October 1997

Chapter 16: Medical Support

Role Support

1610. The term "Role" or "Echelon" is used to describe the stratification of the four tiers in which medical support is organised, on a progressive basis, to conduct treatment, evacuation, resupply, and functions essential to the maintenance of the health of the force. "Echelon" or "Role" is defined on the basis of capabilities and resources, and is not specific to particular medical unit types. The term "role" is used by land or air forces, while "echelon" is primarily a maritime term. While closely related, they are not exactly interchangeable. The treatment capability of each role/echelon is intrinsic at the higher level, e.g. a role 3 facility will have the ability to carry out role 2 functions. Each level of support has the responsibility to resupply and otherwise support the levels below them. There is no requirement that a patient must necessarily pass through each echelon of care in progression during treatment and evacuation.

1611. Role/Echelon 1 medical support is that which is integral or allocated to a small unit, and will include the capabilities for providing first aid, immediate lifesaving measures, and triage. Additionally, it will contribute to the health and well-being of the unit through provision of guidance in the prevention of disease, non-battle injuries, and operational stress. Normally, routine sick call and the management of minor sick and injured personnel for immediate return to duty are a function of this level of care.

1612. Role 2 support is normally provided at larger unit level, usually of Brigade or larger size, though it may be provided farther forward, depending upon the operational requirements. In general, it will be prepared to provide evacuation from Role/Echelon 1 facilities, triage and resuscitation, treatment and holding of patients until they can be returned to duty or evacuated, and emergency dental treatment. Though normally this level will not include surgical capabilities, certain operations may require their augmentation with the capabilities to perform emergency surgery and essential post-operative management. In this case, they will be often referred to as Role 2+. In the maritime forces, Echelon 2 is equivalent to the land forces' Role 2+, as a surgical team is integral to this echelon. Maritime echelon 2 support is normally found on major war vessels and some larger logistics or support vessels, and at some Forward Logistics Sites (FLS).

1613. Role/Echelon 3 support is normally provided at Division level and above. It includes additional capabilities, including specialist diagnostic resources, specialist surgical and medical capabilities, preventive medicine, food inspection, dentistry, and operational stress management teams when not provided at level 2. The holding capacity of a level 3 facility will be sufficient to allow diagnosis, treatment, and holding of those patients who can receive total treatment and be returned to duty within the evacuation policy laid down by the Force Surgeon for the theatre. Classically, this support will be provided by field hospitals of various types. Maritime Echelon 3 is equivalent to land/air forces Role 3, though it will normally have increased specialty capabilities. Echelon 3 is normally found on some major amphibious ships, on hospital ships, at Fleet Hospitals, at some FLS, and at a few Advanced Logistics Support Sites (ALSS).

1614. Role/Echelon 4 medical support provides definitive care of patients for whom the treatment required is longer than the theatre evacuation policy or for whom the capabilities usually found at role/echelon 3 are inadequate. This would normally comprise specialist surgical and medical procedures, reconstruction, rehabilitation, and convalescence. This level of care is usually highly specialised, time consuming, and normally provided in the country of origin. Under unusual circumstances, this level of care may be established in a theatre of operations.

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