCs, supplement
medical care, provide medical transportation via TRANSCOM
2. T/F. DoD is the lead agency for Emergency Support Functions #8 and #11. [civilian authority]
3. An active component AMEDD officer is likely to support DSCA as part of the operating force in what
capacity? TO&E unit assigned to NORTHCOM force package

4. An active component AMEDD officer is likely to support DSCA as part of the generating force in what
capacity? TDA FCC supporting regional DSCA operation
5. T/F. Military forces remain OPCON to their military chain of command and are direct support to the
civilian incident commander while at the incident site.
❖ DSCA Overview
➢ Include specific DOD medical responsibilities as part of the National Disaster Medical System
(NDMS) and the National Response Framework (NRF) under Emergency Support Function
(ESFs), specifically:
▪ ESF #8, Public Health and Medical Services
▪ ESF #11, Agriculture and Natural Resources
❖ DSCA Tasks
➢ While DSCA tasks may require various types and levels of support, the primary purpose of such
missions are to:
▪ Save lives
▪ Alleviate suffering
▪ Protect property
➢ The primary Army DSCA tasks are to:
▪ Provide support for domestic disasters
▪ Provide support for domestic CBRN incidents
▪ Provide support for domestic civilian law enforcement agencies
▪ Provide other designated support
❖ DSCA Characteristics
➢ Four primary characteristics of DSCA tasks are:
▪ State/federal laws define how military forces support civil authorities
▪ Civil authorities are in charge and military forces support them
▪ Military forces depart when civil authorities can continue w/o military support
▪ Military forces must document costs of all support provided
❖ Review of terms
➢ National Incident Management System (NIMS): A comprehensive, nationwide, systematic
approach to incident management, including the incident command system, multiagency
coordination systems, and public information
➢ National Response Framework (NRF): describes the guiding principles, roles and
responsibilities, and structures for implementing nationwide response policy and operational
coordination for any type of disaster or emergency regardless of scale, scope, or complexity
➢ Emergency Support Functions (ESF): is the grouping of governmental and certain private
sector capabilities into an organizational structure in support of a domestic incident
➢ National Disaster Medical System (NDMS): an interagency partnership between the DHHS,
DOD, DHS, and the VA established to augment the Nation’s medical response capabilities
▪ NDMS combines federal and nonfederal resources into a unified response to meet natural
and man-made disasters and support patient treatment requirements from military
contingencies
▪ NDMS’s mission is to temporarily supplement federal, tribal, state, and local capabilities by
funding, organizing, training, equipping, deploying, and sustaining a specialized and focused
range of public health and medical capabilities
● Components of NDMS:
♦ Medical response to a disaster area in the form of personnel (teams and individuals),
supplies, and equipment.
♦ Patient movement from a disaster site to unaffected areas of the nation.
♦ Definitive medical care at participating hospitals in unaffected areas
● Activation of NDMS does not necessarily mean that all active Army, Reserve Component,
and National Guard are activated.
♦ ex/ Disaster medical assistance teams are activated to provide medical response, but
the patient movement and definitive care components are not activated
❖ DOD & AHS Support within NRF
➢ The DOD is considered a supporting agency for all NRF ESFs

➢ Serves as the coordinator and primary agency (through the U.S. Army Corps of Engineers) for
ESF #3, Public Works and Engineering.
➢ The DOD is also the primary agency for aeronautical search and rescue under ESF #9, Search
and Rescue.
➢ During domestic disasters, primary DOD functions in support of the federal medical response are
outlined in ESFs #8, Public Health and Medical Services and #11, Agriculture and Natural
Resources
❖ DOD & AHS Support to NDMS
➢ The NRF activates the NDMS under ESF #8 for management and coordination of the federal
medical response to major emergencies
➢ Under NDMS patients moved from a disaster area to a federal coordinating center (FCC) patient
reception area
➢ The mission of the FCCs is to receive, triage, stage, track, and transport inpatients affected by
the disaster to a participating inpatient hospital capable of providing definitive care.
➢ There are 15 DOD MTFs within the DOD designated as FCCs
➢ DOD also:
▪ Supplement DHHS emergency medical care
▪ Provide necessary patient transportation assets via TRANSCOM
❖ AHS & NRF: ESF #8
➢ DHHS serves as the coordinator and primary agency for ESF #8
➢ Under ESF #8, public health and medical services are delivered through surge capabilities that
augment public health, medical, behavioral, and veterinary functions with health professionals
➢ Supplemental assistance is also provide many functional areas, to include:
▪ Health surveillance, medical surge, medical supplies, patient movement, patient care, vector
control, safety and security of drugs, blood and tissue, food safety and defense, behavioral
health, preventive medicine, mass fatality management, victim identification
➢ See ATP 4-02.42, Table 6-1 for a list DOD functions ISO ESF #8
❖ AHS & NRF: ESF #11
➢ DHS/FEMA activates ESF #11
➢ U.S. Department of Agriculture coordinates for ESF #11
➢ ESF #11 primary functions, include:
▪ Providing nutrition assistance
▪ Responding to animal and agricultural health issues
▪ Providing technical expertise in support of animal and agricultural emergency management
▪ Ensuring the safety and defense of the Nation’s supply of meat, poultry, and processed egg
products
▪ Protecting natural, cultural, and historical resources
➢ See ATP 4-02.42, Table 6-2 for a list DOD functions ISO ESF #11.
❖ Legal Considerations
➢ During a DSCA operation, a careful understanding of eligibility criteria is necessary to ensure that
medical personnel know when and how they may or may not treat civilian casualties
➢ The Joint Task will issue Medical Rules of Eligibility (MROE)
➢ Bottom line; authorization is implied when the SECDEF approves a request for medical units to
deploy to the scene of a disaster at the request civil authorities
➢ Pursuant to the Federal Tort Claims Act, DOD health care providers will not face personal liability
if there is a “therapeutic misadventure” while providing medical care during an emergency or
disaster
❖ Medical Functional Areas & DSCA
➢ AHS support to DSCA will be tailored to meet the specific mission. Determining factors
include:
▪ Type, severity, and geographic location of the incident
▪ Capabilities available within the local community
▪ Health threat and anticipated patient workload
➢ The AHS can be called upon to provide assets from each of the ten medical functional
areas (MFAs) to:
▪ Support the activation of an Army HRP designated as a federal coordinating center (FCC)
▪ Support a military health emergency
▪ Provide personnel to assist in the medical response

➢ DSCA - Hospitalization
▪ Hospitalization in the generating force consists of fixed HRPs capable of providing definitive
care to conclusively manage patient conditions
▪ Definitive care within the DoD includes all of the capabilities embedded in the MHS, plus
extraordinary preventive, restorative, and rehabilitative capacity that may not exist in smaller
facilities
▪ Within CONUS - represent the most definitive medical care available within the MHS and are
expanded to include VA and civilian hospitals to meet the requirements of the NDMS
▪ Army HRPs/FCC may be activated/alerted to provide this support
▪ Deployable Role 3 units (CSH, Field Hospitals, or EMEDS) may be assigned to NORTHCOM
response force packages (DCRF/SWRF)
➢ DSCA - Medical Mission Command
▪ During DSCA, military forces are operating in support of federal, state, and local authorities
which will require that the MMC system, organizations, and procedures be adapted to
function within a non-combat, civilian-led structure
▪ MMC - key function to coordinate, integrate, and synchronize AHS resources in support of
interagency efforts. AHS support is provided by both the operating and generating force, to
include:
● Army HRPs activated to function as NDMS FCCs
● Specialized medical capabilities such as MEDCOM’s designation as the theater lead
agent for MEDLOG support to NORTHCOM
● Deployable AHS MMC organizations deployed ISO NORTHCOM
▪ Incident Command (IC) system effectively integrates government agencies and NGOs within
common organizational structure
● Organizes on-scene operations for a broad range of emergencies
● Responsible for overall management of an incident and consists of an incident
commander
♦ Single or unified command structure
♦ Unified command - defined by the incident command system from the military use of
this term
● Military forces remain OPCON/ADCON to their military CoC and work ISO the civilian
incident commander
➢ DSCA - Medical Treatment
▪ Includes Roles 1 and 2 medical support provided by organic assets or on an area support
basis by medical companies or detachments
▪ Medical force package (i.e. Role 2 medical company) may be task-organized based on
specific mission requirements to provide triage and treatment, augmented with a surgical
capability to stabilize disaster victims for evacuation out of the area of operations.
▪ Medical treatment or trauma care can also be provided by a FCCs
▪ Role 2 medical company may also be deployed to provide medical treatment for military
personnel operating ISO DSCA
➢ DSCA - Medical Evacuation
▪ NRF provides detailed information on medical evacuation/medical regulating requirements
and responsibilities during a federal response
▪ The Global Patient Movement Requirements Center (GPMC) is the DOD agency responsible
for regulating patients from major disaster sites that require activation of the NDMS, the
GPMC:
● Receives the patient’s medical information
● Determines the medical equipment needed for ground or air transport
● Coordinates movement to the FCC’s patient reception area
● Communicates with the FCC concerning medical MEDEVAC missions
▪ AHS MEDEVAC and medical regulating support provided during a incident will differ
depending upon the type of activity supported
▪ AHS ground and aeromedical evacuation may be used to evacuate/rescue civilian personnel
▪ Commanders must have clearly defined guidelines as to the scope of the MEDEVAC
operations IOT maximize MEDEVAC assets
▪ AHS MEDEVAC assets are required to evacuate military personnel from Roles 1, 2 and
between Role 3 treatment facilities

● Service component responsibility

▪ MEDEVAC from Role 3 hospitals is accomplished TRANSCOM (U.S. Transportation
Command)
➢ DSCA - Medical Logistics
▪ MEDCOM is the designated theater lead agent for medical materiel (TLAMM) to
USNORTHCOM
● The NORTHCOM Commander may designate any Service component as the Single
Integrated Medical Logistics Manager (SIMLM)
▪ CL VIII may be donated from a variety of sources with no single organization designated to
provide support for handling all of it
● MEDLOG element may be deployed to manage, sort, store, repackage, distribute, and
account for all donated supplies
▪ Medical equipment maintenance support is accomplished by the medical maintenance
section of the MEDLOG company and may support civilian agencies
▪ Blood support to DSCA tasks consists of U.S.-based resupply of blood and blood products for
deployed forces
▪ The CDC and Prevention’s Strategic National Stockpile is designed to supply medical
supplies and equipment in the event of a disaster or emergency, DoD or VA may also provide
supplies
➢ DSCA - Medical Laboratory
▪ Consists of clinical and operational capabilities:
● Clinical laboratory services are provided in support of individual patient care (provided by
Role 2 MTFs)
● Operational laboratory support focuses on the total health environment of the theater
(provided by area medical laboratory)
▪ Many medical laboratories throughout the country have state-of-the-art equipment and may
be called upon to respond during an emergency known as the Laboratory Response Network
● Integrated national and international network of laboratories fully equipped to respond to
the need for rapid testing/notification and secure messaging
● The U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID) is the
only lab within the DoD equipped to study highly hazardous pathogens
● USAMRIID serves as the Army’s representative in the Laboratory Response Network
➢ DSCA - Preventative Medicine
▪ Disease and non-battle injuries (DNBI) are the primary health threat during DSCA operations;
must also be assessed in terms of their impact on the civilian population in affected area
▪ Injuries from exposure to occupational and environmental health hazards (i.e. toxic industrial
materials) pose a significant threat during a disaster
▪ PM personnel may be called upon to:
● Provide guidance and assistance in restoring public health services
● Conduct epidemiological investigations
● Prepare educational programs in field hygiene and sanitation to victims
▪ PM personnel can also provide technical advice to assist local authorities in recovery
operations:
● Clearing debris from drainage structures
● Collection and disposal of animal carcasses
● Collection and disposal of food condemned by local authorities
● Preparation of homes for re-entry by homeowners
➢ DSCA - COSC
▪ Behavioral health personnel play a major role in disaster relief efforts during DSCA: provide
support to both the deployed force and civilian disaster victims and may be requested to:
● Provide assistance in assessing mental health and substance abuse needs
● Provide disaster mental health training
● Provide additional consultation and education as needed
▪ Commanders appoint a disaster-trained, licensed behavioral health provider as disaster
mental health response team lead
▪ Behavioral Health Support
● The adverse effects of stress not only impact the victims of an incident, but Family
members, friends, rescue workers, medical personnel, and others supporting a disaster

● Resiliency measures should be instituted for both military and civilian emergency
responders
▪ Religious Support: Army chaplains are trained to recognize signs and administer support to
Soldiers exposed to potentially traumatic events
▪ Disaster Mental Health Response Team: The designated team that provides command
consultation, prevention, outreach, screening, triage, and psychological first aid, education,
and referral services following an all-hazards incident. The team shall:
● Consist of (at a minimum) individuals in each of the following:
♦ Behavioral Health (psychiatrist, psychologist, social worker, etc)
♦ Spiritual Support (chaplain or chaplain’s assistant)
♦ Family Support (community readiness consultant)
▪ Responsible for:
● Coordinating with family assistance centers
● Establishing SOP (team composition/role, locally trained resources, response/activation
plan, initial/periodic training, etc.)
● Conducting quarterly training
➢ DSCA - Dental
▪ Due to the capabilities available within the U.S. civilian health care system - dental support to
DSCA tasks may be limited
▪ Operational dental support, including emergency and essential dental care, to the deployed
force is the primary role of Army dental personnel
▪ Support ranges from traditional support to deployed military forces to the emergency dental
support including treatment for maxillofacial injuries
▪ The DoD may also be tasked to assist in reestablishing and augmenting civilian dental
infrastructure following a disruption caused by a natural or man-made disaster or civil
disturbance
➢ DSCA - Veterinary
▪ U.S. Army Veterinary Services is the DoD Executive Agent for veterinary public and animal
health services in support of all Services
▪ ESF #11 lists the DoD as the agency responsible for assessing the availability of DoD food
supplies and storage facilities and assisting animal emergency response organization
▪ The veterinary services animal care mission provides complete medical care for military
working dogs and other non-DoD owned government animals located in the area of
operations
▪ The Pets Evacuation and Transportation Standards Act of 2006 ensures state/local
emergency plans address the needs of individuals with household pets/service animals
following a major disaster or emergency
❖ AHS response to CBRN
➢ Provide medical care to casualties at the mass casualty decontamination site
➢ Supervise patient decontamination at the patient decontamination site
➢ Provide enroute care for patients from the incident site to treatment facilities
➢ Provide guidance to local responders in the management of CBRN casualties
➢ Provide CBRN levels of identification and analysis
➢ Provide guidance on the application of standard precautions for CBRN
➢ Manage, triage, and treat mass casualties
❖ Joint Staff DSCA EXORD Forces
➢ CAT 1: Assigned/Allocated
▪ COCOM can place on 24 hour PTDO. Deploy forces after SECDEF and CJCS notification.
Employ forces on receipt of COCOM approved RFA ISO PA after SECDEF and CJCS
notification
● No Medical Forces
➢ CAT 2: Pre-Identified Resources
▪ COCOM may publish message traffic requesting forces be deployed, attached, or placed on
24 hour PTDO. Units will not be expected to deploy in less than 48 hours.
● Deployable Medical Platform (EMEDS)
● NDMS Patient Movement Enablers
● Federal Coordinating Centers (FCCs)
➢ CAT 3: Internal DOD Use Only

▪
COCOM may publish message traffic requesting forces be deployed, attached, or placed on
24 hour PTDO. Units will not be expected to deploy in less than 48 hours.
● Med Logistics Management Center (MLMC)
● Med Detachment (Preventive Medicine)
➢ CAT 4: Large Scale Response
▪ Request For Forces (RFF) Required (CRE)
▪ COCOM requests these forces thru normal RFF process (GFM/GFMIG); PA RFA not
required to submit RFF Forces should BPT deploy within 96 hours of notification
● Area Support Medical Company
● Med Logistics Management Center (MLMC)
● Med Logistics Company
● Med Detachment (Preventive Med)
● Med Detachment (Veterinary Services)
❖ NORTHCOM AHS Force Packages
➢ CBRN Response Enterprise (CRE)
▪ Defense CBRN Response Force (DCRF) COMPO 1
▪ Technical Support Force (TSF) Mass Casualty Denomination
▪ General Support Force (GSF)
➢ C2CBRN Response Enterprise (C2CRE)– A/B
▪ TSF [Mass Casualty Decontamination (MCD)] COMPO 1 & 2
▪ GSF (Medical) COMPO 3
➢ FORSCOM Severe Weather Response Force (SWRF)
▪ Medical Brigade Headquarters
▪ Multifunctional Medical Battalion
▪ Area Support Medical Company
▪ Med Logistics Management Center
▪ Med Logistics Company
▪ Med Detachment (Preventive Med)
▪ Med Detachment (Veterinary Services)
▪ Combat Support Hospital (44 bed)
OP112 THE COMMAND POST ORGANIZATIONS AND OPERATIONS
Discuss:
1) Within a CMD Post what does the protection cell do?
a. Preserves the force through composite risk management.; Manned by members of
several staff sections: air and missile defense; chemical, biological, radiological, nuclear,
and high-yield explosives; engineer; and provost marshal (among others).
❖ Fundamentals of Command Post Organization and Operations

➢ Command Post - unit HQ where the commander and staff perform their activities
▪ Types of Command Posts (Gives commanders a flexible mission command structure):
● Main CP
● Tactical CP
● CMD Group for BDEs, divisions, corps
▪ Combined arms battalions also resourced with a combat trains CP and field trains CP
▪ Theater army HQ are resources with a main CP and contingency CP
➢ Mission command structure
▪ Where commander and staff perform activities common to all CPs including:
● Maintaining running estimates and the COP
♦ Running estimates: a staff officer’s ongoing assessment of how current operations
are going and if planned future operations are supportable. A good staff officer will be
able to provide an up-to-date running estimate on demand
● Controlling operations
♦ The control aspect of mission command focuses more on science than art. A
significant aspect of control is an understanding of physical capabilities and

limitations of both friendly and enemy organizations (time-distance, systems

capability, etc.)
● Assessing operations
♦ A staff exists to assist the commander understand. Part of this understanding is the
continuous monitoring and evaluation of the current situation
● Developing and disseminating orders
● Coordinating with higher, lower, and adjacent units
● Conducting knowledge management and information management
● Performing CP administration (displacing, security)
● Supporting the commander’s decision-making process
● Provide a facility for the commander control operations, issue orders and conduct
rehearsals
● Maintaining a common operational picture
● Conduct network operations
❖ Three Types of Army Staff Groups
➢ Staff section- grouping of staff members by area of expertise under:
▪ Coordinating staff officer
● Assistant chief of staff (ACOS) G-1 (S-1)—personnel • ACOS, G-2 (S-2)—intelligence •
ACOS, G-3 (S-3)—operations • ACOS, G-4 (S-4)—logistics • ACOS, G-5—plans •
ACOS, G-6 (S-6)—signal • ACOS, G-7 (S-7)—inform and influence activities
▪ Special staff officer
● AIR AND MISSILE DEFENSE OFFICER • AIR LIAISON OFFICER • AVIATION
OFFICER • CBRN OFFICER • CIVILIAN PERSONNEL OFFICER • COMMAND LIAISON
OFFICER • DENTAL SURGEON • ELECTRONIC WARFARE OFFICER • ENGINEER
OFFICER • EXPLOSIVE ORDNANCE DISPOSAL OFFICER • EQUAL OPPORTUNITY
ADVISOR • FORCE MANAGEMENT OFFICER • FOREIGN DISCLOSURE OFFICER •
HISTORIAN
▪ Personal staff officer
● AIDE-DE-CAMP • CHAPLAIN • COMMAND SERGEANT MAJOR • INSPECTOR
GENERAL • INTERNAL REVIEW OFFICER • PUBLIC AFFAIRS OFFICER • SAFETY
OFFICER • STAFF JUDGE ADVOCATE • SURGEON
❖ Types of Command Posts
➢ Platoon, Company, Battalion, Brigade, Division, Corps
❖ Command Post Organization
➢ CP Cell - grouping of personnel and equipment organized by WFF or planning horizon to
facilitate the exercise of military command
▪ Functional Cells - coordinate and synchronize forces and activities by warfighting function
● Intelligence Cell
♦ Helps the commander understand enemy, terrain and weather, and civil
considerations.
♦ Requests, receives and analyzes information to produce and distribute intelligence
products
➢ Information without analysis is not intelligence
● Movement and Maneuver Cell
♦ Coordinates activities and systems to allow the commander to gain a positional
advantage.
♦ Maneuver: employment of forces through movement in combination with fires.
♦ Movement: Distribution over lines of communication.
♦ Manned by aerospace command/control (AC2), aviation, engineer, geospatial, and
space personnel
● Fires Cell
♦ Coordinates use of Army indirect fires, joint fires, and cyber-electromagnetic activities
through the targeting process
♦ Led by fire support officer (BDE and below)
♦ Manned by elements of fire support, the USAF, and the Electronic Warfare staff
section
● Protection Cell
♦ Preserves the force through composite risk management.

♦ Manned by members of several staff sections: air and missile defense; chemical,
biological, radiological, nuclear, and high-yield explosives; engineer; and provost
marshal (among others)
● Sustainment Cell
♦ Coordinates for support and services that ensure freedom of action, extended
operational reach, and prolonged endurance
♦ Most tasks are associated with logistics, personnel services, and Army health support
system
♦ Manned by representatives from personnel, logistics, financial management,
engineer, and surgeon
● Mission Command
♦ Command Post - assist the commander in the exercise of mission command
➢ Therefore, commanders do not form a specific mission command functional cell
➢ All CP cells and staff sections assist the commander with specific tasks of the
mission command WfF
▪ For example, all functioning and integrating cells assist the commander in the
operations process. As such, the CP as a whole, including the commander,
deputy commanders, CSMs, represents the mission command WfF. FM 6-0
para 1-30 p. 1-5 to 1-6
▪ Integrating Cells - coordinate and synchronize forces and warfighting functions within a
specified planning horizon
● (Doctrine is descriptive, not prescriptive)
● Plans Cell
♦ Planning Responsibilities
➢ Plans for long-range planning horizons.
➢ Develops plans and orders, including branch plans and sequels beyond the
current order.
➢ Oversees military deception planning
● Future Operations Cell (FOUP)

♦ Plans for in mid-range planning horizon.
♦ Divisions and above have a future operations cell.
♦ Battalion and brigades do not have a future operations cell
● Current Operations Integration Cell (COIC)
♦ Assesses the current situation, regulates forces and warfighting functions IAW
mission, commander’s intent, and concept of operations.
♦ Displays the comm on operational picture and conducts shift
♦ Changes, assessments, and other briefings as required
➢ Establish a Common Operating Picture (COP)
▪ A single display of relevant information within a CDR’s area of interest tailored to the user’s
requirements and based on common data and information shared by more than one CMD
● An information requirement is any information element the commander and staff require
to successfully conduct operations. Relevant information that answers information
requirements is—

♦ Accurate: conveys the true situation.

♦ Timely: available in time to make decisions.
♦ Usable: portrayed in common, easily understood formats & displays.
♦ Complete: provides all information necessary.
♦ Precise: contains sufficient detail.
♦ Reliable: trustworthy and dependable
➢ Battle Rhythm
▪ Deliberate daily cycle of command, staff, and unit activities (primarily meetings and briefings)
intended to synchronize current and future operations
● Establishes a routine for staff interaction and coordination.
● Facilitates interaction between the commander and staff.
● Synchronizes the staff in time and purpose.
● Facilitates planning by the staff and decision-making by the commander.
▪ Considerations :
● Higher HQs’ battle rhythm & report requirements.
● Subordinate HQs’ battle rhythm & requirements.
● The duration and intensity of the operation.
● Integrating cells’ planning requirements
▪ See slide deck for BCT 2400 Battle Rhythm
▪ See slide deck for Targeting Meeting Quad Chart example
▪ CEMA Working Group
● Lead by the Electronic Warfare Officer (EWO) (O4)
● Additional Team Members:
♦ S2, S3, S6, S7, S9, STO, KMO, LNOs, FSCOORD, JAG, ADAM/BAE, Space
● Anyone who has operations using the Electromagnetic Spectrum
▪ Every soldier is an operator
● CEMA systems are only as effective as their operators
● Incorporate into SOPs and training
▪ Working Groups - major part of CP’s battle rhythm (overseen by COS or XO)
● Scheduled and sequenced logically so one group’s outputs become the next group’s
inputs
● Allow time between meetings for analysis & preparation
● Attendance decisions are critical—some staff groups may not have adequate personnel
to attend all WG’s
● When one is attending a meeting, he or she is not attending to other duties and
responsibilities.
● Combine WG’s when feasible to reduce the number of meetings
▪ Boards
● Grouping of predetermined staff reps with delegated decision authority for a particular
purpose or function.
● Similar to working groups except for the additional authority.
● Commanders determinef the subjects boards address and the membership.
● Unit SOPs establish the following for each board: purpose, frequency, required inputs,
expected outputs, attendees, agenda
▪ Bureaus
● A long-standing functional organization, with a supporting staff designed to perform a
specific function or activity within a JFC's HQ.
♦ Examples: Joint Visitor Bureau (JVB) and Joint Information Bureau (JIB)
▪ Centers
● A command and control facility established for a specific purpose with a narrow focus.
♦ Centers are common at operational echelons; for example the Joint Interrogation and
Debriefing Center of a JTF and the Theater Materiel Management Center of an Army
Service Component Command.
♦ Centers are also formed by Army tactical commanders; for example, a civil affairs
battalion under the operational control of a division normally establishes a Civil-
Military Operations Center.

AS215.2 HOSPITAL INCIDENT COMMAND SYSTEM (HICS)

❖ History
➢ NRF - provides structure and mechanisms for national level policy of incidence response
➢ NIMS - companion document to NRF that provides template for management of any type of
incident
➢ Homeland Security Presidential Directive – 5 (HSPD-5) created the National Incident
Management System (NIMS) → NIMS provides structure to the Incident Command System (ICS)
→ The Hospital Incident Command System (HICS) is how hospitals integrate the ICS process in
their Emergency Management Programs
▪ NIMS - foundation or architecture that all (including Hospital) ICS programs are maintained or
modified after
❖ What NIMS “is” and “is not”
➢
❖ The Incident Command System
➢ Standardized management tool for meeting the demands of small or large emergency or non-
emergency situations
▪ Represents “best practices” and has become the standard for emergency management
across the country.
▪ May be used for planned events, natural disasters, and acts of terrorism.
▪ Is a key feature for the National Incident Management System (NIMS)
❖ Flow of Requests and Support
➢ Incident complexity is considered when making incident management level, staffing, and safety
decisions
▪
❖ Objectives of HICS

➢ Managing all routine or planned events, of any size or type, including emergent events, by
establishing a clear chain of command
➢ Allow personnel from different departments and services to be integrated into a common structure
that can effectively address issues and delegate responsibilities
➢ Provide needed logistical and administrative support to operational personnel
➢ Ensure key functions are covered and eliminate duplication
❖ HICS Planning Process
➢ Process may begin with the scheduling of a planned event, the identification of a credible threat,
or the initial response to an actual or impending event.
➢ The incident planning process takes place regardless of the incident size or complexity
➢ Steps of HICS Planning Process -
❖ Hospital Emergency Management Plan

➢ Developed from the Emergency Operations Plan (EOP) much like an OPORD or OPLAN
➢ Includes the following steps
▪ Designating an Emergency Program Manager
▪ Establishing the Emergency Management Committee
▪ Developing the “all hazards ” Emergency Operations Plan
▪ Conducting a Hazard Vulnerability Analysis
▪ Developing incident-specific guidance (Incident Planning Guides)
▪ Coordinating with external entities
▪ Training key staff
▪ Exercising the EOP and incident-specific guidance through an exercise program
▪ Conducting program review and evaluation learning from the lessons that are identified
❖ Checklists
➢ present guidelines and tasks each position must accomplish or consider, to include the Incident
Commander
❖ HICS - Command Structure
➢ Command staff - carry out functions to support the IC

➢ General Staff - responsible for functional aspects

OP141 RAPID DECISIONMAKING & SYNCHRONIZATION PROCESS (RDSP)
❖ Compare MDMP & RDSP

➢ Similarities
▪ Deliberate analytical approach to problem solving
▪ Produces an order
▪ Seeks an optimal solution
➢ Differences (RDSP-oriented)
▪ Intuitive approach to problem solving
▪ Relies on a previously published order (intent, concept, CCIR)
▪ Produces a timely and effective solution
❖ RDSP defined
➢ A model for commanders and staffs to use during current operations to determine if they are still
on plan or if a change is required
➢ Decision making and synchronization technique that commanders and staffs commonly use
during execution.
➢ Approach is not new; its use in the Army is well established.
➢ Commanders and staffs develop this capability through training and practice
▪ Seeks a timely and effective solution within the commander’s intent, mission, and concept of
operations
▪ Lets leaders avoid the time-consuming requirements of developing decision criteria and
comparing COA
▪ Mission variables continually change during execution, which often invalidates or weakens
COAs and decision criteria before leaders can make a decision
▪ Leaders combine experience and intuition + situational awareness to quickly reach situational
understanding → develop and refine workable COAs
❖ RDSP - meets following criteria for effective decision during execution:
➢ Comprehensive, integrating all warfighting functions - not “stove-piped”
➢ Ensures all actions support the decisive operation by relating them to the commander’s intent and
concept of operations.
➢ Allows for rapid changes to the order or mission
➢ Is continuous, allowing commanders to react immediately to opportunities and threats.
➢ Accommodates, but is not tied to, cyclical processes such as targeting
❖ RDSP Critical Skills
➢ Recognize when a variance requires an adjustment
➢ Visualize several possible COAs and rapidly select an acceptable one
➢ Recognizes what actions are feasible in the time available
❖ Variance
➢ A difference between the actual situation during an operation and what the plan forecasted the
situation would be at that time or event

❖ Execution Decision
➢ Implement a planned action under circumstances anticipated in the order. In their most basic
form, execution decisions are the decisions the commander foresees and identifies for execution
during the operation
❖ Adjustment Decisions
➢ Modify the operation to respond to unanticipated opportunities or threats. They often require
implementing unanticipated operations and resynchronizing the warfighting functions
❖ Decision Types and Related Actions
➢
❖ Five Steps of RDSP
▪ Steps 1 & 2 two may be performed in any order
▪ Steps 3 to 5 are performed interactively until commanders identify an acceptable course of
action
➢ Step 1: Compare the current situation to the order (expected situation)
▪ Identify WFF variances
▪ Analyze inputs from ISR efforts
▪ Analyze inputs from units (from SITREPS and SPOT reports)
▪ Identify Exceptional Information
➢ Step 2: Determine that a decision has to be made, and what type is required
▪ Describe the variance
● Does variance provide a significant opportunity or threat?
● Determine if a decision is needed by identifying the variance—
▪ Directly threatens the decisive operation success
▪ Indicates an opportunity that can be exploited to accomplish the mission faster or with fewer
resources
▪ Threatens a shaping operation such that it may threaten the decisive operation directly or in
the near future
▪ Can be addressed within the existing commander’s intent and concept of operations
▪ Requires changing the concept of operations substantially
➢ Step 3: Develop a response
▪ If the variance requires an adjustment decision, screen possible COAs based on:
● Mission
● Commander’s intent
● Current dispositions and freedom of action
● CCIRs
● Limiting factors, such as supply constraints, boundaries, and combat strength
▪ Goal: Acceptable COA - may not have time to synchronize the optimal COA

➢ Step 4: Refine & validate the COA

▪ Refinement and validation occurs quickly
▪ If COA is acceptable - refine to resynchronize WFF
▪ Must consider enemy reactions, unit’s counter actions, and secondary effects
▪ If COA is unacceptable - inform the commander with recommended changes
▪ COA Feasibility
● Is the new COA feasible in terms of my area of expertise?
● How will this action affect my area of expertise?
● Does it require changing my information requirements?
♦ Should any of the information requirements be nominated as a CCIR?
♦ What actions within my area of expertise does this change require?
♦ Will it require changing objectives or targets nominated by the staff section?
● What other command post cells and elements does this action effect?
● What are the potential enemy reactions?
● What are the possible friendly counteractions?
➢ Step 5: Implement
▪ Collaborative synchronization
● Update DSTs and synchronization matrices
● Commanders communicate/synchronize with higher, adjacent, and subordinate
commanders
● Subordinates execute initiative within commander’s intent, planning guidance, and CCIR
▪ Issue FRAGORD or new OPORD with updated control measures:
● Enemy situation, including the situation template
● Revised CCIRs
● Updated ISR plan
● Updated scheme of maneuver and tasks to maneuver units, including and execution
matrix and decision support matrix (DSM) or a template (DST)
● Updated scheme of fires, including the fire support execution matrix, high-payoff target
list, and attack guidance matrix
● Updated information tasks
▪ Conduct confirmation and back-briefings as needed
❖ Cautions
➢ Designed to be intuitive using only minimum coordination required
➢ Decisions made at the lowest level - even small changes have an impact
➢ Must keep decision support tools current
➢ Must weight the decisive operation - use minimum force required for all shaping operations
➢ Must continually reprioritize - execution is multilayered
➢ Must be continuous - loses its utility if linked to a cyclical process
➢ The key is to be able act and react in real time as events occur, not at predetermined points
HR242.1 CIVILIAN HUMAN RESOURCE MANAGEMENT

❖ See Slide Deck
LE150 PROPERTY MANAGEMENT IN THE COE

Discuss:
❖ What are the types and classifications of property?

➢ Types of property, AR 735-2, Ch 4
▪ Real: lands and permanent structures
▪ Personal: Equipment and other non-expendable supplies, collectively called nonconsumable
supplies, all consumable supplies, and buildings the can be re-located.
➢ Property Classification, AR 735-5, Ch 7
▪ Expendable – often single use; perishable or disposable
▪ Non-expendable – any loss of these materials requires investigation

▪ Durable – keeps it shape after multiple uses but can eventually break
❖ AR 735-5 describes the Command Supply Discipline Program. Describe its purpose, policies, and
procedures as outlined in the assigned readings.
➢ The CSDP addresses supervisory and/or managerial responsibilities within the supply system
from the user to the Army command (ACOM), Army service component command (ASCC),
and/or direct reporting unit (DRU) level.
➢ The CSDP is a compilation of existing regulatory requirements brought together for visibility
purposes. It is directed at standardizing supply discipline throughout the Army.
➢ It is meant to simplify command, supervisory, and managerial responsibilities.
❖ List the five types of responsibility as explained in AR 735-5, Table 2-1.
➢ Command responsibility – all property within the command
➢ Supervisor responsibility – all property in the possession of personnel under their supervision
➢ Custodial responsibility – supply sergeant, supply custodian, supply clerk, or warehouse person
responsibility for property in storage awaiting issue or turn-in
➢ Direct responsibility – responsibility for all property within their command
➢ Personal responsibility – property in your possession
❖ List and explain the three forms (DA Form 3161, DA Form 581 and DA From 4949) that are used as
change documents for Primary Hand Receipts. Use www.apd.army.mil
➢ DA 3161: Request For Turn-In or Issue. Used to request: 10 or more line items of supplies
normally provided by a Self-Service Supply Center when SSSCs are not available; 5 or more line
items of packaged class 3 items; expendable medical items within a medical facility; 5 or more
lines of supplies normally ordered on a recurring basis (eg. insignia, badges, individual awards)
➢ DA 581: Used for turn-in of unserviceable ammunition, used ammunition packing material,
ammunition components, and empty cartridge cases
➢ DA 4949: Administrative Adjustment Report. Used to correct errors of copying, such as incorrect
serial numbers.
❖ FM 10-27-4, Chapter 6 describes the procedures for conducting inventories. What are they?
➢ Determine what is to be inventoried
➢ Set the dates
➢ Use correct publications
➢ Notify the hand or sub-hand receipt holder
➢ Conduct the inventory
➢ Record results and adjust records
❖ What is the purpose of an inventory as outlined in AR 710-2 paragraph 3-24.
➢ The purpose of a physical inventory is to determine the condition and quantity of items by
physical inspection and count.
❖ According to AR 710-2 Paragraph 1-4m, what are the commanders and supervisors’ roles in
requesting and using Government Property?
➢ Commanders, civilian supervisors, and managers at all levels will ensure compliance with
applicable policy described by this regulation and outlined in the internal control checklists
➢ The Director, USAPC, is responsible for executing the Petroleum Quality Surveillance and
Technical Assistance Program in subject areas
➢ All Government employees will properly use, care for, and safeguard all Government property.
They will seek and most efficient and economical means of accomplishing assigned tasks and will
limit request for an use of material to the minimum essential
➢ Commanders will establish and implement an A&E amnesty program
➢ Commanders will monitor the amnesty program as an indicator of effectiveness of ammunition
accounting
➢ Ensure assigned personnel are briefed on A&E amnesty program policies and procedures
semiannually and prior to each exercise or training event that requires the use of A&E
➢ Develop standard operating procedures detailing specific functional responsibilities for handling
A&E amnesty items
❖ According to AR735-5 Chapter 12, when military or civilian employee admits liability for the loss of
property and offers cash payment or a payroll deduction to settle a charge of financial liability what
form will be used to obtain relief from responsibility?
➢ DD Form 362
❖ According to AR 735-5 Chapter 13 what is the purpose of a Financial Liability Investigation of
Property Loss form DD 200?

➢DD 200: Documents the circumstances concerning the loss or damage of Government property
and serves as or supports a voucher for adjusting the property from accountable records. It also
documents a charge of financial liability assessed against an individual or entity, or provides for
the relief from financial liability.
➢ You get flagged for a DD200
❖ Components of Army Programs from AR 34-4
➢ Clear description of the benefits
➢ Clear objectives
➢ Authoritative publication
➢ Plan for implementation
➢ Procedure for enforcement
➢ Clearly delineated responsibilities

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Small Group 1

AMEDD CAPTAINS CAREER COURSE 18-181

L170 LEAD IN ORGANIZATIONS

L130 THINK CRITICALLY AND CREATIVELY

⇱RETURN to Table of Contents

2) How to use practical tools to enhance creative thinking.

⇱RETURN to Table of Contents

➢ Tools for creativity and innovation

L120 LEADER DEVELOPMENT DOCTRINE

⇱RETURN to Table of Contents

❖ The Army leadership requirements model (ADRP 6-22)

⇱RETURN to Table of Contents

M112 FUNDAMENTALS OF MISSION COMMAND PHILOSOPHY

❖ The Warfighting Functions

⇱RETURN to Table of Contents

M116 TROOP LEADING PROCEDURES (TLPS)

⇱RETURN to Table of Contents

➢ Use backwards planning to schedule

L160 WRITE EFFECTIVELY

❖ Clear, concise, and effective

⇱RETURN to Table of Contents

▪ Read paper backwards

L161 STAFF COMMUNICATIONS

Figure 1. Information briefing format example

⇱RETURN to Table of Contents

Figure 2. Decision briefing format example

L162 ENGAGE THE MEDIA

⇱RETURN to Table of Contents

❖ Concepts and requirements of media engagement

LE170 COMMANDER’S PROGRAMS

⇱RETURN to Table of Contents

⇱RETURN to Table of Contents

❖ What are the objectives of the SHARP and EO programs?

⇱RETURN to Table of Contents

⇱RETURN to Table of Contents

LE130 RESILIENCY FOR MID-GRADE LEADERS

⇱RETURN to Table of Contents

L171 ESTABLISH AND EXERT INFLUENCE

⇱RETURN to Table of Contents

L141 EXAMINE THE ARMY ETHIC

❖ Moral dilemma = available courses of action represent conflicting values

⇱RETURN to Table of Contents

AC111 ANALYZE CULTURAL VARIABLES

⇱RETURN to Table of Contents

➢ Behavior – the way in which someone conducts himself

⇱RETURN to Table of Contents

Raw Data Information

AC121 CROSS-CULTURAL SKILL BUILDING

❖ Describe the communication process and how culture affects it.

AC131 CULTURAL CONSIDERATIONS OF NEGOTIATIONS

⇱RETURN to Table of Contents

❖ Discuss Interest-Based Negotiation (IBN)

⇱RETURN to Table of Contents

LE110 - MILITARY JUSTICE FOR LEADERS

⇱RETURN to Table of Contents