1. On 15 May 2015, the Department of Defense’s Joint Requirements Oversight Council (JROC)
approved a formal recommendation that proposed a set of solutions to enhance integration and
synchronization of Joint Theater Patient Evacuation (JTPE) activities inside a Joint Force Commander’s
geographic area of responsibility. This approval was published as a JROC memorandum (JROC-M) signed
by the Vice Chairman of the Joint Chiefs of Staff, who also serves as chair of the JROC, comprising all the
Service Vice Chiefs. The JROC-M directs the Services and other stakeholders to take specified actions to
advance patient evacuation capabilities on behalf of Joint Force requirements. The JROC-M was the
culmination of nearly two years’ worth of research, analysis, writing development, collaboration, and
coordination across the spectrum of DoD’s medical and capability development communities-of-
interest.i
The actions directed in the JROC-M offers a unique opportunity for the Army to ensure that air
ambulance, ground ambulance, and other evacuation system force development is more directly
informed by the requirements of the future Joint Force, and as an acknowledgement that the dedicated
systems the Army provides are not just critical for Army forces but for all deployed Joint Forces. This
may also assist Army OTSG/MEDCOM force developers to secure the resourcing necessary to maintain
and enhance these Joint Force capabilities. Perhaps most importantly, it is an opportunity to
incorporate the systems developed and lessons learned from recent conflicts into Doctrine,
Organization, Training, materiel, Leadership & education, Personnel, Facilities and Policy (DOTmLPF-P)
that will sustain and improve the patient evacuation enterprise so that it functions flawlessly on day one
of the next major conflict across all modes of evacuation, between Service forces, and in any operational
environment on behalf of a Joint Force Commander.
The final set of recommendations to the JROC was in the form of a DOTmLPF-P Change
Recommendation (DCR). The Joint Capabilities Integration and Development System (JCIDS) prescribes
this product when the identified gaps can be solved through non-materiel means. (I.e. changes in the
way we train or organize as opposed to the acquisition of a particular aircraft or weapon system). JCIDS
is the DoD’s process for defining acquisition requirements and evaluation criteria.ii
The central focus of
the process is to address capability shortfalls, or gaps as defined by combatant commanders.iii
The basis
for identifying these gaps is a Capabilities-Based Assessment (CBA) which is typically overseen by a DoD
component sponsor. For the case of JTPE, The Army Surgeon General and the Joint Staff Surgeon were
co-sponsors for the CBA. What this meant in practical terms was taking on responsibility for resourcing
a core study & writing team and leading a DoD-wide workgroup of stakeholder representatives. This
workgroup would convene periodically to conduct reviews and participate in collaborative analyses of
ideas or products throughout the development of the DCR.
Impetus for this project was partially driven by discussion over resourcing USMC CV-22 Ospreys
to conduct what was termed enhanced CASEVAC in the ‘Tank’ (the conference room and eponymous
periodic executive meetings of the Joint Chiefs) in June and August 2013. These discussions illustrated
several Joint Force DOTMLPF-P gaps with regard to OEF patient evacuation. The Chiefs directed their
respective surgeons to participate in the CBA which was also broadly scoped out at that time. The
workgroup finally defined JTPE as those theater activities (medical care, transportation, logistics,
command, control, communications, computers and intelligence [C4I], medical regulation, etc.) that

2. when integrated provide for the effective enroute care and efficient movement of patients through
appropriate levels of care from the point of injury (POI) through a return to duty (RTD) decision or
evacuation out of the joint operations area (JOA). iv
JTPE, as approved in the JROC-M, is about integrating capabilities under the JTF commander for
patient evacuation and care inside the JOA. This includes ground ambulances, air ambulances, other
designated medical evacuation aircraft, ship to ship transfers and other activities inside the JOA. JTPE
addresses the tactical to operational levels of patient evacuation within existing Geographic Combatant
Commander (GCC) authorities. It also focuses on improving the capabilities of the JFC/GCC to provide
patient evacuation support from the POI by improving planning and coordination capabilities.v
The JTPE
DCR uses existing command relationships in seeking to improve the JFC/GCC management and
integration of existing service component capabilities.
In the course of developing the CBA the workgroup realized the need to use new, non-doctrinal
terms in order to achieve unambiguous understanding across the stakeholders. The existing patient
movement or medical evacuation lexicon lacks the clarity and consistency required for joint integration
efforts. The reader has probably noticed that this article avoids using terms such as MEDEVAC or
CASEVAC because they have conflicting definitions as well as ambiguous vernacular usages. As an
example, aeromedical evacuation can refer to either the Air Force system “for providing time sensitive
en route care to regulated patients to and between medical treatment facilities”vi
or to the movement
of patients to medical treatment facilities by air transportation, including Army air ambulance
helicopters. Accordingly, one of the key actions directed in the JROC-M is to resolve this fundamental
issue with a true Joint evacuation lexicon.
However, the JTPE JROC-M does not prescribe changes in existing command relationships.
Proposed JTPE coordination cells will work within existing JFC/GCC authorities and processes, using
assigned or attached forces to evacuate patients to an appropriate level of care within the JOA or entry
into the global patient movement system. Additionally it is still the responsibility of the Services to build
and deploy the capabilities that will accomplish all the evacuation missions for the JFC. A crucial part of
this responsibility falls to the Army’s MEDEVAC enterprise to ensure that the organizational structures of
evacuation C4I can meet all the Joint requirements. This may mean creating new or different MTOE
designs of existing medical and aviation units, or making even more fundamental functional-needs
assessments on how best to design theater-wide evacuation force structure. Evacuation requirements
remain proportionally tied to theater treatment capabilities, so it is clear joint patient evacuation must
be planned, executed, and assessed in support of a Joint theater-wide medical plan.
The JTPE JROC-M is a true milestone in the long and storied evolution of evacuation capabilities
in the US military. For the first time, there is an articulated Joint requirement on behalf of the GCC’s and
the larger Joint Force. This offers an unprecedented opportunity for the Army’s medical evacuation
enterprise to look to the future and lead innovation efforts, not just in Army evacuation, but across the
spectrum of Joint health services.

3. i
Joint Theater Patient Evacuation DOTMLPF Change Recommendation, Joint Staff Memorandum, JROCM 148-15,
15 May 2015.
ii
CJCSI 3170.01i, Joint Capabilities Integration and Development System, 23 Jan 2015.
iii
Manual for the Operation of the Joint Capabilities Integration and Development System (JCIDS), 19 January 2012
iv
Joint Theater Patient Evacuation DCR, Submitted by Army Surgeon General and Joint Staff Surgeon, 15 April
2015.
v
Ibid.
vi
DoDI 6000.11, Patient Movement, 4 May 2012.