More recently, CINCs are conducting operations within their areas of responsibility (AOR) by activating joint task forces (JTF). JTFs are established to accomplish specific, limited objectives that require the significant and closely integrated efforts of forces from two or more services. The JTF commander (CJTF) is appointed by the CINC and exercises operational control (OPCON) over assigned and attached forces. The CJTF may wear an additional hat as the commander of a JTF service component. Joint Pub 5-00.2, Joint Task Force Planning Guidance and Procedures, provides detailed guidance and procedures for forming, staffing, deploying, employing, and redeploying a JTF for short-notice contingency operations. 

A variety of scenarios exist that lend themselves to designating an Army corps, a Marine Expeditionary Force (MEF), or a numbered fleet or air force as the basis upon which a JTF is built. When this occurs, the command or fleet surgeon frequently becomes the JTF Surgeon, and the corps, MEF, fleet, or air force medical staff forms the core of the JTF Surgeon’s Office to be augmented by medical planners, operations officer and specialists from other services and commands. 
 

Joint Pub 4-02, Doctrine for Health Service Support in Joint Operations, provides operational and organizational guidelines to meet the health service support (HSS) requirements of combatant commands, JTFs, and service components. The JTF Surgeon is the principal advisor to the CJTF for these medical matters and assumes responsibility for planning, coordinating, and controlling joint HSS within the CJTF’s joint operational area (JOA);. The JTF Surgeon can expect to receive broad guidance and a general concept of medical operations from the Unified Command Surgeon. 

The staff of JTF Surgeon’s Office should be large enough to effectively facilitate joint planning and coordination of JOA HSS, medical standardization and interoperability, and integration of medical activities within the overall joint operation. Specifically, the JTF Surgeon must be prepared to accomplish the following tasks: 

• Maintain liaison with component command surgeons and resolve medical staff conflicts surfaced by JTF components.
• Provide detailed medical guidance, assign medical tasks, and develop the joint medical concept of operations. In the interest of maximizing the use of potentially limited resources, the JTF Surgeon may direct joint use of medical assets. For example, the JTF Surgeon may determine that the Navy component will provide all third echelon hospitalization or that the Army component will provide all rotary-wing aeromedical evacuation for the JTF. In these instances, joint staffing of units is not usually considered a prerequisite for their joint use.
• Consolidate component patient estimates, assess the sufficiency of the theater evacuation policy, and recommend changes to the Unified Command Surgeon if warranted.
• Advise the CJTF on HSS aspects of combat operations; rest, rotation, and reconstitution policies; preventive medicine; and other medical factors that could affect joint operations.
• Monitor JTF medical readiness status to include status of component patient beds, blood products, medical logistics, and staffing.
• Report JTF medical readiness status to the CINC in accordance with the unified command operation order (OPORD).
• Coordinate HSS provided to and received from allies or friendly nations.
• Coordinate medical intelligence support and identify medical essential elements of information (EEI) and requests for information (RFI).
• Prepare Annex Q (Medical Services) for all JTF plans and orders. (See Appendix B)
• Advise the CJTF of HSS aspects of the Geneva and other Conventions.
• Supervise the activities of a Joint (or the Theater) Patient Movement Requirements Center (TPMRC) and the Joint (or Area Joint) Blood Program Office (JBPO/AJBPO). 

The JPMRC functions as part of the JTF Surgeon’s Office and integrates aeromedical evacuation with patient regulating requirements. Additionally, it coordinates all related activities that support or affect patient movement. If it is the only Patient Movement Requirements Center within the unified command, it will probably be designated as a TRMRC and coordinate directly with the Global Patient Movement Requirements Center (GPMRC). If the Unified Command Surgeon is already operating a TPMRC, the JTF center will be designated as a JPMRC and coordinate patient movements with both the TPMRC and the GPMRC. Specifically, the JPMRC should perform the following functions: 

• Develop and disseminate JOA patient movement policies, procedures, and guidance.
• Manage the JOA patient movement system.
• Receive and validate JTF patient movement requests.
• Direct within-JOA patient movement to joint-use third echelon facilities and coordinate with the TPMRC/GPMRC to establish the appropriate out-of-JOA destination treatment facility and mode of travel.
• Match patient movement requirements with appropriate transportation assets and forward patient movement requirements to the appropriate agency for mission execution.

Establish, in conjunction with the TPMRC/GPMRC, patient movement reporting and tracking procedures and provide in-transit visibility for JTF patients.
 

The JBPO/AJBPO also functions as part of the JTF Surgeon’s Office and manages the theater blood program. If the JTF is the only Blood Program Office operating within the unified command, it will probably be designated as the JBPO. If the Unified Command Surgeon is already operating a JBPO, it will be designated as an AJBPO. Specifically the JBPO/AJBPO should take the following actions: 

• Develop and disseminate JOA blood management policies, procedures, and guidance.
• Coordinate and monitor component blood programs, blood product requirements, and capabilities within the JOA.
• Manage the blood distribution system within the JOA.

Operations that require the activation of a JTF are usually crisis or emergency situations for which there may or may not be an existing operation plan (OPLAN). Joint crisis action planning (CAP) for these situations progresses through a logical sequence of six phases from problem recognition to the execution of an OPORD. The six phases are situation development, crisis assessment, course-of-action (COA) development, COA selection, execution planning, and execution. Time constraints may force the phases to be compressed. 

The unified command usually identifies and activates the JTF during the COA development phase. Upon JTF activation, the JTF Surgeon should begin operational planning. Specifically, the JTF Surgeon should accomplish the following actions: 

• Review all unified command standing operating procedures and applicable OPORDs.
• Update and standardize HSS planning factors as required.
• Determine the extent of and initiate planning to support noncombatant evacuation operations (NEO),see Joint Pub 3-07.5, Joint Tactics, Techniques, and Procedures for Noncombatant Evacuation Operations.
• Obtain and review medical threat and preventive medicine information pertinent to the operations. Identify additionally required medical EEI and RFI to the JTF intelligence section.
• Develop JTF medical policies and procedures.
• Coordinate with JTF operational planners during concept development and assess medical risks associated with alternate courses of action.
• Assess host nation medical support availability.
• Develop and coordinate the JTF medical support concept with component and unified command surgeons. Plan for joint use of assets to ensure minimum essential hospitalization and evacuation support is identified for deployment.
• Evaluate projected force deployment flow and ensure that timely and responsive medical support, including the Theater Aeromedical Evacuation System (TAES), is available throughout the operation.
• Activate the JPMRC/TPMRC and JBPO/AJBPO and disseminate patient movement and blood management procedures.

As the operation nears completion, the JTF Surgeon should begin planning medical support for the redeployment of the JTF and/or transfer of medical responsibilities to a follow-on subunified command. 
 

The following checklist can be used to help manage the JTF medical planning process. 
CAP Phase I, Situation Development. Often the JTF has not been activated at this stage of the CAP process. However, if it has, the JTF Surgeon should consider the following: 

• What type of military forces might be used to resolve the crisis or conflict, and how might they best be supported medically?
• Are any in-place medical treatment facilities available for use including: U.S. military assets, host nation support, allied assets, contracts with civilian organization (e.g. the International Red Cross)?
• If combined action is possible, what type of medical support could be required or provided by other nations?
• Have intelligence offices been tasked to provide appropriate medical information?
• How should medical requirements be entered into the consolidated intelligence collection plan?
• What steps can be taken to collect additional medical information about the threat, crisis, conflict, or region?
• Have augmentation packages for the JTF Surgeon’s Office been identified and submitted?
• Has a JPMRC/TPMRC been established?
• Has a supportable evacuation policy been established?
• If authority to coordinate with in-place and out-of-JOA medical treatment facilities has been granted, has coordination already begun?
• Has aeromedical evacuation support been properly requested and coordinated, and does the proposed aeromedical evacuation support include sufficient crews, equipment sets, staging facilities, and medical supplies?
• Has a JBPO/AJBPO been established?
• Has the handling, storage, and distribution of whole blood within the JTF been planned and coordinated with the JTF service component surgeons?
• Have in-place blood and blood products been inventoried?
• Have all JTF service component blood and blood product requirements been consolidated and coordinated with the JBPO/AJBPO?
• Who are the JTF service component surgeons?
• Have medical task, functions, and responsibilities been delineated and assigned to the JTF service component medical units?
• Have preventive medicine procedures and countermeasures been established and have sufficient personnel been identified to ensure protection of the health of the JTF?
• Have provisions been made within the AOR/JOA to provide support to U.S. national, enemy prisoners of war (EPW), civilian internees (CI), and other detained persons (DET)?
• Has the medical supply and resupply status of each service component been reported?
• Have provisions for emergency resupply been established?
• Are there any medical communications systems that are already available in the AOR and JOA? If so, what are there capabilities and how are they systems accessed?
• Have communications requirements been identified to include nonsecure and secure channels, frequencies for medical personnel, and any medically dedicated or unique communications nets, operating procedures, or requirements?
• How will the communications system support the passing of medical information, reports, and requests?

• If a NEO is anticipated, the JTF Surgeon should consider the following:
• How many of the noncombatants are know to require medical care?
• Where are these noncombatants and is there a published plan addressing their collection prior to evacuation?
• Is a permissive or non-permissive NEO anticipated, and how best can it be medically supported?
• Are there any civilian casualty projections for the NEO?
• What is the medical evacuation policy for NEO casualties?
• Has the Department of State authorized pets to accompany NEO evacuees?
• Are any animals prohibited from entry into the United States by the Food and Drug Administration (FDA) or other agency?
• What will be done with pets brought to evacuation control points?
• If any humanitarian, civil, or security assistance (SA) medical requests have been made by foreign governments, how can they be supported?
• Are there any medically significant treaties, or legal, host nation, or status-of-forces agreements between the United States and involved foreign governments?
• Are there any OPLANs or conceptual OPLANs (CONPLAN) for the area or situation?
• What type of foreign military or civilian medical infrastructure is established within the JOA? What and where are its key elements?

• What specific medical factors affect the actions under consideration?
• What medical assets are provided for in the OPLAN or draft OPORD?
• Is available HSS adequate to support planned operations? If not, what additional assets are required and how will the JTF request them?
• Are all medical units—to include Aeromedical Evacuation Liaison Teams (AELT) and air crews—on the Time-Phased Force and Deployment List (TPFDL) and scheduled for timely arrival?
• If an intermediate staging base (ISB) is required, what medical units should be positioned there?
• What airfields are available for intratheater and intertheater aeromedical evacuation?
• Have JTF service components identified and requested medical personnel augmentation for the medical units and treatment facilities?

CAP Phase V, Execution Planning 

• Is the selected COA medically supportable with currently available medical assets?
• If not, will required medical assets be available before mission execution?
• If not, has the CJTF been made aware of the risks?
• What is the status of communications? Have any dedicated or medially unique nets, procedures, or requirements be properly identified and requested? 
• Has sufficient medical coordination with allies and the host nation been conducted?
• Have medical sustainability and resupply requirements been identified?
• Have Class VIII responsibilities and channels be established?
• Is the medical portion of the OPORD ready to be published and does it address assistance to U.S. nationals, CIs, DETs, displaced persons, and EPW?
• Is the JPMRC/TPMRC fully functional?
• Is the JBPO/AJPBO fully functional?
• Is the TAES planning complete?
• Are sufficient TAES assets in-place or programmed for early arrival? 
• Have primary and secondary aeromedical airfields been identified?
• Are AELTs ready to locate at key locations within each JTF service component medical system?
• Do JTF service components understand that they are required to move patients to supporting aeromedical staging facilities, and will they be able to do so?
• Are sufficient litters, straps, blankets, etc. available?