Levels of Medical Care in the Army’s Health Service Support System

The U.S. Army Medical Department’s (AMEDD) health service support system is an integrated system that spans from the combat zone in the theater of operations (TO) to the continental United States (CONUS). With the goal of both providing care to its beneficiaries and furthering the Army’s wartime mission, the health service support system is tasked with triaging, treating, evacuating, and returning soldiers to duty as efficiently as possible.

To fulfill these requirements, AMEDD’s health service support system is organized into five different “echelons” (or levels) of care, each of which denotes the capabilities that are available at a specific mobile field hospital or medical facility. Every level of care has the same capabilities as the level preceding it numerically, plus an expansion of those capabilities. The lowest levels of care serve to treat soldiers with minor injuries and return them to duty as well as to prepare those with more serious injuries for evacuation to a higher level of care.

Note: Be careful not to confuse AMEDD’s levels of care with the levels of care that the American College of Surgeons uses to describe U.S. trauma centers.

Level I

Echelon I of medical care is the first medical care that a soldier receives after becoming injured. Soldiers are evacuated from the location of illness or injury to the unit-level aid station, where they’ll receive treatment to either return them to duty or to stabilize them for evacuation to the next echelon of care. Specific capabilities of level I medical care include:

• First aid and immediate life-saving measures
• Disease and nonbattle injury (DNBI) prevention
• Combat stress support
• Casualty collection
• Evacuation to supporting medical treatment 

Level I medical treatments generally do not necessitate the skills and knowledge of a physician and are thus provided by available personnel:

• Self-aid and buddy aid: Soldiers are trained in many first-aid procedures, including life-saving tasks, so that they can provide immediate care to both themselves and buddies in life-threatening incidents.
• Combat lifesaver: Commanders of nonmedical units typically select at least one unit member to undergo additional medical training (beyond basic first-aid procedures) and serve as a combat lifesaver. The combat lifesaver performs their additional medical duties whenever necessary, including providing enhanced first aid to injured soldiers until the combat medic arrives.
• Combat medics: The combat medic, or aidman, is the first person in the health service support chain who has specific medical military occupational specialty (MOS) training. Combat medics have emergency medical technician- (EMT-) level training and are assigned to a specific troop, the headquarters service company (HSC), a section of the headquarters and headquarters company (HHC), or the medical platoon.
• Treatment squad: A treatment squad consists of a physician and physician’s assistant at an aid station who are trained to provide advanced trauma medicine (ATM) and, when necessary, perform routine sick calls.

Level II

Echelon II of medical care encompasses health service support at the division level provided by support battalions, medical battalions, medical companies, and forward surgical teams. Like at level I, at level II patients are examined and evaluated, after which they may either be treated and returned to duty or evacuated to a higher level of care.

 Echelon II capabilities include all echelon I capabilities plus the following:

• Evacuation of patients at level I, unit-level aid stations
• Initial resuscitation 
• Emergency care
• Dental capabilities
• Laboratory capabilities 
• X-ray capabilities
• Patient holding for soldiers who can be returned to duty within 24 to 72 hours

Level III

Echelon III medical care is the highest level of medical care that patients can receive within the actual combat zone and is provided at the corps level using medical treatment facilities (MTFs) such as field hospitals (FHs), evacuation hospitals (EVACs), combat support hospitals (CSHs), and mobile army surgical hospitals (MASHs). Most of these MTFs are modular so that commanders can match their medical response to the situation’s specific demands.

Echelon III capabilities include evacuating patients from division-level and other units and providing hospital care and resuscitation. Level III medical treatment facilities provide treatment that will either prepare patients for return to duty or stabilize them so they can be evacuated out of the corps or out of the entire theater of operations. Patients who are incapable of surviving evacuation undergo surgical care in echelon III medical treatment facilities when possible (unsuitable terrain or tactical situations may make it necessary to locate level III hospitals in the communications zone [COMMZ], third-country support bases, or offshore support facilities).

Level IV

Level IV medical care takes place in the COMMZ outside of the combat zone and involves receiving patients who have been evacuated from the corps. These patients are then treated in a field hospital (FH) or general hospital (GH) equipped to provide both general and specialized surgical and medical care:

• Field hospitals provide general hospitalization and, for those who can return to duty, reconditioning and rehabilitation. Additional field hospital capabilities include orthopedics, urologic, OB/GYN, dental, and oral surgery services. 
• General hospitals serve as the principal channel for evacuating patients back to the CONUS, but also provide general hospitalization and stabilization. Capabilities include all of those of field hospitals plus optometry.

[Related: Israel Defence Forces Field Hospital Ranked “Number One in the World” by WHO]

Level V

The highest level of medical care available in the health service support system, echelon V medical care is provided in the CONUS. Department of Defense (DoD), Department of Veterans Affairs (DVA), and — when necessary due to overflow — civilian hospitals provide medical, surgical, rehabilitative, and convalescent care to help soldiers return to function.

Integration of All Levels of Care

Many different elements are necessary in order for all of the levels of care to function, including:

• Hospitalization
• Laboratory services
• Medical logistics
• Blood management assets
• Evacuation assets
• Preventive medicine support
• Dental services 
• Veterinary services
• Command elements
• Combat stress support
  

The theater of operations must integrate all of these components and all levels of care in order to achieve an effective health service support system.

[Related: Tensile Fabric Medical Systems for the U.S. Army and Airforce]

Modular Medical Systems for Levels II-IV

A final element necessary to provide any level of medical care is the medical facility itself. The Alaska AMEDD Shelter™ and Alaska XP Medical Shelter System from Alaska Defense® both feature modular and scalable designs ideal for meeting echelon levels II through IV.

Although these two structures differ in setup time (10-12 minutes for the Alaska XP Medical Shelter System and 20-60 minutes for the Alaska AMEDD Shelter), both shelter systems are engineered for use in any environment — from mountainous terrains and tundra regions to jungles and deserts. Medical shelters from Alaska Defense are designed for the following:

• Low weight and cube for fast and efficient transport
• Rapid setup
• Endure short or long-term deployment strategies
• Provide a clean and safe space for advanced-level care, including isolation wards for infectious diseases (COVID-19, SARS-CoV, MERS-CoV, flu, and Ebola)
• Maintain a comfortable temperature in any weather type, including extreme hot, humid, dusty, and cold environments
• Engineered for safety to withstand high wind and snow loads, including rain and hail
• Easily expanded or reconfigured to meet the medical needs of the situation
• Quickly relocated or stored for future missions

Alaska Defense is AMEDD’s first choice when it comes to establishing level II, level III, and level IV care facilities. We’ve deployed thousands of our medical shelters for use in combat zones and CONUS sustainment bases. 

Request a quote or call us at +1-575-541-9116 for more information about these structures and how they can help you provide a specific echelon level of care.