1. Office of the Director, Naval Medicine
2. Commander, Naval Medical Command
3. Medical Department Support to the Fleet Marine Force (FMF)
4. Mobile Medical Augmentation Readiness Team (MMART)
5. Unit Augmentation System

References

As you advance in rate, you will become more involved in Medical Department administration, the "paperwork" required of any functioning organization. To perform effectively within the organization, you must understand the structure of the Navy, its relationship to other organizations, and the relationship between the various components within the Navy. It is also important that you understand your relationship to these organizations.

Let us begin with you, as a senior corpsman. If there are others below you, they look to you as their first step in the chain of command. You, in turn, are responsible to your division officer, who reports to the executive officer (XO), who in turn represents and reports to the commanding officer (CO). As far as the internal function of the ship is concerned, the organization culminates there. However, the CO reports to the type commander, on up the line to the Chief of Naval Operations (CNO), through the Secretary of the Navy (SECNAV), the Secretary of Defense (SECDEF), and eventually to the President of the United States.

Compared to civilian businesses, the Navy is a massive organization. It operates on the assumption that every individual knows what is expected of him or her in any given situation. Jobs run the gamut from the recruit who swabs the deck to the President, who is Commander in Chief of all the Armed Forces. Since the President cannot become involved with telling the recruit how, when, and where to swab the deck, the task is delegated to others through the chain of command.

Delegating authority means assigning it to certain individuals within the command, from the top downwards through the chain of command, to accomplish the task at hand. To achieve an effective Navy, authority is delegated down the chain of command at all levels, from the Commander in Chief to the last individual in the organization. The delegation of authority and the issuance of orders and instructions by people in the naval service does not relieve such persons from any responsibility imposed on them. They must ensure that the delegated authority is properly exercised and the orders are properly executed. The Navy expects all individuals to fully understand the command organization and to function in their capacity within the command.

The Department of Defense (DOD) consists of the Office of the Secretary of Defense (OSD), the Joint Chiefs of Staff (JCS), the Joint Staff, the unified and specified commands, as well as the Departments of the Army, the Navy, and the Air Force.

The Department of the Navy (DON) is organized under SECNAV and operates under the authority, direction, and control of the SECDEF. DON is composed of three major elements: the Navy Department, the Shore Establishment, and the operating forces. In time of war or when directed by the President, the U.S. Coast Guard comes under DON, but at all other times is a part of the Department of Transportation.

The Navy Department is the executive part of DON and is located at the seat of government. Members of the Navy Department include the SECNAV, the Chief of Naval Operations (CNO), the Chief of Naval Material, the Surgeon General, the Commandant of the Marine Corps, the Judge Advocate General (JAG), the Office of the Comptroller, and the Head of the U.S. Coast Guard (when operating as part of DON.)

The Shore Establishment is composed of the systems commands under the Office of the Chief of Naval Material; and various naval support commands such as Naval Education and Training, Naval Intelligence, and Naval Telecommunica- tions. The Marine Corps support establishment and the Marine Corps Reserve are also components of the Shore Establishment.

The operating forces are composed of several fleets, seagoing forces, district forces, sea frontier forces, the Military Sealift Command, the Fleet Marine Forces, the operating elements of the Coast Guard (when assigned), and all other forces, commands, and activities not otherwise assigned. Figure 8-1 shows the basic organization of DON.

Office of the Director, Naval Medicine

The Office of the Director, Naval Medicine develops policy and serves as the resource sponsor for Navy medical and dental operations. Under the direction of the SECNAV and the CNO, the Surgeon General (Director, Naval Medicine) is responsible for developing policies to:

• Establish a readiness status to meet medical requirements during contingencies to support the operational forces
• Safeguard and promote the health of Navy and Marine Corps personnel
• Provide policy guidance for the care and treatment of sick and injured Navy and Marine Corps personnel and their dependents, and other personnel as authorized by law.

Commander, Naval Medical Command

The Naval Medical Command is comprised of a headquarters element, eight geographic direct health care commands, and seven special mission commands. The Commander, Naval Medical Command (COMNAVMEDCOM) is charged with overall program execution to maintain medical readiness through ensuring the highest level of health for Navy personnel through the promotion of physical fitness, the prevention and control of diseases and injuries, and the treatment and care of the sick and injured. Additionally, it is the responsibility of the Commander, Naval Medical Command to ensure the overall readiness, training, and deployment of medical personnel to augment the operating forces. To fulfill this responsibility, the COMNAVMEDCOM is actively concerned with all phases of Navy life and provides technical assistance for all echelons of the Navy on matters affecting the health of naval personnel. The organizational chart for the COMNAVMEDCOM is shown in Figure 8-2.

Navy Medical Department

The Medical Department is composed of the following:

• Medical Corps (physicians and medical students)
• Dental Corps (dentists)
• Medical Service Corps (administrators and allied scientists)
• Nurse Corps (registered nurses)
• Hospital Corps (enlisted medical personnel)
• Dental Technicians (enlisted dental personnel)

The Hospital Corps is the only enlisted corps in the Navy. Hospital Corps personnel are trained in the Hospital Corps "A" School, and may receive further training in the health sciences through formal school in such areas as X-ray, Pharmacy, Cardiopulmonary, Clinical Nuclear Medicine, Advanced Hospital Corps, and so forth.

The Dental Technician Rating is composed of enlisted personnel trained to assist dental officers. Like hospital corpsmen, dental technicians are trained through basic "A" School and other formal programs.

Navy Geographic Health Care System

Eight geographic naval medical commands (GEOCOMs), six in CONUS and two in OCONUS, are responsible for control and administration of medical and dental subordinate activities within their assigned geographic region. Under the direction of a geographic naval medical commander, the GEOCOM ensures that its subordinate activities provide for local readiness training programs, maintain a high state of medical and dental contingency readiness status, provide the highest possible quality health care service, and receive adequate management direction. Naval hospitals, medical clinics, dental clinics, and their component activities are responsible for direct health care delivery within assigned geographic regions. Figure 8-3 shows the internal structure of the geographic naval medical commands.

The objectives of establishing geographic naval medical commands are to:

• Monitor the delivery of health care services to active duty personnel and other eligible beneficiaries.
• Assess and improve patient, staff, and command satisfaction with the health care service provided.
• Achieve more efficient, economical, and effective use of health care resources.
• Achieve organizational uniformity within the naval regional health care system, to simplify and expedite the efficient provision of health care.
• Collect and submit accurate management information.
• Orient personnel in initial and subsequent assignments.
• Administer medical care programs, as established by the COMNAVMEDCOM, throughout the regional health care system.
• Decentralize coordination of readiness issues such as MMARTs and unit augmentation through the local contingency planning officer.

Naval Hospitals, Medical Clinics, And Dental Clinics

Naval hospitals, medical clinics, dental clinics, and subordinate branches and annexes are assigned responsibility for the care and treatment of the sick and injured in the following order:

• Primary Mission
  • The care and treatment of military personnel to expedite their return to full duty.
  • The prompt disposition of patients who require special treatment not satisfactorily available, or who are physically unfit for retention in the Navy.
  • To maintain a staff of manpower to meet mobilization requirements (peacetime versus wartime).
• Secondary Mission
  • Instruction of assigned medical and dental personnel.
  • Care and treatment of all other eligible beneficiaries.
  • Authorized research and development.
  • Cooperation with other military and civil authorities in matters pertaining to health and sanitation.

The basic organization of naval hospitals, medical clinics, and dental clinics is outlined in figures 8-4, 8-5, and 8-6.

Detailed descriptions of component directorates, special assistants, and committees are contained in NAVMEDCOMINST 5450.1, Organizational Manual for Geographic Naval Medical Commands, Naval Hospitals, Naval Medical Clinics, and Naval Dental Clinics. Hospital and clinic directorates for medical, nursing, administrative, and support functions are responsible for direction of day-to-day operations associated with health care delivery. These directorates are generally comprised of a number of departments and divisions. In addition to the directorates, a variety of committees and special assistants provide staff assistance to the CO/XO.

Medical Treatment Facilities

Medical treatment facilities of the DON are classified as either fixed or nonfixed.

• Fixed Medical Treatment Facilities
  • Hospital. A health treatment facility capable of providing limited definitive inpatient care. It provides emergency diagnostic, therapeutic, and related services in general medicine, surgery, preventive medicine, and ancillary services.
  • Clinic. A health treatment facility that provides limited emergency treatment and outpatient care. A clinic also performs certain nontherapeutic services, such as physical examinations, immunizations, medical administration, and preventive medicine services necessary to support a primary military mission. A clinic may be equipped with beds for observing patients awaiting transfer to a hospital and for the care of patients who cannot be cared for on an outpatient basis, but who do not require admission to a hospital facility. Patients cannot be kept overnight.
  • Branch Hospital. A health treatment facility that provides limited inpatient and outpatient care and is established at the discretion of the COMNAVMEDCOM, based on the size and dispersion of the patient population, health care resources available, and specialty requirements.
  • Branch Clinics. A small health treatment facility that provides any general primary outpatient care, and is established at the discretion of the COMNAVMEDCOM, based on the size and dispersion of the patient population, health care resources available, and specialty requirements.
  • Dental Clinic. Provides comprehensive outpatient dental care services to Navy and Marine Corps units of the operating forces, shore activities, and other authorized beneficiaries. Exercises command and control over the operation of subordinate dental care facilities (i.e., Branch Dental Recruit Clinic, Branch Dental Clinic, and Area Dental Labora tory).

    To differentiate between the various administrative types of hospitals, clinics, branches, and annexes, the following titles are used:

  • Naval Hospital (location), for a hospital that is an established shore (field) activity with a CO, under the command of the COMNAVMEDCOM.
  • Naval Medical Clinic or Dental Clinic (location), for a clinic assigned as an established shore (field) activity with a CO, under the command of the COMNAVMEDCOM.

    The titles of activities located outside of the United States are preceded by the abbreviation U.S.

  • Nonfixed Medical Treatment Facilities
    • Medical facilities for field service with the Marine Corps, such as aid stations, clearing stations, and division field and force evacuation hospitals.
    • Medical facilities afloat, such as hospital ships, and sick bays aboard a ship. (Currently there are no hospital ships in the active fleet.)
    • The medical advance base functional components are units (medical and other) that are prepositioned units or mobile units such as fleet hospitals, casualty staging units, triage units, and so forth.

Medical Department Support to the Fleet Marine Force (FMF)

To understand the complexity of medical support to FMF, you must first be familiar with its overall organization.

FMF is a balanced force of combined air and ground troops trained, organized, and equipped primarily for offensive amphibious deployment. It may consist of a headquarters, force troops, a force service support group (FSSG), one or more Marine divisions, brigades, and aircraft wings. Each of these units is assigned a specific number of medical support personnel, providing an interrelated network of medical support.

FMF Medical Support

In general, Medical Department personnel serving with FMF may be divided into:

• Combat personnel, who provide medical and initial first aid to prepare the casualty for further evacuation
• Support personnel, who provide surgical and medical aid to those who need early definitive care and cannot be further evacuated

Medical personnel are an integral part of the combat unit to which they are assigned; they train with their units and live with and accompany them at all times.

All of the units comprising a FMF have Medical Department personnel organic to them. However, the majority of medical support comes from the medical battalion of FSSG. FSSG is a composite grouping of functional units that provide combat service support beyond the organic capability of the supported units to all elements of FMF.

The medical battalion provides combat medical support required for independently deployed battalion landing teams, regimental landing teams, Marine amphibious units, or Marine amphibious brigades. The primary mission of the medical battalion is to provide:

• Casualty collection
• Emergency treatment
• Temporary hospitalization
• Specialized surgery
• Evacuation
• Graves registration support

In addition, medical battalions must plan, supervise, and coordinate timely preventive measures for controlling disease. The medical battalion consists of a headquarters and service company, five medical companies, and one hospital company as shown in figure 8-7.

FMF Dental Support

The mission of EMF dental units is to provide dental service support for a Marine amphibious force and to provide specialized care of casualties with maxillofacial injuries. During a mass casualty situation, FMF dental units will assist the medical effort as required.

The majority of dental support comes from the dental battalion of FSSG. A dental battalion is composed of a headquarters and service company and three dental companies. The three dental companies shall be task organized to meet the changing requirements for dental service support.

Each dental company is designed to provide dental service support for a Marine division, Marine aircraft wing, or a Marine FSSG. A dental company is capable of subdividing into detachments of varying sizes for assignment to smaller or separate Marine units (i.e., Marine amphibious unit or Marine amphibious brigade).

Mobile Medical Augmentation Readiness Team (MMART)

The mission of a Mobile Medical Augmentation Readiness Team (MMART) is to serve as a force of trained Medical Department personnel capable of rapidly augmenting operating forces for limited, short term military operations, disaster relief missions, fleet and FMF exercises, and scheduled deployments. The MMART system is a peacetime subset of the unit augmentation system. During contingencies requiring medical augmentation, the MMART surgical and surgical support teams become the integral augment core for LHA/LPHs. Other MMARTs dissolve into other augment units.

The MMART is a composite of separate teams manned by medical and dental specialists, the nucleus is the surgical team. When combined, a number of distinct specialty teams comprise a single MMART. A full composite MMART consists of one of each of the following component specialty teams:

• Surgical team
• Surgical support team
• Head and neck trauma team
• Neurosurgical team
• Nursing team
• Medical regulating team
• Special psychiatric rapid intervention team (SPRINT)
• Blood bank team
• Preventive medicine team
• Disaster relief/evacuation team

A MMART may be deployed as a full composite team. However, in most situations an individual specialty team or a combination of specialty teams is all that is required. The personnel and material organization of the MMART may be modified at COMNAVMEDCOM direction to meet the specific operational or disaster mission. MMARTs are generally deployed as intact units to an operational commander. These teams may be augmented or decremented as necessary, but are deployed to a single unit. The exception to this situation is in medical regulating teams; which are fragmented to various ships to set up a regulating NET.

Unit Augmentation System

Unit augmentation is an ADP-supported system that assists in providing medical personnel to support the operating forces during contingency situations requiring medical personnel augmentation. Inherent in this system is the ability to monitor wartime manning readiness stature and determine the impact of future personnel requirements. This system also allows for the planning of training for Medical Department personnel. Necessary corollaries include establishment of training requirements, development of a readiness reporting system, and integration with the time-phased force deployment data system.

Discussion

Through unit augmentation the requirements of the supported operational commanders are combined with the active duty resources of the augmentation sourcing commands. The supported commands are functional units, typically manned only at a cadre level during peacetime and require manpower augmentation in order to fulfill their missions during contingency situations. Currently the supported commands include the FMF, LHA/LPHs, RDMFs, and overseas medical treatment facilities. Future requirements such as hospital ships and fleet hospitals will be added to the system when they come on line. The augmentation sourcing commands are the CONUS-based medical and dental treatment facilities, which will provide and train the augmentees. Specific unit configurations will not be discussed here, but briefly one unit consists of two GEOCOMS as an augmentation supporting unit, and one-third of the FMF/CRTS/RDMF/OCONUS requirements (i.e., one MAF, including the LHA/LPH hulls committed and the OCONUS medical treatment facilities in the area of operations).

The unit augmentation system is divided into two sections: the enlisted system, which is executed by EPMAC (Code 90) and the officer system, which is managed by the COMNAVMEDCOM. Both systems are based on similar types of data manipulations, but use different types of ADP support.

In general, both systems calculate augmentation requirements (to M + 1, T/O, or SMP, as applicable) in the following manner. For each NOBC/NEC, the current on board (COB) of the supported UIC is subtracted from the M + 1 requirements of that UIC. This provides the augmentation requirement by NOBC/NEC. Current manpower authorization levels are not a factor in defining unit augmentation requirements.

Assets are reviewed for the supporting UICS. The COB by NOBC/NEC of the supporting UIC is then matched with the augmentation requirements.

The scope of the unit augmentation system is based on a 'worst case' scenario involving total augmentation to satisfy the early support requirements of the operating forces. This requirement entails bringing all operational units to their full M + 1, T/O, or SMP allowance, but does not infer mobilization. Limited augmentation scenarios are within the scope of this system. Attrition augmentation, as well as expanded facility manning requirements, likewise requires manipulation of the core system.

Double tasking is not permitted under the unit augmentation. The MMART system is the subset of the unit augmentation system and should not be viewed as a separate entity. The MMART surgical/surgical support teams are incorporated into the system as the core of the LHA/LPH augment. These individuals will have both MMART and LHA/LPH mission assignments, but these are identical, not dual tasks.

References:

1. NAVMEDCOMINST 6640.2, Mobile Medical Augmentation Readiness Team (MMART) Manual
2. FMFM 4-5, Medical and Dental Support
3. NAVMEDCOMINST 5430. 1, Organizational Manual, Naval Medical Command, Navy Department
4. NAVMEDCOMINST 5450. 1, Organizational Manual for Geographic Naval Medical Commands, Naval Hospitals, Naval Medical Clinics, and Naval Dental Clinics

Naval Education and Training Command: Hospital Corpsman 1 & C: August 1986

Approved for public release; Distribution is unlimited.

The listing of any non-Federal product in this CD is not an endorsement of the product itself, but simply an acknowledgement of the source. 

Operational Medicine 2001

Health Care in Military Settings

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