Army Health System Support To Stability And Defense Support Of Civil .

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ATP 4-02.42ARMY HEALTH SYSTEM SUPPORTTO STABILITY AND DEFENSE SUPPORTOF CIVIL AUTHORITIES TASKSJune 2014DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.Headquarters, Department of the Army

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*ATP 4-02.42HeadquartersDepartment of the ArmyWashington, DC, 9 June 2014Army Techniques PublicationNo. 4-02.42Army Health System Support to Stability andDefense Support of Civil Authorities TasksContentsPagePREFACE.vINTRODUCTION .viiPART ONEChapter 1ARMY HEALTH SYSTEM SUPPORT TO STABILITYSTABILITY OVERVIEW. 1-1Section I — Stability in Operations. 1-1Stability Principles . 1-1Primary Stability Tasks . 1-2Section II — Lead Federal Agency. 1-2Department of State . 1-2Section III — National Strategy and Defense Policies . 1-4National Strategy . 1-4Policy Documents . 1-4Section IV — Regional Focus . 1-6Theater Engagement Strategy . 1-6Theater Security Cooperation Plan . 1-6Chapter 2ESSENTIAL STABILITY TASKS . 2-1Section I — Primary Stability Tasks . 2-1Essential Task List. 2-1Section II — Establish Civil Security . 2-2Ensure Adequate Health, Food, and Security for Belligerents . 2-3Section III — Restore Essential Services . 2-4Provide for Immediate Humanitarian Needs of the Population . 2-5Ensure Sanitation, Purification, and Distribution of Drinking Water . 2-5Provide Interim Sanitation, Wastewater Management, and Waste DisposalServices . 2-5Distribution Restriction: Approved for public release; distribution is unlimited.*This publication supersedes FM 8-42, dated 27 October 1997.9 June 2014ATP 4-02.42i

ContentsSupport Famine Prevention and Emergency Food Relief Programs. 2-6Section IV — Support to Economic and Infrastructure Development . 2-8Protect Natural Resources and the Environment . 2-8Support General Infrastructure and Reconstruction Programs . 2-11Chapter 3ARMY HEALTH SYSTEM SUPPORT TO STABILITY TASKS . 3-1Section I — Building Partner Capacity . 3-1Medical Capacity Building . 3-1Health Care Program Development . 3-2Section II — Civil-Military Operations . 3-3Role of Civil Affairs in Stability . 3-3Section III — Legal Considerations . 3-4Eligibility Criteria. 3-4Standard of Care . 3-5Military Medical Training Considerations . 3-5Section IV – Medical Support to Stability Tasks . 3-5Army Medical Functions . 3-6Medical Mission Command Support to Stability Tasks . 3-6Medical Treatment (Organic and Area Support) Support to Stability Tasks . 3-8Hospitalization Support to Stability Tasks . 3-9Medical Evacuation and Regulating Support to Stability Tasks . 3-11Medical Logistics Support to Stability Tasks . 3-12Medical Laboratory Support to Stability Tasks . 3-13Dental Support to Stability Tasks . 3-14Preventive Medicine Support to Stability Tasks. 3-16Combat and Operational Stress Control Support to Stability Tasks . 3-20Veterinary Support to Stability Tasks . 3-20Chapter 4MEDICAL PLANNING FOR STABILITY. 4-1Section I — Planning for Contingency Operations . 4-1Section II — Transition and End State . 4-2Transition . 4-2Transition Planning for Medical Support to Stability . 4-2End State . 4-3Section III — Medical Planning Considerations for Stability . 4-4Foundations for Army Health System Support . 4-4Section IV — Army Health System Support to Joint Operations . 4-4Joint Operations . 4-4Military Engagements in Peacetime. 4-5PART TWOChapter 5ARMY HEALTH SYSTEM SUPPORT TO DEFENSE SUPPORTOF CIVIL AUTHORITIES TASKSDEFENSE SUPPORT OF CIVIL AUTHORITIES OVERVIEW . 5-1Section I — Defense Support of Civil Authorities . 5-1Primary Defense Support of Civil Authorities Tasks . 5-2Primary Characteristics . 5-2Section II — National and Defense Policy . 5-2iiATP 4-02.429 June 2014

ContentsNational Policy . 5-2Defense Policy . 5-3Section III — Primary Defense Support of Civil Authorities Tasks . 5-4Support for Domestic Disasters . 5-4Support for Domestic Chemical, Biological, Radiological, and NuclearIncidents . 5-5Support for Civilian Law Enforcement Agencies . 5-5Other Designated Support . 5-6Section IV — National Emergency Management . 5-6National Response Framework . 5-6National Disaster Recovery Framework . 5-6National Incident Management System. 5-7National Disaster Medical System . 5-8Chapter 6ARMY HEALTH SYSTEM SUPPORT TO DEFENSE SUPPORT OF CIVILAUTHORITIES TASKS . 6-1Section I — Department of Defense Medical Support for DomesticIncidents . 6-1Department of Defense Support to the National Disaster Medical System . 6-1Department of Defense Role Within the National Response Framework . 6-2Section II – Legal Considerations . 6-6Section III – Army Health System Support. 6-6Army Health System Support to Defense Support of Civil Authorities . 6-6Hospitalization . 6-7Medical Mission Command . 6-9Medical Treatment (Organic and Area Support) . 6-16Medical Evacuation . 6-16Medical Logistics . 6-19Medical Laboratory . 6-21Preventive Medicine . 6-22Combat and Operational Stress Control . 6-24Dental Support . 6-27Veterinary Support. 6-27Chapter 7INTERORGANIZATIONAL COORDINATION . 7-1Section I — Coordination Requirements . 7-1Section II — Coordination in Support of Stability Tasks. 7-1Governmental Agencies . 7-1Department of Defense . 7-2Multinational and Nongovernmental Organizations . 7-4Section III — Coordination in Support of Defense Support of CivilAuthorities . 7-5Requests for Department of Defense Assistance . 7-5Pre-Scripted Mission Assignments. 7-7National Disaster Medical System Requests for Assistance. 7-7Section IV — National Response Resources . 7-9Department of Health and Human Services . 7-9Food and Drug Administration . 7-129 June 2014ATP 4-02.42iii

ContentsSection V — National Response Framework Support Agencies . 7-12Support Agencies for Emergency Support Function #8. 7-12Department of Agriculture . 7-12Department of Commerce . 7-13Department of Energy . 7-13Department of Homeland Security . 7-14Department of the Interior . 7-15Department of Justice . 7-15Department of Labor . 7-15Department of State . 7-16Department of Transportation . 7-16Department of Veterans Affairs. 7-16Environmental Protection Agency . 7-17American Red Cross . 7-17Section VI — Other Emergency Response Resources . 7-18Emergency Alert System . 7-18Mobile Emergency Response Support . 7-19National Preparedness Network . 7-19Recovery Radio Support . 7-19Federal Emergency Management Agency National Shelter System. 7-19Radiation Emergency Assistance Center/Training Site . 7-20Appendix AARMY HEALTH SYSTEM SUPPORT ASSESSMENTS . A-1Appendix BSECTIONS OF TITLE 10, UNITED STATES CODE, PERTAINING TO FOREIGNHUMANITARIAN ASSISTANCE . B-1GLOSSARY . Glossary-1REFERENCES. References-1INDEX . Index-1FiguresFigure 2-1. Stability task alignment . 2-2Figure 6-1. Incident command structure . 6-12Figure A-1. Medical aspects of the operational variables . A-4Figure A-2. Civil affairs area study and assessment . A-6TablesTable 2-1. Medical considerations . 2-3Table 6-1. Department of Defense support to emergency support function #8 . 6-4Table 6-2. Department of Defense support to emergency support function #11 . 6-5Table 6-3. Critical information requests during the alerted phase . 6-15Table 6-4. Critical information requests during the activated phase . 6-15Table 6-5. Critical information requests during deactivation . 6-16Table 7-1. Mission assignment/request for assistance process . 7-8ivATP 4-02.429 June 2014

PrefaceThis ATP establishes Army Health System (AHS) support doctrine and provides the guiding principles for theprovision of medical support to stability and defense support of civil authorities (DSCA) tasks.The principal audience for this publication is commanders, their staffs, medical planners, and personnel at alllevels. Commanders, staffs, and subordinates ensure their decisions and actions comply with applicable UnitedStates (U.S.), international, and in some cases, host-nation laws and regulations. Commanders at all levelsensure their Soldiers operate in accordance with the law of war and the rules of engagement. (See FM 27-10.)This manual is a guide for providing AHS support to stability and DSCA tasks in an area of operations. Thispublication applies to the Active Army, Army National Guard/Army National Guard of the United States, andthe United States Army Reserve, unless otherwise stated.This publication implements or is in consonance with American, British, Canadian, Australian, and NewZealand (Armies) Standard 815, Blood Supply in the Area of Operations; Quadripartite Advisory Publication256, Coalition Health Interoperability Handbook; and the following North Atlantic Treaty OrganizationStandardization Agreements:TITLENUMBERMedical Employment of Air Transport in the Forward Area2087Allied Joint Medical Support Doctrine—Allied Joint Publication-4.10(A)2228Training Requirements for Health Care Personnel in International Missions—Allied Medical Publication-8.32249Allied Joint Doctrine for Civil-Military Cooperation—Allied Joint Publication-3.4.92509Allied Joint Doctrine for Non-Combatant Evacuation Operations—Allied JointPublication-3.4.22514Allied Joint Medical Planning Doctrine—Allied Joint Medical Publication-12542Allied Joint Civil-Military Medical Interface Doctrine—Allied Joint MedicalPublication-62563Army Techniques Publication 4-02.42 uses joint terms where applicable. Selected joint and Army terms anddefinitions appear in both the text and the glossary. This publication is not the proponent for any Army terms.Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men.The proponent of this publication is the U.S. Army Medical Department Center and School. The preparingagency is the Doctrine Literature Division, U.S. Army Medical Department Center and School. Send commentsand recommendations on a DA Form 2028 (Recommended Changes to Publications and Blank Forms) toCommander, U.S. Army Medical Department Center and School, ATTN: MCCS-FC-DL (ATP 4-02.42),2377 Greeley Road, Suite D, Building 4011, JBSA Fort Sam Houston, Texas 78234-7731; by e-mail; or submit an electronic DA Form2028. All recommended changes should be keyed to the specific page, paragraph, and line number. A rationaleshould be provided for all recommended changes to aid in the evaluation and adjudication of each comment.9 June 2014ATP 4-02.42v

IntroductionArmy Techniques Publication 4-02.42 examines the various situations in which Army medical personnel maybe required to provide support for stability and DSCA tasks. While the Department of Defense (DOD) is not aprovider of first resort in disasters, requests for support from U.S. forces may be required when military-uniquecapabilities (such as lift capability, engineering, or deployable medical support) exist that can expedite reliefefforts during urgent, life-threatening situations.This manual is a two-part publication. Part one of the ATP discusses AHS support to stability tasks and parttwo covers medical support to DSCA tasks. A summary of significant changes include— Adjustments in the stability discussion based on current doctrinal and terminology changes toinclude the change from stability and support operations to stability and DSCA tasks. The addition of the essential stability tasks. Building partner capacity as a stability principle and the medical capacity building activities thatmay be employed in support of this principle. Part two of the manual, which provides a separate discussion of AHS support to DSCA tasks, theNational Response Framework (NRF), National Disaster Recovery Framework, and the DOD’srole in the National Disaster Medical System (NDMS).Army Techniques Publication 4-02.42 consists of seven chapters— Chapter 1 provides an overview of stability in operations, the primary stability tasks, national andDOD-level guidance, and the importance of ensuring that AHS support to stability tasks isregionally focused and conducted in consonance with the combatant commander’s theaterengagement strategy. Chapter 2 discusses the Department of State’s Post-Conflict Reconstruction Essential Tasks matrixas it relates to the Army primary stability tasks. The chapter also provides the doctrinaldescription for three of the five Army stability tasks, medical aspects of the supporting initial andtransformational response tasks, and corresponding health service support (HSS) and force healthprotection (FHP) considerations for each task. Chapter 3 discusses the employment of AHS assets in support of the primary stability tasks, themedical aspects of building partner capacity, the role of civil affairs, legal considerations, andAHS support to operations with a stability focus. Chapter 4 provides medical planning considerations for AHS support to joint operations andstability tasks to include transition and end state considerations. Chapter 5 provides a brief overview of the primary DSCA tasks, national and DOD-levelguidance. This chapter also provides a brief description of medical aspects of the NRF, NationalDisaster Recovery Framework, and the NDMS. Chapter 6 provides legal considerations that may apply when providing medical support to DSCAtasks and a discussion of the support provided for each of the 10 medical functions. Chapter 7 describes the interorganizational and interagency coordination required in support ofDSCA tasks, the process for requesting DOD assistance for support to civil authorities, some ofthe NDMS medical resources that may be employed during a disaster, as well as some of theparticipating organizations that may be involved in the relief effort.viATP 4-02.429 June 2014

PART ONEArmy Health System Support to StabilityChapter 1Stability OverviewStability tasks are conducted as part of operations outside the U.S. in coordinationwith other instruments of national power to maintain or reestablish a safe and secureenvironment, provide essential governmental services, emergency infrastructurereconstruction, and humanitarian relief. This chapter discusses the primary stabilitytasks, national- and DOD-level guidance, and the importance of ensuring that AHSsupport to stability tasks is regionally focused and conducted in consonance with thecombatant commander’s theater engagement strategy.SECTION I — STABILITY IN OPERATIONSSTABILITY PRINCIPLES1-1. Operations with a stability focus employ U.S. military capabilities to assist other U.S. governmentagencies, nongovernmental organizations, foreign governments, and international governmentorganizations in planning and execution of disaster relief, reconstruction, and stabilization efforts in supportof affected nations. Stability tasks are an important part of unified land operations and occursimultaneously, with combinations of offensive and defensive tasks. The focus of stability tasks is toidentify, target, and mitigate the underlying causes of instability and set the conditions for long-termdevelopment by building the capacity of local institutions.1-2. When conducting stability tasks, U.S. forces work to achieve the military end state not by any singlemeans applied in isolation, but through the integrated, collective activities of all instruments of national andinternational power. The conditions that describe the desired end state are— A safe and secure environment. Established rule of law. Social well-being. Stable governance. Sustainable economy.1-3. The stability principles are the basis for the Army’s primary stability tasks and lay the foundation forbuilding the long-term capacity of local institutions. The Army’s stability principles are—conflicttransformation, unity of effort, legitimacy and host-nation ownership, and building partner capacity.9 June 2014ATP 4-02.421-1

Chapter 1PRIMARY STABILITY TASKS1-4. The joint stability functions are security, humanitarian assistance, economic stabilization andinfrastructure, rule of law, and governance/participation. The joint stability functions mirror the fiveDepartment of State stability sectors, which are security, humanitarian assistance and social well-being,economic stabilization and infrastructure, justice and reconciliation, and governance and participation. TheArmy’s primary stability tasks are— Establish civil security. Establish civil control. Restore essential services. Support to governance. Support to economic and infrastructure development.1-5. The primary stability tasks (including the subordinate tasks for each area) are not performed inisolation, but are used as lines of effort to integrate with offensive and defensive tasks. Stability tasks areperformed in various operational environments to include— Supporting a partner nation during military engagements in peacetime. Providing assistance after a natural or man-made disaster as part of a humanitarian-based limitedintervention. Conducting peace operations to enforce international peace agreements. Supporting a legitimate host-nation government during irregular warfare. Establishing conditions during major combat operations that facilitate post-conflict activities. Conducting operations in a post-conflict environment following the general cessation oforganized hostilities.1-6. There are various types of joint operations conducted across the range of military operationsincluding peacekeeping, noncombatant evacuation operations, foreign humanitarian assistance, and others.Varying types and levels of medical resources are required to support the stability tasks and ensure missionsuccess. See Chapters 2, 3, and 4 of this manual for a discussion of each type of operation and thecorresponding medical support required.SECTION II — LEAD FEDERAL AGENCYDEPARTMENT OF STATE1-7. Within the U.S. government, the Department of State is the lead agency responsible for diplomaticinitiatives and oversees program support for stabilization. The Department of State leads the whole ofgovernment approach to stabilization, which encompasses the efforts of numerous U.S. governmentdepartments and agencies, including the DOD components. To that end, the Department of State hasdeveloped the Post-Conflict Reconstruction Essential Tasks matrix, which is a detailed interagencydocument used by planners to identify specific requirements to support conflict transformation. The jointstability functions and Army primary stability tasks are derivatives of the stability sectors and theDepartment of State Post-Conflict Reconstruction Essential Tasks matrix.UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT1-8. The Administrator of the U.S. Agency for International Development (USAID) serves as the Directorof Foreign Assistance for the Department of State and the lead federal agency responsible for U.S.government foreign humanitarian assistance and interagency coordination. The USAID’s Bureau forDemocracy, Conflict, and Humanitarian Assistance contributes to this effort by bringing together a widerange of technical expertise and global operational capabilities essential to crisis prevention, response,recovery, and transition. The Bureau for Democracy, Conflict, and Humanitarian Assistance has nineoffices, including the Office of Foreign Disaster Assistance and the Office of Civil-Military Cooperation.1-2ATP 4-02.429 June 2014

Stability Overview1-9. The USAID’s Office of Foreign Disaster Assistance is the U.S. government’s lead for facilitating andcoordinating assistance in response to both natural disasters and complex emergencies overseas. TheOffice of Foreign Disaster Assistance is responsible for coordinating and validating all requirements forDOD support to foreign humanitarian assistance or disaster relief before requests for assistance aresubmitted, even when the Department of State or USAID are not the originators of the specific request.The Office of Foreign Disaster Assistance Military Liaison Unit coordinates with the DOD prior to, during,and after disasters. Military Liaison Unit advisors are permanently based at the following DOD combatantcommands: United States Africa Command. United States European Command. United States Central Command. United States Pacific Command. United States Southern Command.1-10. The Office of Foreign Disaster Assistance Military Liaison Unit advisor based at U.S. SouthernCommand also provides coverage for U.S. Northern Command. See the USAID Field Operations Guidefor Disaster Assessment and Response for additional information on military operations involvingcoordination with the Office of Foreign Disaster Assistance.1-11. The Office of Civil-Military Cooperation is USAID’s primary point of contact with the DOD. TheOffice of Civil-Military Cooperation provides the focal point for USAID interaction with U.S. and foreignmilitaries in formalized relationships through coordinated policy, planning, training, education, andoutreach. Areas of interaction include foreign humanitarian assistance, disaster management counter

Medical Employment of Air Transport in the Forward Area 2087 Allied Joint Medical Support Doctrine—Allied Joint Publication-4.10(A) 2228 Training Requirements for Health Care Personnel in International Missions— Allied Medical Publication-8.3 2249 Allied Joint Doctrine for Civil-Military Cooperation—Allied Joint Publication-3.4.9 2509

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