JP 3-28, page 87

Supporting and Sustaining Activities V-13 save lives, prevent human suffering, or mitigate great property damage and is covered under the immediate response authority provision in DOD policy. For more details on federal coordinating centers, see the National Disaster Medical System Federal Coordinating Center Guide. c. Responsibilities. The joint force surgeon advises the JFC on health services plans, policies, and procedures pertaining to and affecting military and civilian personnel in the AOR/JOA. The joint force surgeon’s cell provides the central location for medical planning and operations. The staff monitors current and future operations and conducts required planning support. The joint force medical staff must maintain close contact with the geographic CCMD’s joint regional medical planners and with the DCO to carry out ESF #8 (Public Health and Medical Services) activities. The military public health emergency officer shall function as the commander’s primary public health advisor during an emergency. Some of the obstacles medical responders may face are: (1) Triage. Often the first casualties to receive care are those least injured. Failure to triage and organize resources for more seriously injured could limit patient access to life-saving care. Health care services delivery should be prioritized at both the local and regional level. (2) Unequal Distribution of Casualties. Casualties tend to be concentrated locally and travel to the nearest health care facility. This concentration of casualties may overwhelm some local facilities, while others in the same area may be under-utilized. (3) Multiple Casualty Entry Points. Emergency medical services is the usual route of entry into the health care system for casualties. In mass casualty situations, casualties also access the system through non-emergency medical services means (e.g., privately owned vehicles and police transport). Casualty evacuations and casualty collection points produce additional and unusual demands for health care. Also, non-local responders may add to the overall confusion due to their unfamiliarity with the local health system. (4) Health Threat. The purpose of the medical portion of the commander’s estimate is to identify the health services and force health protection (FHP) requirements. Because there are so many variables that affect the need for FHP, an up-front analysis of multiple sources of intelligence or information, including information gathered by trained medical personnel on scene is required. Medical personnel must assess the safety of local food and water sources, the risk from vectors and environmental factors, and the adequacy of hygiene in lodging and public facilities as early as possible. Therefore, it is critical to have medical personnel on all survey or advance teams. Identifying health risk factors, medical capabilities available, and FHP requirements for military and civilian personnel are key factors when developing appropriate courses of action for the commander. (5) Damage to the Health Care Infrastructure. The level of damage to the health care infrastructure and the level of involvement of the other civil medical organizations is a starting point when developing situational awareness for the