FM 8-10-14

APPENDIX A

TACTICAL STANDING OPERATING PROCEDUREFOR HOSPITAL OPERATIONS

A-1. Tactical Standing Operating Proce-dure

This appendix provides a sample TSOP for a CSH.It provides the tactics, techniques, and proceduresfor hospital operations; however, it should not beconsidered as all-inclusive. It may be supple-mented with information and procedures requiredfor operating within a specific command, con-tingency, or environment.

A-2. Purpose of the Tactical StandingOperating Procedure

The TSOP prescribes policy, guidance, and pro-cedures for the routine tactical operations of aspecific unit. It should cover broad areas of unitoperations and be sufficiently detailed to providenewly assigned personnel the guidance requiredfor them to perform their mission. A TSOP maybe modified by TSOPs and operation plans(OPLANs)/OPORDs of higher headquarters. Itapplies to a specific unit and all subordinate unitsassigned and attached. Should a TSOP not be inconformity with the TSOP of the higher head-quarters, the higher headquarters’ TSOP governs.The TSOP is periodically reviewed and updatedannually.

A-3. Format for the Tactical StandingOperating Procedure

a. There is not a standard format forall TSOPs; however, it is recommended that aunit TSOP follow the format used by its higherheadquarters. The TSOP can be divided intosections (specific functional areas or majoroperational areas). The TSOP may contain oneor more annexes, each of which may have one ormore appendixes. The appendixes may each haveone or more tabs. Appendixes can be used to

provide detailed information on major subdivi-sions of the annex, and tabs can be used to provideadditional information (such as report formats orarea layouts) addressed in the appendix.

b. Regardless of the format used, theTSOP follows a logical sequence in the presen-tation of material. It should discuss the chain ofcommand, major functions and staff sections ofthe unit, operational requirements, requiredreports, necessary coordination with higher andsubordinate elements for mission accomplish-ment, programs (such as command information,PVNTMED measures, and CSC), and otherrelevant topics.

c. Pagination of the TSOP can be accom-plished by starting with page 1 and numberingthe remaining pages sequentially. If the TSOP issubdivided into sections, annexes, appendixes,and tabs, a numbering system that clearlyidentifies the location of the page within thedocument should be used. Annexes are identifiedby letters and are listed alphabetically. Appen-dixes are identified by numbers and arrangedsequentially within a specific annex. Tabs areidentified by a letter and are listed alphabeticallywithin a specific appendix. After numbering theinitial sections using the standard numberingsystem (sequentially starting with page 1 throughto the end of the sections), number the annexesand their subdivisions. They are numbered as theletter of the annex, the number of the appendix,the letter of the tab, and the page number. Forexample, page 4 of Annex D is written as “D-4”;page 2 of Appendix 3 to Annex D is written as“D-3-2”; page 5 of Tab A to Appendix 3 of AnnexD is written as “D-3-A-5.” This system of num-bering makes the pages readily identifiable as totheir place within the document.

d. In addition to using a numberingsystem to identify specific pages within the TSOP,

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descriptive heading should be used on all pagesto identify the subordinate elements of the TSOP.

(1) The first page of the TSOPshould be prepared on the unit’s letterhead. Theremaining pages of the sections should includethe unit identification in the upper right handcorner of the paper (for example: "XXX CombatSupport Hospital").

(2) A sample heading for an annexis: “Annex Q (Nursing Service) to XXX CombatSupport Hospital.”

(3) A sample heading for an ap-pendix to Annex Q is: “Appendix 4 (Patient FoodService) to Annex Q (Nursing Service) to XXXCombat Support Hospital.”

(4) A sample heading for a tab toAppendix 4 to Annex Q is: “Tab C (Diet Roster) toAppendix 4 (Patient Food Service) to Annex Q(Nursing Service) to XXX Combat SupportHospital.”

e. As the TSOP is developed there maybe an overlap of material from one annex toanother. This is due in part to similar functionsthat are common to two or more staff sections.Where overlaps occur, the material presentedshould not be contradictory. All discrepancies willbe resolved prior to the authentication andpublication of the TSOP. The TSOP will beauthenticated by the hospital commander.

A-4. Sample Tactical Standing OperatingProcedure (Sections)

The information contained in this paragraph canbe supplemented. It is not intended to be an all-inclusive listing. Different commands will haveunique requirements that need to be included.

a. The first section of the TSOP identi-fies the specific unit/headquarters that developedthe TSOP.

(1) Scope. This paragraph estab-lishes and prescribes procedures to be followedby the CSH and its assigned, attached, or opera-tional control (OPCON) units/elements.

(2) Purpose. This paragraph pro-vides policy and guidance for routine tacticaloperations of the headquarters and its assigned,attached, or OPCON units.

(3) Applicability. Except whenmodified by SOPs and OPLANs/OPORDs ofhigher headquarters, this paragraph applies tothe hospital and to all units assigned, attached,or OPCON for combat operations. These orders,however, do not replace judgment and commonsense. In cases of nonconformity, the documentof the higher headquarters governs. Each sub-ordinate element will prepare a unit TSOP,conforming to the guidance herein.

(4) General information. Thisparagraph discusses the required state ofreadiness of the unit; primary, secondary, andcontingency missions; procedures for operatingwithin another command’s AO; and proceduresfor resolution of conflicts with governing regu-lations, policies, and procedures.

(5) References. This paragraphcan include any pertinent regulations, policyletters, higher headquarters TSOP, or otherappropriate documents.

b. The second section of the TSOPdiscusses the hospital organization.

(1) Organization. The unit isorganized and equipped in accordance with theapplicable MTOE an/or other staffing docu-mentation. The applicable MTOE and other

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staffing documentation should be listed in thisparagraph.

(2) Succession of command. Theguidance for determining the succession ofcommand is discussed.

(3) Task organization. Task or-ganization is contingent on the mission and willbe approved by the headquarters orderingdeployment.

(4) Organizational charts. Con-tained in Annex A.

c. The third section of the TSOP dis-cusses hospital functions. It will supplement thehospital organizational chart(s). The functions ofthe various hospital divisions/sections, to includepersonnel and some of their responsibilities, areprovided in Chapter 2 of this publication. For amore detail description of personnel duties, seeFM 101-5, AR 611-201, and AR 611-101.

d. The fourth section of the TSOPpertains to division/section operations and issubdivided into annexes.

A-5. Sample Tactical Standing OperatingProcedure (Annexes)

Annexes are used to provide detailed informationon a particular function or area of responsibility.The commander determines the level of specificityrequired for the TSOP. Depending upon thecomplexity of the material to be presented, theannex may be further subdivided into appendixesand tabs. If the annex contains broad guidanceor does not provide formats for required reports,paragraphs may be used. The annex should notrequire further subdivision. However, as thematerial presented becomes more complex,prescribes formats, or contains graphic materials,the annex will require additional subdivision.

Applicable references, such as ARs, FMs, andTMs, should be provided in each annex. Thenumber of annexes and their subdivisions shouldbe based on command/contingency requirements.Each annex should contain information relatingto mission, organization, duties and/or respon-sibilities, and procedures. The following sampleannexes are provided as a guide and are notconsidered all-inclusive.

a. Annex B, Hospital Headquarters.This annex discusses the hospital commander andhis responsibilities. The hospital commander isthe senior MC officer assigned or as appointed byhigher headquarters. The hospital commander,assisted by the chiefs of surgery, nursing, andmedicine, XO, chaplain, and CSM, provides theC2 necessary to accomplish the mission. The day-to-day operations shall include a review ofhospital activities occurring during the pre-ceding shift and the implementation of directivesreceived from higher headquarters.

(1) The daily assessment of hos-pital operations is accomplished via a report(s) onadmissions, dispositions, bed census (by type),unusual occurrences, and significant seriouslyill patients. The chief of professional servicesreports on bed availability by type bed and servicecapabilities that can be provided. This infor-mation must also be provided daily to the PADfor medical evacuation and patient regulatingoperations.

(2) The commander and his staff,in the conduct of daily operations, can use per-sonal and telephonic contact to become aware ofpersonnel, logistical, and administrative problemswhich may affect the overall hospital operations.

(3) Regularly scheduled meetingsand review of reports and programs can be usedto monitor the effectiveness and efficiency ofhospital operations.

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(4) The hospital commander, dur-ing command visits or contacts with the medicalgroup, can be apprised of the tactical situation.The hospital commander provides higher head-quarters the hospital’s overall status to includepatient work load, hospital capability, personnelstatus, logistical requirements, and other infor-mation as he deems appropriate. The hospitalcommander maintains liaison with the MEDLOGbattalion, medical evacuation battalion, MASH,and corps support organizations.

(5) The hospital commander mayactivate the TOC based on the tactical situation.(See Annex D for a discussion on TOC operations.)

(6) This annex should also addressthe hospital hours of operation, to include thehospital staff and personnel shifts.

b. Annex C, Company Headquarters.This annex discusses the C2 structure for allassigned or attached officers and enlistedpersonnel of the hospital. The annex outlinesprocedural guidance for, but not limited to, thefollowing:

• Unit-level administration.

• Reenlistment and extensionprograms.

• Billeting, to include fire safety,sanitation, and key control.

• Security, assignment, account-ability, and maintenance of weapons.

• Perimeter security.

ment.

ties.

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• Life support and site improve-

• Welfare and recreational activi-

•

•

•

•

•Justice actions.

Unit supply.

Duty rosters.

Physical fitness.

Training.

Uniform Code of Military

c. Annex D, Tactical Operations Cen-ter. Areas covered by this annex include—

(1) Definition. The TOC is thecommand element of the hospital containingcommunications and personnel required tocommand, control, and coordinate hospital andCHS operations.

(2) Purpose. The purpose of theTOC is to provide a secure area where the com-mander and key staff can assemble to estimatethe situation, assess the requirements, and reactto varying problems such as area defense, NBCoperations, mass casualty situations, and CHSoperations.

(3) Responsibilities. The hospitalcommander has overall supervision and controlover the TOC. The hospital XO has primary staffresponsibility in the absence of the commander.Daily operations of the TOC are the responsibilityof the operations section.

(4) Operations. The TOC operateson a 24-hour basis. It is principally staffed byeach primary staff section. furnishing necessarymanpower as required. The TOC will be adjacentto the communications facility, as well as inproximity to the emergency room and triageareas. The TOC should be of sufficient size toallow for establishment of maps, storage ofindividual weapons and chemical defense equip-ment, and facilitate communications among the

FM 8-10-14

staff. Telephone communications connect theTOC to other staff sections within the hospital,higher headquarters, and other appropriate units.The CNR will also provide the appropriatecommunications for CHS. Access to the TOC isstrictly controlled by means of an access rosterand, if available, security badges. Only essentialpersonnel and authorized visitors are allowed toenter. Each hospital element maintains a TSOPon the organization and operation of its section.All elements within the TOC maintain, whenappropriate, a current situational map of theirspecific operations. Discussion and portrayal oftactical plans outside of the security area areprohibited.

(5) Composition of the tacticaloperations center. This is a listing of thosepersonnel comprising the TOC. It normallyincludes the commander, XO, CSM, principal staffmembers, and other specific staff members asrequired.

(6) Tactical operations center con-figuration. This is a schematic representation ofthe physical layout of the TOC. It can be includedas an appendix to the annex.

(7) Message center. This para-graph establishes procedures for the handling ofclassified messages; provides delivery and serviceof IMMEDIATE and FLASH messages to theappropriate staff section; and provides proceduresfor preparing outgoing messages and deliveryservice to the servicing message center for thetransmission of outgoing messages.

(8) Appendixes. The addition ofappendixes to this annex is permissible and maycover topics such as—

• Schematics of the physicallayout.

• Change of shift proce-dures.

• Security requirements, toinclude guard duties and identification badges.

• Briefing requirements.

• Overlay preparation.

(9) Camouflage. This paragraphdiscusses what camouflage procedures are re-quired, to include type and amount of requiredcamouflage materials (such as nets and terrainfeatures); display of the Geneva Conventions dis-tinctive emblem on facilities and vehicles; andother pertinent information. See FM 8-10 forinformation concerning the camouflaging of medi-cal units.

d. Annex E, Operations. This annexestablishes procedures for the operations sectionwithin the hospital and provides a basis for stand-ardization of CHS operations in a tacticalenvironment. It is essential that these proceduresbe standardized to ensure common understand-ing, facilitate control and responsiveness, andenhance mission accomplishment. Although in-telligence and hospital defense are functions ofthe hospital operations section, they may beaddressed in separate annexes. For simplicityand coherency, these areas are discussed in para-graphs e and f, respectively. Commanders mayelect to consolidate the S2/S3 functions into asingle annex. Appendixes to this annex shouldinclude the following areas:

(1) Operational situation report.Requirements for format, preparation, andsubmission of this report are discussed in thisappendix.

(2) Operations security. Thisappendix provides the guidance and proceduresfor secure planning and conduct of combatoperations.

(a) Responsibilities. Thecommander is ultimately responsible for denying

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information to the enemy. The operations officeris responsible to the commander for the overallplanning and execution of operations. He hasthe principle staff interest in assuming the re-quired degree of OPSEC and has the primary staffresponsibility for coordinating the efforts of allother staff elements in this regard. The opera-tions officer is responsible for the preparation ofthe essential elements of friendly information(EEFI) and for providing classification guidance.Additionally, the OPSEC officer identifies the pri-orities for OPSEC analysis and develops OPSECcountermeasures. Coordination is effected withhigher headquarters in planning an OPSECanalysis of operations and analyzing EEFI.

(b) Classified and sensitiveinformation. Document classification, down-grading, and declassification is the responsibilityof the operations section. Classified and sensitiveinformation, such as the status of the forces,readiness condition, equipment status, and otherinformation relative to the hospital’s ability toperform its mission, will be limited to thoseindividuals with a security clearance and the needto know.

(3) Hospital relocation. This ap-pendix provides the procedures for hospitalrelocation. Because of the hospital’s limitedmobility, transportation support and other sitepreparation are required from COSCOM assets.The operations officer, in conjunction with thesupply and service division, plans and coordinateshospital movement. Considerations should in-clude, but not be limited to, the following:

•headquarters.

•

•

•ments availability.

Coordination with higher

Patient relocation.

Tactical situation.

Transportation require-

• Convoy operations (toinclude clearance and security).

• Terrain analysis and siteselection.

• Availability of requiredsupport (engineer, communications, and supply).

(4) Communications-electronics.This appendix establishes communicationspolicies, procedures, and responsibilities for theinstallation, operation, and maintenance ofcommunications-electronics (CE) equipment.Responsibilities of the CE NCO include—

• Advising the hospitalcommander and operations officer on CE matters.

• Determining requirementsfor communications support.

•

•munications.

•tions center service.

•

Radio communications.

Radio teletypewriter com-

Message and communica-

Message handling proce-dures.

• Wire communications.

• Switchboard operations.

• Communications securityand operations.

• Security violations. Thisprescribes procedures for reporting any event oraction which may jeopardize communicationssecurity.

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• Daily shift inventory.

• Physical security of com-munications equipment.

• Transmission security.

• Security areas. This dis-cusses access procedures and rosters, accessapproval requirements, and prohibited items.

• Communications securityofficers and custodians. The appointment pro-cedures, orders requirements, and duties ofpersonnel are described.

• Safety. This discussesrequirements for the grounding of, handling, andstorage of COMSEC equipment.

• Power units.

• Emergency destruction ofclassified operating instructions and associatedmaterials.

e. Annex F, Intelligence and Security.This annex pertains to intelligence require-ments and procedures and operational securityconsiderations. Appendixes to this annex mayinclude the following subjects:

(1) Intelligence. The operationssection has the responsibility of collectinginformation to assist the commander in reachinglogical decisions as to the best courses of action topursue. Essential elements of information (EEI)include, but are not limited to, the location, type,and strength of the enemy threat; location of areaof casualty concentration; known or suspectedNBC activity; and issues which the commanderconsiders to be EEI.

(2) Intelligence reports. The opera-tions section is responsible for disseminating all

applicable estimates, analyses, periodic intel-ligence reports, and intelligence summariesgenerated within the hospital or received fromhigher headquarters. Information on submissionof reports and suspenses on intelligence productsand reports should also be addressed in thisappendix.

(3) Counterintelligence.

• Camouflage. When orderedor directed by the tactical commander all unitswill initiate and continually strive to improvecamouflage operations of positions, vehicles, andequipment. Noise and light discipline is empha-sized at all times.

• Communications security.These measures are enforced at all times. Specificrequirements and considerations are included.

• Signs and countersigns.This paragraph outlines procedures for estab-lishing signs and countersigns to be used duringhours of darkness.requirements andcountersign is lost or

•paragraph discusses

It also includes reportingprocedures if the sign/compromised.

Document security. Thisthe procedures for inven-

torying, marking, safeguarding, and destroyingclassified material, both work documents andcompleted documents. Reporting requirementsin the event of compromise are also included.

(4) Captured personnel, equip-ment, supplies, and documents. This appendixprovides specific guidance on the handling ofcaptured personnel, equipment, supplies, anddocuments. The disposition of captured medicalequipment and supplies is governed by theGeneva Conventions and is protected againstintentional destruction.

(5) Security. This appendix dis-cusses weapons security, SOI (communications)

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security, TOC security, and Sensitive Item StatusReport policies, guidance, or procedures.

f. Annex G, Hospital Defense. Thisannex describes procedures for security of thehospital in a wartime environment. Securityshould be a part of an integrated defense plan(base cluster commander and HN base defenseplan). Within the theater area, the base clusterand base commanders are appointed by the areacommander. These commanders have the overallresponsibility for the base cluster defense andbase defense organizations and plans. Thehospital should be included as a part of the basecluster/base plan as established by the base cluster/defense commander. This annex addresses, as aminimum, the following:

• Sustainment operations.

• Defense reaction force(s).

• Hospital movement.

• Terrain management.

• Medical unit self-defense ac-cording to the Law of Land Warfare (see AppendixG). For a comprehensive discussion on the Lawof Land Warfare, see FM 8-10 and FM 27-10.

g. Annex H, Administration and Per-sonnel. This annex outlines procedures relatingto administrative and personnel matters andassociated activities. The theater surgeon hasassignment, reassignment, and career man-agement authority for all AMEDD officer and WOpersonnel arriving into or within the theaterduring mobilization and wartime. Request forpersonnel and administrative support will besubmitted through the medical group (S1[Adjutant, U.S. Army]) to the appropriate sup-porting regional personnel center. Paragraphs ofthe annex or attached appendixes should discussthe following:

(1) Personnel loss estimate. Ini-tially, FM 101-10-1/1 and FM 101-10-1/2 will beused as a basis for the computation of gross andspecial personnel loss estimates. Factors and lossrate tables in the FMs may not accurately reflectcurrent situations and should be modified asactual experience factors are developed.

(2) Emergency personnel replace-ments. A request for hospital personnel replace-ment is submitted to the medical group S1 whenthere are unexpected losses for which no replace-ments are allocated.

(3) Personnel daily summary (PDS).This paragraph provides the procedures for fillingout and submitting a daily personnel statusreport. The instructions may include require-ments for encrypting the report prior totransmission, specific guidance on time ofsubmission, corrections, or other administrativerequirements.

(4) Casualty reports. This para-graph applies to all US military personnel whoare serving within the hospital’s area of supportand become casualties in areas under US control.It is also applicable to EPWs and civilianinternees who become casualties while undercontrol of US units.

• Casualty feeder report.This report is submitted on DA Form 1156.Instructions on the completion of the form andsubmission requirements are included.

• Witness statements onindividuals (DA Form 1155). This statement iscompleted only when the recovery of a body is notpossible, or cannot be identified. It is to besubmitted to the S1 within 24 hours of theincident. The paragraph should contain infor-mation on obtaining the form, instructions forcompleting it, and other relevant information orprocedures.

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• This section may alsoinclude other reports required by the command.

(5) Personnel management.

• Replacements. Individualreplacements will not be readily available duringthe initial phases of operations. The adminis-trative division will automatically initiatereplacement requests for personnel who arereported on the PDS report as wounded in action,missing in action, or killed in action.

• Assignments and reas-signments. This paragraph will address theactions required for patients and permanent partypersonnel.

• Leaves. Ordinary andemergency leave procedures are outlined in AR630-5. Policies established by the theater willtake precedence.

• Personnel actions. Allpersonnel actions are channeled through theadministrative division. Division/section chiefsand NCOICs are the hospital points of contact.Actions will be handled expeditiously and meetsuspense dates (tactical situation permitting).

• Efficiency reports. Thisparagraph describes the pertinent informationneeded for the completion and submission of thesereports.

• Award recommendations.This paragraph delineates the responsibilities andguidance for submitting recommendations forawards and for scheduling and conducting awardceremonies.

• Promotions. This para-graph discusses the procedures for submittingrecommendations for promotion and for sched-uling and conducting promotion ceremonies.

• Correspondence. All cor-respondence addressed to higher headquarters issubmitted through the administrative division.Requirements for submission, preparation, andapproval are also provided.

• Personnel records. Thisparagraph discusses requirements for coor-dination of this support. It also discusses theprocedures for having correspondence includedin the official military personnel records ofpersonnel assigned and attached.

(6) Personnel services. Personnelservices are those activities pertaining to soldiersas individuals. Unless prohibited by the tacticalsituation, the services listed below will beavailable to all assigned and attached units.

• Sporting activities andmorale and welfare activities.

• American Red Cross.

• Finance. This serviceincludes disbursements and currency control,payday activities, currency conversion, checkcashing, and the appointment of Class A agents.

• Legal services. Informa-tion and specific guidance on administrativeboards, courtmartial authority and jurisdiction,legal assistance, and general services should beprovided.

• Religious activities. Reli-gious activities include chaplain support, servicesavailable for different faiths, schedule of services,and hospital visitations.

• Postal services. This in-cludes hours of operation and services available.Emergency destruction, prisoner of war mail, andmail restriction policies will be outlined. Postalservices should be addressed in an appendix tothis annex.

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• Post exchange services. clothing), procedures, and marking and reportingThis includes hours of operation and availability. of burial site.

• Distribution. Pick up anddelivery schedules and any command-specificissues and procedures are provided.

(7) Mortuary affairs. Commandersat all levels are responsible for unit MA and thesearch, recovery, and evacuation of remains tocollection points. Selected hospital personnelshould be trained on MA tasks to ensure properhandling of remains and the deceased’s personaleffects.

• Responsibilities. Thisparagraph discusses hospital responsibilities andthe relationship with the medical group andsupporting MA activity.

• Disposition. Specific guid-ance on procedures, MA collection points,transportation requirements, and handling ofremains is provided.

• Hasty burials. Specificrequirements for conducting hasty burials andmarking and reporting of grave sites are included.

• Personal effects. Guid-ance on accounting for personal effects andrequirements for burial should a hasty burial berequired is contained in this paragraph.

• Disposition of civilian andEPW remains. The local civilian government isresponsible for the burial of remains of its citizens.The remains of EPWs are buried in separatecemeteries from US and allied personnel. If thisis not possible, a separate section of the samecemetery is used and will be properly marked.

• Contaminated remains.This paragraph discusses handling and dis-position requirements (to include protective

(8) Public information. This ap-pendix contains procedures for obtaining approvalon the public release of information to includethe hometown news release programs.

(9) Maintenance of law, order,and discipline. This appendix should provideapplicable regulations, policy, and commandguidance on topics such as serious incidentreports, notifications and submission formats,straggler control, confinement of militaryprisoners, and EPWs (also discussed in (10)below).

(10) Enemy prisoners of war. Thisappendix discusses the unit responsibility forEPWs captured by or surrendered to the unit.These procedures do not pertain to EPW patientscaptured by other units. Medical personnel donot guard, search, or interrogate EPWs while inthe CHS system; guards are provided bynonmedical personnel designated by the tacticalcommander for these duties. Until EPW per-sonnel can be evacuated to an EPW collectionpoint, medical personnel should remember andenforce the basic skills: segregate, safeguard,silence, secure, speed, and tag. (The speed portionof evacuating EPWs to designated collectionpoints is of paramount importance to medicalunits.)

NOTE

The treatment of EPWs is governed byinternational and US law and theprovisions of the Geneva Conventions.Personnel should be aware of theserequirements and have ready access tothe applicable regulations and policyguidance (see FM 8-10 and AR 190-8).

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(11) Records disposal procedures.The emergency disposal of files, when hostileaction is imminent and if retention is prejudicialto the interest of the US, will be outlined.Nonemergency disposal, to include lost ordestroyed files, will be included.

(12) Appendixes. The followingappendixes should be developed as part of thisannex:

•equal opportunity.

•

•

•

•

•

Human relations and

Civilian personnel.

Provost marshal.

Safety (see Appendix D).

Postal operations.

Command message center.

h. Annex I, Chaplain. This annex out-lines the duties and responsibilities of the hospitalchaplain and the hospital ministry team.Although the chaplain reports directly to thehospital commander, his activities will becoordinated with the hospital adjutant.

(1) Chaplain support and cover-age. This paragraph will address the following:

•chaplain duties.

•

•

•

•

Normal and emergency

Religious services.

Visitation.

The seriously ill.

Death.

• Burial services.

• Reports.

(2) Chaplain funds. Procedureswill be outline for the establishment of a non-appropriated chaplain’s fund upon mobilization.

i. Annex J, Nuclear, Biological, andChemical Defense. This annex provides generalguidance regarding unit and individual defenseagainst NBC attacks, decontamination proce-dures, and care of NBC casualties.

(1) The NBC NCO is the technicaladvisor to the hospital commander and the opera-tions officer on all matters pertaining to NBCoperations. Procedures should be developed for—

• Organizing and trainingthe required NBC teams.

• Establishing a warningand alarm system. The system will include vocal,visual, and sound.

• Training hospital person-nel on MOPP and other NBC defensive measures.

• Advising the hospital com-mander on activation of the appropriate MOPPlevel, to include masking and unmaskingprocedures, based on the tactical situation.

• Maintaining NBC recordsand submitting the required reports.

• Establishing collective shel-ters. The operations section will determine therequirements for NBC collective shelters, The re-sponsibility for establishing and maintainingNBC shelters rest with the section beinghardened.

• Publishing radiation ex-posure guidance. This includes methods to

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minimize exposure and protect against electro-magnetic pulses.

• Maintaining and distrib-uting unit NBC defense equipment.

• Maintaining account-ability and proper stockage of NBC defenseequipment and PLL items.

(2) This annex should include thefollowing appendixes:

• Appendix l—NBC Teams.

• Appendix 2—Decontami- nation Procedures.

• Appendix 3—Operating inan NBC Environment.

• Appendix 4—Individualand Collective Protective Plan.

• Appendixand Patient Care of NBC Patients.

• AppendixContaminated Patients.

5—Handling

6—Handling

• Appendix 7—EstablishingDecontamination Sites.

• Appendix 8—LocatingContaminated Areas (to include traffic control inand out of the area).

•porting.

•Recovery.

•Exposure Guidance.

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Appendix 9—NBC Re-

Appendix 10—Hospital

Appendix 11-Radiation

• Appendix 12—References.

j. Annex K, Nutrition Care. Thisannex outlines procedures relating to patientnutrition management and Army medical fieldfeeding operations. The annex addresses thenutrition care division’s organization and staffresponsibilities. The organization and a detaileddiscussion of the following specific areas shouldbe included as appendixes:

•

•

•

•feeding.

•

•

•

•forced fluids.

•

•

•

•

•

Organization.

Medical rations.

Patient meal delivery.

Staff and ambulatory patient

Safety.

Sanitation.

Nutritional support.

Nourishments, to include

Ration accountability.

Ration procurement.

Equipment maintenance.

Training.

References.

k. Annex L, Logistics. This annex out-lines sources, procedures, requirements, respon-sibilities, and planning guidance for logisticalsupport for a CSH.

FM 8-10-14

(1) Specific areas which are ad-dressed are listed below. The discussion to theareas should be provided in appendixes with theinclusion of tabs, if appropriate.

cal).

tenance.

•

•

•

•

•

•

•

•

Supply and services.

Medical supply.

General supply.

Maintenance (less medi-

Medical equipment main-

Waste disposal.

Linen.

Interface with theMEDLOG battalion (forward).

• Transportation and mo-bility.

• Supply and distribution.

• Engineer support.

• Quartermaster support.

• Hospital safety.

• Blood component resup-ply.

Logistics applications of automated markingand reading symbols (LOGMARS), TACCS,MEDTCU, and test, measurement, and diagnosticequipment are included in the discussions whenappropriate.

(2) Transportation and movementrequirements. This appendix covers the followingareas: applicability; responsibilities; policies onspeed, vehicle markings, transporting flam-mable materials, transporting ammunition andweapons, convoy procedures; safety; and accidentreporting.

(3) Fire prevention and protection.Guidance on the use of flammable materials, useof cigarettes, matches, and lighters, electricalwiring and appliances, safety of tents andoccupants, spacing of tents, stoves and ranges,and firefighting equipment are presented in thisappendix.

(4) Field hygiene and sanitation.This appendix provides uniform guidance andprocedures for the performance of functionsrelated to field hygiene and sanitation. It includespolicies, communicable disease control, field watersupply, water trailers and cans, fabric waterstorage containers, food sanitation, latrines, liquidwaste disposal, and garbage and rubbish disposal.For additional information on field hygiene andsanitation, see FMs 21-10 and 21-10-1.

(5) Conventional ammunition down/upload procedures. This appendix delineatesresponsibilities; provides guidance and proce-dures for the requisition, storage, and distributionof ammunition and weapons, reporting require-ments, arid safety.

(6) Petroleum, oils, and lubricantsaccounting.

(7) Health service logistics sup-port. The health service logistics concept ofoperations, requisition, and distribution proce-dures, accountability, and reports are providedin this appendix.

1. Annex M, Laboratory. This annexprescribes laboratory policies and procedures in

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FM 8-10-14

support of the hospital. Procedural guidance willinclude, but not be limited to—

• Hematology and urinalysis.

• Performing white cellcount.

• Performing completeblood count (red blood cell [RBC], white bloodcell [WBC], hemoglobin [Hgb], and hematocrit[Hct]).

ferential.

time.

• Determining Hct.

• Determining WBC dif-

• Determining prothrombin

• Determining partialthromboplastin time (APTT).

• Performing cerebrospinal fluid (CSF) cell count and differential.

• Performing urinalysis(dipstick).

• Performing urinalysis(microscopic).

• Performing platelet esti-mate.

• Performing platelet count.

• Determining fibrinogenlevel.

• Determining fibrin degra-dation products.

• Biochemistry.

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• Performing blood gasanalysis.

• Performing electrolytelevels (Na, K, Cl, and C02).

protein.

atinine.

ylase.

activity.

activity.

activity.

cose.

bilirubin.

cium.

•

•

•

•

•

•

•

•

•

•

•

•

•

Determining total serum

Determining serum pre-

Determining serum am-

Determining serum AST

Determining serum ALT

Determining serum CK

Determining serum glu-

Determining serum T.

Determining serum cal-

Determining CSF glucose.

Determining CSF protein.

Determining urine protein.

Determining urine glucose.

• Microbiology and serology.

• Performing occult bloodtest.

FM 8-10-14

• Performing thick and thinsmears for malaria.

• Performing gram stains.

• Performing RPR test(syphilis).

• Performing IM (infectiousmononucleosis) tests.

cysts, and

hydroxide

tests.

• Examining feces for ova,parasites.

(KOH)

•able with specific

• Performing potassiumpreps.

• Performing pregnancy

Microbiology (capabilities avail-augmentation).

• Performing urine cultures(colony counts and sensitivity).

• Performing wound cul-ture and sensitivity.

• Performing culture andsensitivity for gonorrhea.

• Performing throat cul-

• Quality control procedures.

tures.

• Reports.

• Infectious,ous, and solid waste disposal.

• Safety.

chemical, hazard-

m. Annex N, Blood Bank Services. Thisannex prescribes hospital blood bank policies andprocedures. It addresses procedures for—

• Storing, collecting, and admin-istering blood and blood products.

• Performing blood group andtype (ABO, RH).

• Performing abbreviated bloodcrossmatching procedures.

• Thaw and issue freshplasma.

• Blood planning factors.

• Reports.

frozen

• Automated blood managementsystem.

n. Annex O, Dental Services. Thisannex outlines policies and procedures for dentalclinic operations in a CSH. Procedures include—

• Priority of treatment.

• Dental records.

• Narcotics and drug control.

• Dental supply and mainte-nance operations.

• Precious metal control.

• Mercury hygiene andand needle security.

syringe

• Sterilization and infection con-trol.

• Safety.

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FM 8-10-14

o. Annex P, Pharmacy Service. Thepharmacy operation is centered around an in-patient and outpatient system, distribution ofbulk drugs, and the IV-additive program. Thisannex addresses the following procedures:

• Storing, safeguarding, labeling,and dispensing pharmaceutical and drug pro-ducts.

•gram.

•

•

•

•medication.

•plies.

•

Operating an IV-additive pro-

Controlling drugs (Q and R).

Preparing signature cards.

Accessing letters.

Rotating stockage of drugs and

Requisitioning drugs and sup-

Preparing reports.

p. Annex Q, Patient AdministrationDivision. This annex outlines the general func-tions for the PAD. Procedural guidance isidentified for the following:

• Maintenance and account-ability for clinical records.

• Admittance, discharge, andtransfer of patients (surface and air movement).

• Processing and disposition ofweapons, ammunition, maps, and classified andsensitive documents taken from patients admittedto the hospital.

• Medical statistics and reports.

• Claims.

• Processing hospital deaths.

• Theater Army Medical Man-agement Information System MEDPAR andMEDREG.

q. Annex R, Nursing Service. Thisannex provides administrative and operationalguidance for all nursing service personnelthroughout the hospital. It provides nursing carestandards, policies, and procedures which areapplicable to all wards, to include ORs and thetriage, EMT, and preoperative treatment sections.Areas addressed should include, but not belimited to, the following:

•

•

•

•

•

•

•

•ology.

•tory.

•

•

Nursing documentation.

Scope of nursing practices.

Standards of nursing practice.

Standards of patient care.

Assignment of personnel.

Infection control.

Special category patients.

Procedures available in radi-

Procedures available in labora-

Admission and discharge.

Procedures for cardiopulmo-nary resuscitation.

• Mass casualty plan.

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FM 8-10-14

patient.

patient.

catheters.

lines.

•

•

•

•

•

•

•

•

ostomy.

disposal.

Preoperative

Postoperative

care of the

care of the

Care of patient with indwelling

Care of patient with central IV

Care of patient with trache-

Care of patient with chest tube.

Death procedures.

Hazardous and medical waste

(2) Appendixes to the annex mayinclude other information to assist dailyoperations. Suggested areas are—

• Radiation safety.

• Radiation protection.

• Equipment records.

• Radiographic film security.

• Filing procedures.

s. Annex T, Medical Services. Thisannex prescribes the duties and procedures formedical services in the treatment of all patientsadmitted to the hospital. Areas to be addressedinclude, but are not limited to—

• Treatment protocols.

• Examination procedures. • Bedpan and urinal washingand disinfecting procedures.

r. Annex S, Radiological Services.This annex establishes policies and proceduresfor requesting radiological services, preparationof patients, and use of x-ray films.

(1) Request for diagnostic proce-dures is outlined for the following examinations:

• Routine.

• Emergency.

• Bedside.

• Special (upper gastroin-testinal series, gallbladder).

• Urological.

• Preoperative chest x-rays.

• Evaluation and treatment ofinfectious diseases.

• Evaluation and treatment ofinternal medicine disorders.

• Evaluation and treatment ofskin disorders.

• Treatment of patients withgynecological diseases, injuries, or disorders.

• Medical supply and resupplyprocedures.

• Consultation services.

• Infection control (procedures tobe followed to reduce the threat of infection in anaustere environment).

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FM 8-10-14

• Fire evacuation plan.

• Reports.

t. Annex U, Surgical Services. Thisannex outlines diagnostic and surgical treatmentprocedures for the hospital. It should include,but not be limited to, the following:

• Scheduling procedures, to in-clude after-hours and emergency cases.

•

•

•scrub procedures.

•

•

•sanitation.

Aseptic (sterile) techniques.

Maintenance of registry.

Scrub attire and surgical hand-

Environmental safety.

Electrosurgical unit safety.

Operating room environmental

Counts of sponges and sharps.

Bullet removal evidence and

•

•property custody document.

• Death procedures.

• Notifications.

• Autopsy, to include coor-dination with HN health officials or compliancewith valid agreements.

• Disposition.

• Cardiac arrest procedures.

• Traffic patterns.

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• Transportation of patientsto and from the OR.

• Transportation of sterile,clean, and dirty equipment.

and

and

• Evacuation of personnelpatients during contingencies.

• Handling contaminated needlessyringes.

u. Annex V, Operating Room/CentralMateriel Service Control Team. This annexoutlines the functional procedures of the OR,CMS, and anesthesia services, and thepreparation and maintenance of OR-relatedequipment. With exception of CMS, the OR andanesthetists are not a separate paragraph in theL-edition series TOE. As an entity, theseelements are under the supervision of the senioranesthesiologist or the officer appointed by thehospital commander. The operational guidanceincludes, but is not limited to—

(1) Operating room service.

• Verifying personnel quali-fications for assigned duties.

• Scheduling nursing staff.

• Providing immediate post-operative care of surgical patients (recovery room/ICUs).

• Availability of ORs.

• Operating room space uti-lization.

• Medical resupply, to in-clude time lines.

• Medical maintenance, toinclude organic and depot.

FM 8-10-14

(2)

•

•

•

requirements.

cedures.

Anesthesia services.

area.

•

•

•

•

•

•or infectious waste.

•

Standards.

Duty roster and on-call

Master list of clinical pro-

Equipment checklists.

Classification of patients.

Narcotics control.

Infection control in work

Anesthesia carts.

Disposition of hazardous

Storage of combustiblesand cleaning schedule.

• Quality control proce-dures for equipment.

• Verifying personnel quali-fications for assigned duties.

(3) Central materiel service.

• Loading and unloadingthe steam sterilizer.

• Monitoring the steriliza-tion process.

• Labeling and monitoringshelf life of sterile items.

• Providing tray setup andwrapping procedures, to include cleaning and pre-paring equipment and supplies for sterilization.

v. Annex W, Emergency Medical Ser-vices. This annex outlines the procedures forreceiving patients, performing patient assess-ments, providing EMT, and transporting patientsto the appropriate element of the hospital.Procedures include—

• Continuous 24-hour emergencytreatment service.

• Verification of personnel quali-fication.

• A 24-hour physician andnursing service coverage plan.

•

•

•personnel.

•ment.

•agement.

•

Patient registration ledger.

Triage.

Scope of practice of MOS 91B

Routine patient care manage-

Emergency patient care man-

Carependents (as required).

• Care

of HIV military and de-

of HN contract civilianand other HN medical care requirements.

• Admission and transfer ofpatients.

• Mass casualty operations.

• Medical treatment for chemicaland biological agent patients.

• Medical evacuation.

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FM 8-10-14

• Utilization of the hospital litterteam.

• Medical resupply and mainte-nance.

• Care of refugees and displacedpersons.

• Assessment and emergencytreatment of patients undergoing and awaitingNBC decontamination.

w. Annex X, Neuropsychiatric Serviceand Ward. This annex outlines procedures forhospital NP service including diagnosis andconsultation to all areas within the hospital andto others as may be directed by the command.Procedures include, but are not limited to—

• Screening of patients by apsychiatrist.

• Ward support for nonambula-tory or secluded patients.

• Patient ledger and transfercoordination.

• Patient restraining.

• Enemy prisoner of war patientsupport augmentation.

• Records and administration.

• Drug control.

• Identifying and monitoringsuicidal and homicidal patients.

• Neuropsychiatric and combatfatigue-related casualties.

• Medical supplies and mainte-nance.

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• Stress control to patients andstaff of other wards.

x. Annex Y, Physical Therapy. Thisannex outlines procedures for the utilization andsupport of physical therapy services. Areas to beaddressed include, but are not limited to, thefollowing:

• Verification of personnel qual-ification.

• Scope of practice of physicaltherapy personnel.

• Assignment of physical therapypersonnel.

• Services provided.

• Referral procedures.

• Mass casualty role.

• Utilization of radiology andpharmacy services.

• Injury prevention programs.

• Logistical support.

y. Annex Z, Mass Casualty. This an-nex outlines procedures to enable the hospital torespond effectively to a variety of emergency,external, and internal disaster situations. In anysituation, the hospital must be prepared to re-ceive, triage, treat, and hospitalize large numbersof casualties within a short period of time. Thedevelopment of this plan is the responsibility ofthe operations section, or as directed by the hos-pital commander. Procedures include—

• Planning and training require-ments.

FM 8-10-14

• Medical cadre positions. • Discharge of patients.

• Nonmedical personnel posi-tions and duties, including litter teams, perimeterguard, crowd control, and information personnel.

• Location of services, to includetriage, delayed care, immediate care, minimalcare, and expectant care areas.

• Support requirements beyondhospital capability.

• Evacuation.

• Records and reports.

z. Annex AA, Civil-Military Opera-tions. This annex discusses participation in civil-military operations (CMO). Medical elements areoften involved in CMO, humanitarian assistance,and disaster relief operations. The activitieswhich may be covered include providing medicaltreatment within the capabilities of the hospitaland providing training to a HN’s medicalinfrastructure. The responsibility for this annexis the operations officer, or as directed by thehospital commander.

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