ANNEX Q TO CJTF 140 OPORD ???? MEDICAL SERVICES (U) 

(U) REFERENCES: 

a. The Geneva Conventions of 12 August 1949 

b. DOD Directive 6480.4, 5 August 1996, ASBPO Operational Procedures 

c. DOD Directive 6480.5, June 1972, Military Blood Program 

d. Joint Pub 4-02, 26 April 1995, Doctrine for Health Service Support in Joint Operations 

e. Joint Pub 4-02.2, 30 December 1996, Joint Tactics, Techniques, and Procedures for Patient Movement in Joint Operations 

f. Joint Pub 6-04.1, October 1990, U.S. Message Text Format 

g. CJCS Manual 6120.25, Tactical Command and Control Procedures for Joint Operations—Joint Operational Procedures 

h. AR 40-350/BUMEDINST 6320.1E/AFR 168-11, March 1990, Patient Regulating to and within the Continental United States 

i. AR 40-562/NAVMEDCOMINST 6230.3/AFR 161-13/CG COMDTINST M6320.4D, October 1988, Immunizations and Chemoprophylaxis 

j. AFMIC DST-1810H-001-82, undated, Handbook of Diseases of Military Importance 

k. AFMIC DST-?????_???_??, June 1990, ?????????? Area 

l. USCINCLANTINST 6320.3, 6 February 1990, U.S. Atlantic Command Contingency Joint Medical Regulating Program 

m. USCINCLANTINST 6530.2, 23 July 1990, U.S. Atlantic Command Joint Blood Program 

n. USCINCLANT OPORD 2000-YR, Basic Operation Order 

o. USCINCLANT OPORD ????, (Draft) p. USCINCLANT CONPLAN 2730-YR, Integrated CONUS Medical Operations Plan

a. (U) General 
(1) (U) Purpose. To provide a concept of medical operations, assign tasks, and provide guidance to ensure an effective health care system is established in support of the basic CJTF OPORD. (2) (U) Applicability. This annex is applicable to the following components of CJTF 140. 
 
(a) (U) CTF 141 (Army Task Force) 

(b) (U) CTF 145 (Navy Task Force) 

(c) (U) CTF 146 (Air Force Task Force) 

(d) (U) CTF 147 (Marine Task Force) 

(e) (U) CJTF 148 (Special Operations Task Force) 

(f) (U) CJTG 140.1 (Civil Affairs Task Group) (g) 

(U) CJTG 140.2 (PSYOP Task Group) 
 

b. (U) Enemy Forces. Per annex B, reference o 

c. (U) Friendly Forces. 
 

(1) (U) Per annex A, reference o 

(2) (U) In-place medical units and facilities 
 

(a) (U) U.S. Naval Hospital, (USNAVHOSP) Roosevelt Roads 

(b) (U) USNAVHOSP Guantanamo 
 

d. (U) Assumptions 
 
(1) (U) Sufficient medical personnel and units are available or will become available through service component augmentation and mobilization. 

(2) (U) Adequate aeromedical evacuation support will be available throughout the operation. 

(3) (U) Adequate Class VIII materiel is available and methods of resupply are adequate and maintained. 
 

e. (U) Limitations. None identified. (If limitations are identified, this section will be classified.)

3. (U) EXECUTION 

a. (U) Concept of Medical Operations 
 
(1) (U) Transition. Concurrent with the activation of CJTF 140, CINCLANT has directed the U.S. Atlantic Fleet (LANTFLT) to expand USNAVHOSP Roosevelt Roads to mobilization contingency capacity if not precluded by enemy action. Services will begin deployment of additional units and augmentation of the CJTF 140 staff to include the JTF Surgeon’s Office. 

(2) (U) Responsibilities. Medical service is a national and service responsibility. Allied forces operating in concert with this plan will be provided health care in accordance with existing or proposed agreements and evacuated to or returned to control of their appropriate national medical channels as soon as possible. Under the overall coordination of CJTF 140, medical support will be provided by subordinate commanders. U.S. military personnel will not be hospitalized in civilian medical facilities except in emergencies or as authorized by CJTF 140. 

(3) (U) Treatment and Hospitalization. CTF 141 ,CTF 145, and CTF 147 will provide echelon I and echelon II medical care to assigned personnel. CTF 141 and CTF 147 will provide echelon I and echelon II medical care to CTF 146, CJTF 148, CJTG 140.1, and CJTG 140.2 personnel within the combat zone on an area support basis. CTF 145 will provide afloat echelon II care to all CJTF 140 components during initial amphibious, airborne, or air assault operations. In-theater echelon III care will be provided to all CJTF 140 personnel by CTF 145 at USNAVHOSP Roosevelt Roads. Joint use of echelon III facilities is directed. 

(4) (U) Patient Movement. Casualty evacuation between echelon I and echelon II facilities is a task force responsibility. Rotary-wing transport is the preferred means of evacuation. CTF 146 will establish the Theater Aeromedical Evacuation System (TAES). Intratheater, fixed wing aeromedical evacuation between echelon II and echelon III facilities will be required. CTF 146 will coordinate intertheater evacuation of patients to CONUS with Transportation Command (TRANSCOM) and the Theater Patient Movement Requirements Center (TPMRC). Coordination of transport of evacuees to/from CTF 146 mobile aeromedical staging facilities (MASF) is the responsibility of the losing/gaining medical facility. Casualties will be stabilized in accordance with references d and e. UNCLASSIFIED UNCLASSIFIED 

(5) (U) Host Nation Support. There are no host nation medical support agreements. 

(6) (U) Adjunct Medical Support 
 

(a) (U) EPW, CIs, DETs. EPW casualties, civilian internees(CI), and detained persons (DET) will be treated and cared for per reference a. CTF 141 will provide echelon III medical care. Civilian casualties will be transferred to civilian facilities as soon as their conditions permit. Local civilian medical treatment facilities, described in detail in reference k, are as follows: 
 
Medical Center, QQQQQQ. Group of five specialized hospitals with full range of services. 

TTTTTT District Hospital. General surgery, orthopedics, internal and emergency medicine. 

VVVVVV City Hospital. Acute care center with limited surgery. 
 

(b) (U) Formerly Captured U.S. Military Personnel. CTF141 will provide echelon I and echelon II care at processing centers for formerly captured U.S. military personnel if such centers are established. Regulation and movement of formerly captured U.S. military personnel requiring echelon III care will be coordinated by the TPMRC on a case-by-case basis. 

(c) (U) Search and Rescue. CJTF 140 subordinate commanders will ensure search and rescue operations are supported medically. If not engaged in patient evacuation or movement, rotary-wing aeromedical aircraft may be used to rescue casualties in low or medium threat environments, provided location and casualty status are known. 

(d) (U) Noncombatant Evacuation Operations. CJTF 140 subordinate commanders will provide medical care to noncombatant evacuees as required. Assume three percent of noncombatant evacuees will require some type of medical care. 

(e) (U) Civil Affairs. All medical units must be prepared to care for civilian refugees in accordance with the provisions of reference a. Independent medical civic action programs are prohibited. 
 

(7) (U) Joint Blood Program. Blood management will be in accordance with references b, c, d, m, and n. Per reference o, CJTF 140 will establish a Joint Blood Program Office (JBPO) and coordinate blood management with the Armed Services Blood Program Office (ASBPO). CTF 145 will establish a blood supply unit capable of supporting all CJTF 140 medical units. The JBPO will disseminate additional blood management policies and procedures when available. 

(8) (U) Preventive Medicine. CJTF 140 subordinate commanders will maintain vigorous preventive medicine programs. Programs will be conducted in accordance with pertinent service and component directives and regulations. Deploying personnel should be immunized in accordance with reference i. Immune serum globulin immunizations are required for personnel operating in the vicinity of St. Alexander. 
 

(a) (U) The following is a brief summary of medical threat information found in references j and k. 
 
(i) (U) The greatest threat is from water and foodborne gastroenteric infections such as diarrhea, acute viral hepatitis, and typhoid fever. Local food is considered contaminated and should not be consumed. Local water is not potable and should be treated before drinking. Risk of ciguatera fish toxin poisoning exists. Consumption of large reef fish like grouper, snapper, dolphin, and barracuda is prohibited. 

(ii) (U) Risk of influenza and other acute respiratory infections is highest from October through January. Dengue virus has occurred within the region. Malaria is not endemic. Leptospirosis is present in low-lying flood zones with large rat populations; risk can be minimized by avoiding prolonged contact with stagnant water or wet soil in these areas. Trichuriasis, ascariasis, and ancylostomiasis have been reported. 

(iii) (U) Sexually transmitted diseases, including syphilis and gonorrhea are moderately endemic. Human immunodeficiency virus (HIV) appears low. Sexual contact with local civilians is prohibited. 
 

(b) (U) All unusual incidence of disease will be reported to the JTF 140 Surgeon. The JTF Surgeon will forward requests for special assistance in handling actual or potential preventive medicine problems to the U.S. Atlantic Command (USACOM) Surgeon. 
 
(9) ( ) Theater Evacuation Policy. The evacuation policy is A days for noncombatant evacuation operation (NEO) patients and B days for military personnel. CJTF 140 subordinate commanders may recommend changes to the evacuation policy. (Theater evacuation policies are normally classified.) 

(10) (U) Medical Regulating. Medical regulating will be in accordance with references e, g, h, l, and p. CJTF 140 will establish a TPMRC to coordinate patient movement with subordinate command MROs and the Global Patient Movement Requirements Center (GPMRC). The TPMRC will coordinate the pre-regulation of patients directly to a single military facility in the vicinity of Pope Air Force Base (AFB), North Carolina. The TPMRC will disseminate additional regulating policy and procedures when available. 

(11) (U) Ancillary support 
 

(a) (U) Dental Services. Dental support is a service component responsibility. CTF 141 and CTF 147 will provide dental care to CTF 146, CJTF 148, CJTG 140.1, and CJTG 140.2 personnel within the combat zone on an area support basis. Care provided will be limited to treatment necessary to relieve suffering and allow continued mission performance. 

(b) (U) Veterinary Services 
 

(i) (U) Limited veterinary services will be provided by CTF 141. CJTF140 subordinate commanders should address specific veterinary support requests to the JTF140 Surgeon for coordination. 

(ii) Pets will not be allowed to accompany NEO evacuees. Additionally, the following animals are associated with the indicated diseases and are prohibited from entry into CONUS. 

Animal        Associated Diseases

     Cattle        Brucellosis, tuberculosis, toxoplasmosis

     Sheep         Brucellosis, toxoplasmosis

     Goats         Brucellosis, toxoplasmosis

     Swine         Toxoplasmosis, trichinosis

     Chickens      Toxoplasmosis, salmonellosis

     Cats          Toxoplasmosis, rabies

     Dogs          Rabies

     Raccoons      Rabies

     Parrots       Psittacosis

     Sea Turtles   Salmonellosis

(12) (U) Other Requirements 
 
(a) (U) Subordinate task forces without assigned medical staffs will request augmentation through service channels. Medical planning will be provided by service component headquarters until augmentation is accomplished. 

(b) (U) Health service support will be provided to indigenous civilians engaged in CJTF 148 special or unconventional operations. 

(c) (U) Mortuary affairs are not a medical function. However, task force surgeons will assign responsibility for death certificate completion and identification of remains consistent with guidance to be published in Annex D of this OPORD. 
 

b. (U) Tasks 
 
(1) (U) Multiple Task Force Responsibilities. CTF 141, CTF 145, CTF 147 
 
(a) (U) Provide treatment to allied and indigenous personnel in U.S. facilities and return them to national control at the earliest possible time. 

(b) (U) Promptly notify the JTF 140 Surgeon of the initial location and subsequent displacements of echelon II and echelon III medical units and facilities. 

(c) (U) Provide guards for EPW patients from non-medical personnel assigned to non-medical units. 

(d) (U) If required, provide medical support and processing for NEO evacuees. 
 

(2) (U) Task Force and Task Group Specific Responsibilities 
 
(a) (U) CTF 141 
 
(i) (U) Provide echelon I and echelon II medical support to Army units and CTF 146, CJTF 148. CJTG 140.1, and CJTG 140.2 personnel on an area support basis. 

(ii) (U) Provide veterinary service support to all CJTF 140 components. (iii) (U) Provide logistics support to TAES elements on an area support basis. 

(iv) (U) If directed, provide aeromedical ambulance support to other CJTF 140 components. 

(v) (U) Plan for and, if directed, provide medical support to formerly captured U.S. military personnel. 

(vi) (U) Plan for and, if directed, deploy echelon III medical units in support of Army forces and EPW. 

(vii) (U) Plan for and, if directed, establish a blood supply unit capable of supporting all CJTF 140 medical units. 
 

(b) (U) CTF 145 
 
(i) (U) Provide internal echelon I and echelon II medical support to Navy forces. 

(ii) Provide augmented echelon II medical support for CJTF 140 subordinate components as designated casualty receiving and treatment ships during initial amphibious, airborne, and/or air assaults. 

(iii) (U) Provide echelon III medical support for CJTF 140 subordinate components at USNAVHOSP Roosevelt Roads. 

(iv) (U) Establish a blood supply unit capable of supporting all CJTF 140 medical units. 

(v) (U) Provide logistics support to TAES elements on an area support basis. 

(vi) (U) If directed, coordinate sea evacuation of medical casualties. 
 

(c) (U) CTF 146 
 
(i) (U) Coordinate Air Force combat zone medical requirements with CTF 141 and CTF 147. 

(ii) (U) Establish and operate the TAES. Identify logistics support requirements to CTF 141, CTF 145, CTF 147. 

(iii) (U) Coordinate intertheater aeromedical evacuation with TRANSCOM. 
 

(d) (U) CTF 147 
 
(i) (U) Provide echelon I and echelon II medical support to Marine units and CTF 146, CJTF 148, CJTG 140.1, and CJTG 140.2 personnel on an area support basis. 

(ii) (U) Provide logistics support to TAES elements on and area support basis. 
 

(e) (U) CJTF 148. Coordinate echelon I and II medical support requirements with CTF 141 and CTF 147. 

(f) (U) CJTG 140.1. Coordinate echelon I and II medical support requirements with CTF 141 and CTF 147. 

(g) (U) CJTG 140.2. Coordinate echelon I and II medical support requirements with CTF 141 and CTF 147. 
 

c. (U) Coordination Instructions 
 
(1) (U) Coordination between component surgeon’s staffs is directed. 

(2) (U) Coordination between component surgeon’s staffs and supporting commands or agencies is directed as specified within this annex.

a. (U) Medical Logistics 
 
(1) (U) Medical logistics, to include medical supply management, materiel accountability, optical fabrication, and biomedical maintenance, is a service responsibility. 

(2) (U) Resupply will be through normal service channels using previously established procedures. 

(3) (U) Per reference o, the JTF 140 Surgeon may identify critical medical supplies and direct cross task force leveling. 
 

b. (U) Reports. Medical reports will be formatted and submitted in accordance with references f, g, and n. CTF 141, CTF 145, and CTF 147 will submit medical status (MEDSTAT) reports to reach the JTF 140 Surgeon by 1200Z with cutoff times of 0600Z.

a. (U) Command 
 
(1) (U) Command of medical units rests within normal operational channels. Surgeons are the principal medical advisors to their commanders. 

(2) (U) Per reference o, the JTF 140 Surgeon exercises directive authority for CJTF 140 over assigned medical resources and will ensure their effective use to meet the JTF’s health care mission. 
 

b. (U) Medical Communications 
 
(1) (U) Routine coordinating communications between the JTF 140 Surgeon and subordinate component surgeons will be by secure telephone whenever possible. Alternate means of communication are Global Command and Control System/World Wide Military Command and Control System (GCCS/WWMCCS) teleconference and Automated Defense Information Network (AUTODIN) message. 

(2) (U) Official plans, orders, reports, and requests (except for blood management messages) will be passed by both GCCS/WWMCCS teleconference and AUTODIN message. As the ASBPO does not have GCCS/WWMMCS access, blood management messages will be passed telephonically and by AUTODIN message. 

(3) (U) CJTF 140 subordinate component surgeons will coordinate medical communications internal to their commands.

APPENDIX 1 TO ANNEX Q TO CJTF 140 OPORD XXXX JOINT MEDICAL REGULATING SYSTEM (U) 

(U) REFERENCES: 

a. Joint Pub 4-02, 26 April 1995, Doctrine for Health Service Support in Joint Operations 

b. Joint Pub 4-02.2, 30 December 1996, Joint Tactics, Techniques, and Procedures for Patient Movement in Joint Operations 

c. Joint Pub 6-04.1, October 1990, U.S. Message Text Format 

d. CJCS Manual 6120.25, Tactical Command and Control Procedures for Joint Operations—Joint Operational Procedures 

e. AR 40-350/BUMEDINST 6320.1E/AFR 168-11, March 1990, Patient Regulating to and within the Continental United States 

f. USCINCLANTINST 6320.3, 6 February 1990, U.S. Atlantic Command Contingency Joint Medical Regulating Program 

g. USCINCLANT OPORD 2000-YR, Basic Operation Order h. USCINCLANT OPORD ????, (Draft) i. USCINCLANT CONPLAN 2730-YR, Integrated CONUS Medical Operations Plan

2. (U) CONCEPT OF OPERATIONS 

a. (U) The Joint Task Force (JTF) 140 Surgeon has established the Theater Patient Movement Requirements Center (TPMRC) on board the USS MOUNT WHITNEY. The TPMRC will coordinate and communicate regulating requirements directly with CJTF 140 subordinate component Medical Regulating Officers (MRO) and the Global Patient Movement Requirements Center (GPMRC). Information copies of all TPMRC messages, reports, and requests will be provided the U.S. Atlantic Command (USACOM) Surgeon. 

b. (U) The TPMRC will operate in accordance with references a, b, e, f, g, h, and i. 

c. (U) Noncombat evacuation operation (NEO) patients have been pre-regulated to Womac Army Medical Center, Fort Bragg, North Carolina. 

d. (U) Military patients have been pre-regulated to Womac Army Medical Center, Fort Bragg, North Carolina, provided 
 

(1) (U) The patient’s prognosis for return to duty exceeds B days. 

(2) (U) The patient’s condition is stable enough to survive up to eight hours of flying time until final destination. 
 

e. (U) All other patients will be regulated to USNAVHOSP Roosevelt Roads. 

f. (U) As a minimum, bleeding and shock must be controlled, an airway must be established, and fractures must be splinted before a patient is transferred to a Mobile Aeromedical Staging Facility. 

g. (U) Enemy prisoners of war (EPW), civilian internees (CI), and detained persons (DET) will not be regulated to CONUS without prior approval of the USACOM Surgeon. 

h. (U) Patients arriving at Womac Army Medical Center will be reassessed and, if necessary, re-regulated by the GPMRC.

a. (U) All medical regulating messages will be in the formats specified by references c and d. 

b. (U) Medical regulating messages will be sent unclassified. 

c. (U) The TPMRC has been given direct liaison authority with the GPRMC, MROs, and all other agencies involved in patient movement. 

d. (U) Secure voice is the preferred method of TPMRC coordinating communications. Global Command and Control System/World Wide Military Command and Control System (GCCS/WWMCCS) teleconference and Automated Defense Information Network (AUTODIN) message may also be used. Medical regulating requests and reports will be sent by both GCCS/WWMCCS teleconference and AUTODIN message. 

e. (U) The TPRMC plain language address directory (PLAD) designation is RRRRRRRRRRRR.

APPENDIX 2 TO ANNEX Q TO CJTF OPORD XXXX JOINT BLOOD PROGRAM (U) 

(U) REFERENCES: 

a. DOD Directive 6480.4, 5 August 1996, ASBPO Operational Procedures 

b. DOD Directive 6480.5, June 1972, Military Blood Program 

c. Joint Pub 4-02, 26 April 1995, Doctrine for Health Service Support in Joint Operations 

d. Joint Pub 6-04.1, October 1990, U.S. Message Text Format 

e. CJCS Manual 6120.25, Tactical Command and Control Procedures for Joint Operations—Joint Operational Procedures 

f. USCINCLANTINST 6530.2, 23 July 1990, U.S. Atlantic Command Joint Blood Program 

g. USCINCLANT OPORD 2000-YR, Basic Operation Order 

h. USCINCLANT OPORD ????, (Draft)

a. (U) General 
 
(1) (U) The Joint Task Force (JTF) 140 Surgeon has established the theater Joint Blood Program Office (JBPO) on board the USS MOUNT WHITNEY. The JBPO will coordinate and communicate requirements directly with the Armed Services Blood Program Office (ASBPO) and the CJTF 140 subordinate component Blood Transhipment Center (BTC) and Blood Supply Unit (BSU). Information copies of all JBPO messages, reports, and requests will be provided the U.S. Atlantic Command (USACOM) Surgeon. 

(2) (U) Activation of area JPBOs (AJBPO) is not anticipated. (3) (U) The JBPO will operate in accordance with references a, b, c, f, g, and h. 
 

b. (U) In-theater sources. None. However, there is refrigerated space for 1,000 units of liquid-packed red cells at USNAVHOSP Roosevelt Roads. 

c. (U) Distribution of blood and blood supplies. 
 

(1) (U) CTF 145 will establish a BSU at USNAVHOSP Roosevelt Roads. 

(2) (U) CTF 146 will establish a BTC at Hunter Army Airfield, Georgia. 

(3) (U) Blood and blood components will be transported by the most expeditious means, usually Transportation Command (TRANSCOM) airlift from the Armed Services Whole Blood Processing Laboratory (ASWBPL) at McGuire Air Force Base (AFB), New Jersey to the CTF 146 BTC. 

(4) (U) CTF 146 airlift will move blood and blood products from the BTC to the CTF 145 BSU. 

(5) (U) All CJTF 140 subordinate components with echelon II or echelon III medical facilities in theater will: 
 

(a) (U) Ensure medical units deploy with sufficient blood and blood products to meet internal requirements until the CTF 145 BSU is operational. 

(b) (U) Direct all requests for blood and blood products to CTF 145 once it becomes operational. 

(c) (U) Submit daily blood reports (BLDREP) to the CTF 145 BSU by 0200Z with cutoff times of 2359Z. 
 

(6) (U) The CTF 145 BSU will: 
 
(a) (U) Submit daily BLDREPs to the JBPO to arrive by 0400 with cutoff times of 2359Z. 

(b) Notify components of incoming blood shipments using blood shipment reports (BLDSHIPREP).

a. (U) All blood management messages will be formatted specified in references d and e. 

b. (U) Blood management messages will be sent unclassified. 

c. (U) The JBPO has been given direct liaison authority with the ASBPO, the BTC, the BSU, and all other agencies involved in blood management and movement. 

d. (U) Secure voice is the preferred method of JBPO coordinating communications. ASBPO does not have access to Global Command and Control System/World Wide Military Command and Control System (GCCS/WWWMCCS) teleconferences. Blood management requests and reports will be sent by both secure voice and Automated Defense Information Network (AUTODIN) message. 

e. (U) The TPRMC plain language address directory (PLAD) designation is FFFFFFFFFFFF. 

UNCLASSIFIED