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JFHQ-TEXAS
CAMP MABRY, AUSTIN TX
241600JUL14
ANNEX Q (Medical Services) TO OPLAN 14-10 (Task Force Strong Safety)
REFERENCES:
a.
Joint Publication 4-02, 26 July 2012, Health Service Support
b.
DOD Directive 3025.1-M, “Manual for Civil Emergencies” 2 June 1994.
c.
DOD Directive 3025.22, “Use of the National Guard for DSCA”, 26 July 2013
d.
State of Texas Emergency Management Plan Annex H, Revised September 2006/Updated
February 2013, State of Texas Emergency Management Plan.
1.
Situation.
a.
General. This ANNEX supports OPORD 14-10 (Task Force Strong Safety), the
deployment of TXMF personnel to enhance border security by supporting DPS Operation Strong
Safety (OSS).
b.
(1)
Environment of Incident. See base order.
(2)
Policy Goals. See base order.
Area of Concern.
(1)
Operational Area: Lower Rio Grande Valley (RGV), with emphasis between Laredo
and McAllen.
(2)
Mexico.
Area of lnterest. The entire southern U.S. international border between Texas and
(a)
Environmental and Public Health. The environmental health threat is dependent
on the operational area location, weather, and type of incident.
(b)
High temperatures, contaminated air, food & water, and undocumented aliens
carrying communicable threats (scabies and TB) as well as Chagas Disease constitute the primary
risks to the force. Secondary threats include Valley fever.
(c)
Personnel supporting OSS are not authorized to consume or purchase food
unless from approved sources, (i.e. MRE’s contracted dining facilities, or restaurants with current
county health department certificates) due to recent brucellosis occurrences reported by Texas
Department of Health Services (DSHS) at roadside food stands in the AO.
(d)
JTF personnel.
Permetherin treated uniforms and DEET insect repellent are recommended for all
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(e)
Sunscreen is strongly recommended for all personnel.
c.
Deterrent Options. N/A
d.
Risk.
(1)
Military Medical Care Infrastructure. Military Healthcare support to Guard personnel
will be limited to organic medical assets and sick call. If injuries or sickness is greater than
organic/assigned capabilities, the member should be placed into the military healthcare system as
soon as possible. If serious or emergent care is required, 911 should be called immediately.
(2)
Civilian Medical Infrastructure. Local and state healthcare infrastructure may be
limited or severely restricted near the incident site. When possible, civilian healthcare systems
should be utilized for the continuum of care for all non-military patients.
(3)
Legal Status (State Active Duty - SAD) - Medical reimbursement to civilian treatment
facilities will be through the individual soldier’s private insurance carrier or workman’s compensation.
The potential for presumption of full active duty benefits exist while in SAD could occur, leading to
additional charges for an individual’s Soldiers private insurance carrier or liability to TXMF.
(4)
Communication. Specific information on the status of civilian medical infrastructure is
available through GIS data feeds, federal and state partners (i.e. TX DSHS, DHHS), and emergency
response plans. Limited communications and systems capabilities may impact initial patient
tracking.
(5)
Mental Health. Due to scope and magnitude of a hazard, service members may
encounter disturbing situations which can have short or long term mental health effects.
e.
Adversary Forces. See Base OPLAN.
f.
Friendly Forces. See Base OPLAN.
g.
Assumptions.
(1)
Medical response includes but is not limited to sick call, basic medical care, and
stabilization of injured Guardsmen awaiting transport to a higher level of military or civilian care.
(2)
Sufficient military medical personnel, units, and other medical assets may be limited
due to competing operational commitments in the event of a simultaneous domestic emergency.
(3)
limitations.
Civilian medical facilities may be overwhelmed due to capability and capacity
(4)
Soldiers who are MRC 4 (Indeterminate due to delinquent Annual PHA) will not be
placed on orders (SAD/T32/T10); Soldiers who are MRC 3B (Medically correctable in more than 30
days or require a medical review board) are not place on SAD orders without the State Army
Surgeon’s approval (via medical review and Commander’s signed waiver).
(a)
The Office of the State Army Surgeon (OSArS) will process all Operations Strong
Safety (OSS) manning rosters for medical review to identify all MRC 4 and MRC 3A and 3B Soldiers.
Reports for Leader and Commander’s consideration for OSS manning will be sent to the Army G1 or
other Directorate as identified. Do not deploy members with current medical problems or known pre-
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existing conditions that may be exacerbated or have potential to cause the member to seek
treatment while in a uniformed status.
(b)
Leaders may request waivers from the State Army Surgeon for Soldiers who are
MRC 3A, 3B, or 4, and accept risk/liability to meet mission requirements.
(5)
Members requiring over the counter or prescription medications will ensure they have
a 30 day supply when they report for duty. Members will report to first line leaders if they are not
able to obtain medication resupply once they are on SAD orders.
2. Mission. TXMF Medical Forces will support Guard personnel deployed at the direction of the
Governor in order to preserve the lives and property of the people of Texas and ensure continuity of
Federal, State, or local governments.
3.
Execution.
a.
Concept of Operations.
(1)
Commander’s Intent. Execute a timely, safe, effective and efficient medical response
in support of deployed Guardsmen at the direction of the TAG and/or at the request of the Governor.
(2)
General.
(a)
Public Health and Medical Services are listed in the NRF as Emergency Support
Function 8 (ESF-8), with the Department of State Health Services (DSHS) as the lead agency within
Texas.
(b)
The Texas Disaster Medical System (TDMS) is a coalition of the Regional
Advisory Councils (RACs) for Trauma and the Department of State Health Services (DSHS). During
an in-state response DSHS will activate the State Medical Operations Center (SMOC) and may
individually activate Emergency Medical Task Forces (EMTFs) if additional state mobile medical
capabilities are required.
(c)
The Texas Division of Emergency Management (TDEM) coordinates with National
Guard forces and the Adjutant General to request military medical capabilities during local and state
response efforts. The RMPO serves as the state’s military advisor on military medical capabilities.
(d)
Phases of Operations.
1.
Phase 1: Mission Assignment and Orders Production. Mission planning and
orders production occur during this phase. Medical screening and readiness is a priority during this
phase. This phase ends with assignment of a potential mission.
2.
Phase 2: JROSI. During this phase deploying personnel will be integrated
into the task force and trained to conduct the assigned mission. This phase ends when TXMF has
received, assigned, and trained personnel to conduct the mission.
3.
Phase 3: Operations. During this phase assigned missions will be
conducted, specifically OP/LP (Observation Post/Listening Post), Rotary Wing, and Remotely Piloted
Aircraft (RPA) mission JFTX-Surgeon supports command guidance for full or partial manning.
Establish IOC with personnel to provide assessment via the JOC and DSHS. Phase ends with initial
operating capability established in support of TDEM/DPS.
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4.
Phase 4: Redeployment. Redeployment of force packages, reset equipment
for follow on missions, close out of administrative tasks. LODs are transferred to Army and Air
Surgeons offices accordingly. Phase ends when all force package members released from state
active duty (SAD), equipment reset for follow on missions, and administrative tasks complete.
a.
All LOD determinations for ANG personnel will be completed and
processed IAW AFI 36-2910.
b.
All LOD determinations for ARNG personnel will be completed and
processed IAW ARNG 600-8-4.
c.
All Workman’s Compensation Claims will be processed according to the
procedures outlined in ANNEX E.
d.
Medical case management, to include SM records updates and medical
processing, to be handled through the task force and parent units. Component Surgeon's offices will
liaise and advise on all matters medical and report issues/updates to the JFTX-J1 or appropriate
ANG Chain of Command or designated authority.
b.
Tasks.
(1)
TXARNG:
(a)
Provides medical personnel, equipment, and/or force packages for border
operations. Manning will be coordinated through the JOC for efficient and effective sourcing and
cross-leveling of TXMF medical asset.
(b)
Commanders of organic/assigned medical personnel supporting OSS ensure all
BLS and CLS medic bags contain all TA items and expired items are replaced before departure. For
direction regarding replenishment of CLS VIII, contact JFTX J4/JLOC for guidance.
(c)
Ensure proper credentialing for providers is current and on file through the Office
of the Army State Surgeon.
(d)
BPT provide Public Health and medical threat assessment to support military
operations in the AOR.
(2)
TXANG:
(a)
On order, provide medical forces, equipment, and/or force packages for border
operations.
(b)
Ensure proper credentialing for providers is current and on file through the Office
of the State Air Surgeon.
(3)
TXSG:
(a)
Provide medical elements for border operations and/or force packages, or further
augment deficiencies identified by the JFHQ.
(b)
Ensure proper credentialing for providers is current and on file through the Office
of the State Guard Surgeon.
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c.
Coordinating Instructions.
(1)
NGB: Plan and coordinate joint Health Services Support (HSS) within designated area
of operation in coordination with USNORTHCOM, DOD, and ESF-8 partners.
(2)
State/Local: Plan and coordinate joint Health Services Support (HSS) with TDEM,
DSHS, RAC’s, and other ESF-8 partners at the state and regional level.
(3)
Hospitalization.
(a)
Patients will be transferred to health care facilities for definitive care and on-going
stabilization by local EMS and military transport as required when necessary, urgent care clinics will
be utilized before local emergency departments except in emergent circumstances.
(b)
All AGD/State Workman’s Cop information will be collected at time of admission
and maintained by the JTF Surgeon’s cell to be forwarded to JOC representative. Each Workman’s
Comp submission must include Name and Telephone number of the patient and agency/person who
transported the member to a care facility (hospital or urgent care center).
(4)
Patient Movement.
(a)
ICS (if civilian).
(5)
Patient movement will be coordinated through the unit commander (if military) and
(b)
Ground transport is the preferred means of evacuation.
(c)
Rotary MEDEVAC will be requested by proper authority based on availability.
Other Health Services Support.
(a)
Care of Civilians. Military medical personnel and facilities will provide emergency
medical treatment support to save life, limb, and eyesight of civilians.
(b)
Decontamination and Quarantine
1.
Tactical field decontamination of chemical and radiological exposed patients
will be accomplished in accordance with local hazardous material procedures.
2.
Patient decontamination should be performed prior to entering medical
facilities.
3.
Quarantine of casualties known or suspected of exposure to a contagious
biological agent release will be accomplished IAW Lead Federal Agency (LFA)/ HHS guidance.
(c)
Mass Casualties. Medical units and medical personnel will be prepared to triage
and treat patients in a mass casualty situation.
(d)
Force Health Protection. Commanders will institute effective elements of FHP
and health surveillance in force readiness programs.
1.
If deployed, public health (are we going to have deployed PH? Vs medical
units will incorporate public health principles ) a assets from all components will share information,
collaborate with federal counterparts, and coordinate activities.
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2.
JTF Surgeon will ensure assigned units and personnel will incorporate FHP
guidance and principles into all aspects of deployed operations.
3.
All water storage equipment (water buffaloes) will be tested to ensure they
are safe for use and during each filled load of water.
4.
Analyze health surveillance data to identify trends, new outbreaks, and
monitor disease severity.
5.
Conduct epidemiologic investigations and contact tracing.
6.
Communicate and coordinate with tribal, local, state, regional, and federal
partners to contribute to interagency unity of effort.
7.
public health threats.
Ensure appropriate PPE (gloves, mask, etc) is on-hand and for identified
8.
Mess - Only eat at restaurants with current public health department
certifications, contracted dining facilities, and MREs.
9.
Treat uniforms with permetherin and exercise DOD insect and tick avoidance
10.
Sunscreen is strongly recommended for all personnel supporting OSS.
practices daily.
4.
Administration and Logistics.
a.
Concept of Sustainment. CL VIII will be requested through the JTF to the JFHQJFYXJ4/JLOCJLOC. All requests will be vetted through the component Surgeon's representatives.
(1)
FTX-J4/JLOC CL VIII commodity manager will validate requirements and enter
request for support in the IEMS database. Once the information is entered, the CL VIII commodity
manager will coordinate with a State Purchase Card holder to contact an appropriate vendor to
coordinate support and payment and updates any required databases. JFTX-J4/JLOC notifies
requestor that purchase is complete, Requestor will ensure medic or CLS personnel sign for
supplies, all paperwork on items received will be forwarded to JFTX-J4/JLOC, signors (medics,
CLSs), will inventory and account for items expended and receiver of supplies from vendor will
ensure taxes are not charged.
(2)
Medical units providing initial response must be prepared to provide minimum
essential logistics for at least 3 to 5 days.Tasked units will deploy with aid bags and CLS bags only
for qualified personnel. Resupply of Class VIII will be conducted through review of DSCA formulary
and inventory of on hand Combat Lifesaver (CLS) supplies or medical aid bags. Shortages for the
expected mission are requested or called in to the JFTX-J4/JLOC with the required information.
(3)
5.
Personnel. See Base OPLAN.
Command and Control.
a.
Command.
(1)
Command Relationships.
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(a)
One JTF Surgeon Cell is required for JTF medical staffing and support to the JTF
Commander, as well as TXARNG/TXANG Health Services Support staff sections.
1.
One (1) 62B Field Surgeon - preferred, but if not manned mission can still be
2.
One (1) 65D Physicians Assistant.
3.
One (1) 70B Medical Services or 70H Medical Ops Officer.
4.
One (1) Medic - preferred E6 or E7.
accomplished.
5.
One (1) TXANG 4N071 Medical NCO to manage and initiate ANG LOD
program at the forward JTF SG Cell, IAW AFI 36-2910.
(b)
RMPO will establish DIRLAUTH with all State and Regional medical agencies as
directed by JFHQ or Joint SGJFHQ to include regional medical advisory councils (RAC), Department
of State Health Services, or County Health Departments as necessary.
b.
(2)
Command Post. See Base OPLAN.
(3)
Succession to Command. See Base OPLAN.
Joint Communications System Support. See Annex K.
NICHOLS
Maj Gen
OFFICIAL:
ROCHSTEIN
J3
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