Canadian Forces Health Services (CFHS) Doctrine

Home of the library of Canadia Forces Health Services Doctrine. Its purpose, to educate and improve access to medical doctrine while simplifying the doctrine publishing process.

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Doctrine is defined as, fundamental principles by which military forces guide their actions in support of objectives. It is authoritative but requires judgment in application. It embraces established wisdom in the areas of problem solving, decision making and planning, and is sometimes defined as simply “what is taught.”


Interoperability is achieved when Allies act together coherently, effectively and efficiently to achieve tactical, operational and strategic objectives. It reduces duplication and enables pooling of resources, producing synergies between nations’ forces.


The Directorate Health Services (HS) Strategy Doctrine and Interoperability Section is responsible for developing and managing HS doctrine that supports CAF operations at home or abroad, within the framework of either a single service, joint, multinational, or multinational joint task force.


The Directorate Health Services (HS) Strategy Doctrine and Interoperability Section is actively engaged in several key activities:

The development and maintenance of CFHS Doctrine
Represents CFHS on the Canadian Armed Forces (CAF) Joint Doctrine Working Group
Provide HS input to CAF Joint and Service doctrine
Represents CFHS at the NATO COMEDS Medical Standardization Working Group and the Military Medical Structures, Operations and Procedures Working Group.
Administer the ratification and implementation of NATO medical standardization agreements (STANAGS)
Administers the ratification of ABCANZ HS standards aimed at optimizing interoperability and standardization between the armies of Australia, Canada, New Zealand, the United Kingdom, and the United States.
Represents CFHS on the CAF Joint Terminology Panel

Frequently Asked Questions

The term “doctrine” is frequently (and incorrectly) used when referring to policy or strategy. These terms are not interchangeable; they are fundamentally different. Because policy and strategy may impact each other, it is important to first understand their differences before delving into a discussion of doctrine.
  • Policy is guidance that is directive or instructive, stating what is to be accomplished. It reflects a conscious choice to pursue certain avenues and not others. Thus, while doctrine is held to be relatively enduring, policy is more mutable, but also directive. Policies may change due to changes in national leadership, political considerations, or for fiscal reasons. At the national level, policy may be expressed in such broad vehicles as presidential executive orders. Within military operations, policy may be expressed not only in terms of objectives, but also in rules of engagement (ROE)—what we may or may not engage with kinetic and non-kinetic capabilities, or under what circumstances we may engage particular targets.
  • Strategy defines how operations are to be conducted to accomplish national policy objectives. Strategy is the continuous process of developing and applying ways and means to overcome particular challenges and achieve strategic ends (objectives). Strategy provides an overarching construct for conducting activities to create and maintain an advantage, while considering risk.
  • Doctrine presents codified best practices on how to accomplish military goals and objectives. It is a storehouse of analyzed experience and wisdom. Military doctrine constitutes official advice, but unlike policy, is not directive.

    • Doctrine is a body of knowledge and thought that provides direction and aids understanding. The CF definition of doctrine is “fundamental principles by which military forces guide their actions in support of objectives. It is authoritative but requires judgment in application. ”It embraces established wisdom in the areas of problem solving, decision making and planning, and is sometimes defined as simply “what is taught.”

  • Strategic doctrine sets out the most fundamental and enduring principles that guide the use of military forces across the continuum of operations.
  • Operational doctrine applies the principles of strategic doctrine to military actions by describing the use of armed forces in the context of distinct objectives, force capabilities, generic mission types and operating environments. Operational doctrine describes the organizations necessary for the effective employment of military forces.
  • Tactical doctrine applies the principles of operational doctrine when disposing naval, land, aerospace and special operations forces in actual contact with the enemy. The tactical level is concerned with planning and directing military resources in battles, engagements and/or activities within a sequence of major operations to achieve operational objectives.

  • Environment-specific doctrine is doctrine that is specific to an environment (i.e. maritime, land, and aerospace forces).2 Environmental doctrine has distinct characteristics and applications and provides complementary contributions to national and multinational military operations. The Environmental chiefs of staff (ECSs) are responsible for the generation and the maintenance of their respective doctrine.
  • Joint doctrine provides the fundamental principles that guide the employment of forces from two or more environments in coordinated action toward a common objective. Joint doctrine describes the best way to integrate and employ maritime, land, and aerospace forces in unified action towards a single operational objective. The CF is constituted under royal charter as a single entity. When elements of two or more environments of the CF are required to operate in the same theatre or area of operations in pursuit of the same strategic objective, they may operate under a joint command structure. Joint doctrine provides the fundamental principles that guide the employment of forces from two or more environments in coordinated action toward a common objective. Joint doctrine describes the best way to integrate and employ maritime, land, and aerospace forces in unified action towards a single operational objective. The CF is constituted under royal charter as a single entity. When elements of two or more environments of the CF are required to operate in the same theatre or area of operations in pursuit of the same strategic objective, they may operate under a joint command structure.
  • Combined doctrine is military doctrine that describes the best way to integrate and deploy national forces with the forces of allies in coalition or alliance operations. Combined doctrine supports mutual defence treaties, agreements or organizations, and establishes the principles, organization, and fundamental procedures for alliance or coalition operations. For Canada, the most important example of combined doctrine is North Atlantic Treaty Organization (NATO) doctrine. As a member of NATO, Canada is both obliged to follow NATO doctrine during NATO operations and is involved in the continual development and ratification of NATO doctrine.

    • For purposes of doctrine development and approval, CF doctrine publications are grouped in three categories of publications: capstone, keystone, and supporting doctrine. Detail on these groupings and doctrine development processes can be found at Doctrine Development Manual (CFJP A1). The hierarchical relationship of this capstone publication to other CF doctrine publications is illustrated in Annex A and is further detailed in the Doctrine Development Manual. Annex A The Hierarchy of CF Doctrine NOTE: Canadian Military Doctrine tops the hierarchy of CF doctrine publications and as such is the capstone doctrine publication. Doctrine immediately below the capstone level is referred to as keystone doctrine. See CFJP A1, Doctrine Development Manual, for the complete hierarchy.
     

    Roles of Medical Support

    “A category that identifies the functions and capability of a medical unit or element. Medical care is categorized into four roles. Most of the care capabilities of each role are intrinsic to the next higher role."" To be consistent with NATO, Canada uses the term medical rather than health services when describing Roles. In this case medical includes dental.

    • Roles of medical support are not tied to levels of command. Rather, the term “role” is based on the clinical functions it provides.
    • Likewise, roles of medical care do not equate to levels of sustainment or lines of support which are described in B-GL-300-004/FP-001
    • A certain role of medical support does not imply a particular size or location in the battlespace.

    Roles of medical support may be co-located. For example, during a counter-insurgency operation a Forward Surgical Team (a subset of Role 2) may be co-located with a UMS (a subset of Role 1) at a battalion-sized forward operating base.

    The flow of casualties and acute medical cases usually follows a linear continuum of care; however, as depicted in Figure 1-1, one or more roles of medical support may be bypassed due to patients’ needs, the proximity, workload and capacity of MTFs, and the en route care capabilities of the MEDEVAC team.

    The First Response Capability: Point-of-Injury Care

    Although not a doctrinal role of medical care, the first response capability is listed in this section to emphasize its importance for the outcome of clinical treatment and to showcase where the continuum of care begins. Clinical outcomes are influenced by those who apply the first field dressing

    Point-of-injury care. The aim of the care given at the POI is to remove the casualty from immediate threat and to avoid further deterioration of vital functions through immediate lifesaving measures.

    • Whenever practicable, first aid for the most seriously injured should take place immediately, but not longer than within 10 minutes of injury.
    • Often this is conducted by non-medical personnel trained to deliver combat first aid or tactical combat casualty care (TCCC).
    • Security is the foundation of safe and effective care. Before rushing to treat casualties, effective enemy action must be suppressed.
    • The best medicine on the battlefield is to win the firefight.

    Role 1 Medical Support – Emergency and Primary Health Care

    Role 1 medical support, “Provides routine primary health care, specialized first aid, triage, resuscitation, and stabilization.” Role 1 medical support provides:

    • advice to the chain of command on basic occupational and preventive health issues;
    • routine, daily sick parade and the management of minor sick and injured personnel for immediate return to duty;
    • a minimal patient holding capacity; and
    • preparation of patients for evacuation to the next appropriate higher-level treatment.

    Unless enhanced by a surgical capability, a Fd Amb provides only Role 1 medical support. Examples of Role 1 MTFs are the UMS, the BMS, and the airfield medical station.

    Role 2 Medical Support – Surgical Care Capability

    Role 2 medical support, “Provides a capability for the reception and triage of casualties, as well as the structure to perform treatment of wounded, injured and diseased at a higher technical level than Role 1, including resuscitation and surgery.

    Role 2 MTFs capabilities routinely include emergency intake, DCS, diagnostics, a post-operative capability, medical supply, C2, and a limited holding facility for the short-term holding of casualties until they can be returned to duty or evacuated. There are three types of Role 2 MTFs - , and

    • Forward Surgical Team (FST);
    • Role 2 Basic (Role 2B); and
    • Role 2 Enhanced (Role 2E).

    Role 3 Medical Support - Deployed Hospital Care Capability

    Role 3 medical support, “Provides the structure for deployed hospitalization with the elements required to support it, including a mission-tailored variety of clinical specialties and support functions. Dental capabilities comprise comprehensive dental care and oro-maxillofacial surgical capability. Patients who cannot be returned to duty in accordance with the theatre patient return policy are evacuated out of theatre.

    A Role 3 MTF must provide all the capabilities of the Role 2E MTF and be able to conduct specialized surgery, specialized care, computed tomography, oxygen production and additional services such as neurosurgery and internal medicine as dictated by mission and theatre requirements.

    Role 4 Medical Support - Full Spectrum Hospital Care Capability

    Role 4 medical support, “Provides the full spectrum of definitive medical care that cannot be deployed in the theatre or is too time-consuming to be conducted there. Role 4 includes highly specialized medical procedures, specialist and reconstructive surgery, and rehabilitation. It is normally provided in Canadian civilian facilities.

    —E.M. Earle

    Makers of Modern Strategy & 1944

    The highest type of strategy—sometimes called grand strategy—is that which so integrates the policies and armaments of the nation that resort to war is either unnecessary or undertaken with the maximum chance of victory.

    —Napoleon I,

    Maxims of War, 1831

    War should be made methodically, for it should have a definite object; and it should be conducted according to the principles and rules of the art.

    Karl von Clausewitz

    On War, 1832

    War is not only chameleon-like in character, because it changes its colours in some degree in each particular case, but it is also, as a whole, in relation to the predominant tendencies that are in it, a wonderful trinity, composed of the original violence of its elements, hatred and animosity, which may be looked upon as blind instinct; of the play and probabilities and chance, which make it a free activity of the soul; and of the subordinate nature of a political instrument, by which it belongs purely to reason.

    B.H. Liddel-Hart

    Strategy, 1954

    The true aim is not so much to seek battle as to seek a strategic situation so advantageous that if it does not of itself produce the decision, its continuation by a battle is sure to attain this.

    Aristotle

    Ancient Greek philosopher (384–322 BC)

    “We are defined by what we do repeatedly, therefore excellence is a habit, not an act.”

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