nato medical evaluation manual - amedp-27-2010

NATO UNCLASSIFIED AMedP-27

ORIGINAL NATO UNCLASSIFIED

MEDICAL EVALUATION MANUAL

AMedP-27


ORIGINAL NATO UNCLASSIFIED

(INTENTIONALLY BLANK)


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MEDICAL EVALUATION MANUAL

AMedP-27

OCTOBER 2010


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NORTH ATLANTIC TREATY ORGANIZATION

NATO STANDARDIZATION AGENCY (NSA)

NATO LETTER OF PROMULGATION

22 October 2010

1. AMedP-27 MEDICAL EVALUATION MANUAL is a NATO 'UNCLASSIFIED publication. The agreement of nations to use this publication is recorded in STANAG 2560.

2. AMedP-27 is effective on receipt.

Director, NA 0 Standardization Agency

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RESERVED FOR NATIONAL LETTER OF PROMULGATION


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RECORD OF CHANGES

Change Date Date Entered Effective Date By Whom Entered


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RECORD OF RESERVATIONS

CHAPTER RECORD OF RESERVATION BY NATIONS General CAN


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RECORD OF SPECIFIC RESERVATIONS

[nation] [detail of reservation]

CAN a. Minor inaccuracies and omissions have been identified within the main document and annexes that will require revision at the next review of the document; and

b. We are concerned that a "mentor" has not been identified as part of the multinational evaluation team for Level III and IV evaluation, and we recommend this be added in the next revision.


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TABLE OF CONTENTS

Cover NSA Letter of Promulgation National Letter of Promulgation Record of Reservations Record of Specific Reservations Record of Changes Contents Chapter 1 - INTRODUCTION

Background Aim Scope Evaluation

Chapter 2 - DEFINITIONS

General definitions Evaluation levels Evaluation outcome

Chapter 3 – APPLICATION OF THE TOOL

Introduction Responsibilities Evaluation / Validation / Certification authority Evaluation process Application of the MEM

Chapter 4 – EVALUATION TEAM

Introduction Responsibilities Composition Team roles Evaluator roles Evaluator qualifications Task

Chapter 5 – REPORTING

5 – 1 Introduction 5 – 2 Types of Reports 5 – 3 Timelines

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5 – 4 Distribution Chapter 6 – GLOSSARY Annex A First Impression Report (FIR) Annex B Final Exercise Report (FER) Annex C Questions prior to evaluation Annex D Questions during evaluation Annex E Response Ambulance Annex F Forward Medical Evaluation Annex G Medical Emergency Response Team Annex H Primary Healthcare Annex I Command and Control Annex J Resuscitation Annex K Damage Control Surgery Annex L Diagnostic Annex M Patient Holding Annex N Surgical Module Annex O Intensive Care Unit (ICU) Annex P Sterilization Annex Q Mobile Mental Health Annex R Forward Medical Equipment Annex S High Dependency Unit (HDU) Annex T Ward Annex U Enhanced Diagnostic Annex V Enhanced Support Annex W Enhanced C4I Annex X Dental Annex Y Specialist Annex Z CBRN Medical Annex AA Tactical Aero Medical evacuation Annex AB Strategic Aero Medical evacuation Annex AC Strategic Aero Medical evacuation with CCAST Annex AD Patient Evacuation Coordination Cell (PECC) Annex AE Ops & Plans Annex AF Hyperbaric Annex AG Preventive Medicine Annex AH Capability Matrix Annex AI Skill Matrix Reference Publications

5-2 6-1 A-1 – A-2 B-1 – B-3 C-1 D-1 – D-3 E-1 – E-3 F-1 – F-3 G-1 – G-3 H-1 – H-3 I-1 – I-4 J-1 – J-2 K-1 – K-3 L-1 – L-3 M-1 – M-3 N-1 – N-2 O-1 – O-3 P-2 – P-3 Q-1 – Q-2 R-1 – R-3 S-1 – S-3 T-1 – T-3 U-1 – U-3 V-1 – V-3 W-1 – W-3 X-1 – X-2 Y-1 – Y-3 Z-1 – Z-3 AA-1 – AA-3 AB-1 – AB-3 AC-1 – AC-3 AD-1 – AD-4 AE-1 – AE-4 AF-1 – AF-2 AG-1 – AG-2 AH-1 – AH-5 AI-1 – AI-53 Ref - 1


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CHAPTER 1

0101. BACKGROUND a. General. Medical support to NATO forces must meet standards acceptable to all participating nations, as opposed to national support to national contingents, which requires purely national acceptance. Even in crisis or conflict situations, the aim is to provide an acceptable standard of medical care to achieve outcomes of treatment equating to best medical practice. NATO military operations are conducted as an international effort. This allows more nations to participate and use national medical assets more efficiently. However, international medical cooperation poses challenges due to differences between nations’ medical standards and due to legal constraints. The aim of evaluation in the military field is the official recognition that a staff, unit or force component meets defined standards and criteria, and is therefore capable of performing the assigned mission. b. Multinational Medical Support. The medical standards and criteria must be clear to all the interested parties: The Lead Nation (LN), NATO Commander and Troop Contributing Nations (TCN). The LN and each TCN are therefore responsible for the quality of medical care according to the agreed standards. In order to ensure transparency and accountability, the NATO Commander will order an evaluation to identify any risks to the medical facility not meeting the agreed standards, identify how such risks can be mitigated before or during deployment. After the process of evaluation, all the involved parties will be able to form a view on the probability that the medical unit can meet the agreed standards. References refer to a capability-based approach. Using this approach the MEM does not focus on professions, but on requirements to be met by certain capabilities. Medical support capabilities will be tailored to the mission to be supported. Hence the capability based approach needs to be enhanced to a modular system of medical support capabilities. In addition to this, best medical practice is to be achieved by LN and TCN. c. The multinational medical evaluation procedure. The responsibility for the health of the troops is shared among the NATO Commander and the nations. Due to financial, technical and medical specialist shortages across the NATO nations, multinational support options have become a reality. Many nations prefer to contribute modules or individuals to a multinational medical capability. In most cases a LN will integrate these modules into a multinational medical force. The evaluation procedure has to confirm the quality of care delivered by integrated medical forces, but also to reveal shortfalls in order to provide the Commander with a risk assessment concerning medical support to his troops. The evaluation prior to deployment will be performed by a multinational evaluation team (further described in Chapter 4). Upon Transfer of Authority (TOA) the Commander can validate the quality of care of the medical forces. An overview of this procedure is depicted in Fig. 1. The delineated procedure allows the evaluation of medical capabilities that will be deployed either as part of a Combined Joint Task Force (CJTF) or under command and control of a Deployable Joint Task Force (DJTF) in a NATO Response Force (NRF) operation. In both cases the NATO Commander at the strategic level will set the requirements for supporting medical capabilities within the Combined Joint Statement of Requirements (CJSOR). Therefore the evaluation procedure focuses on the performance of medical forces in comparison to the requirements.


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MN EVAL TEAM

26‐8‐2009Evaluation Process

Handover Medical Support Requirement (Part of CJSOR)

MN EVALUATIONNAT EVALUATION

Module W

Module Z

generate

integrate

integrateJFC / JC

CJTF / DJTF

Force Integration

Certification

Module X

Module Y

Module X

Module Y

generateand certify

Nation X

Nation Y

generateand certify

Formation / Unit

Module X

Module W

Module Z

Module Y

Module X

Module W

Module Z

Module Y

TOA

Lessons Learned

Fig. 1 - NATO Medical Evaluation Procedure

0102. AIM The aim of the NATO Medical Evaluation Manual (NATO MEM) is to facilitate and provide the framework for nations to certify their own medical capabilities and also for the medical evaluation of multinational medical modules and units, when formed to support NATO operations. Medical certification in the military field is the official recognition that a staff, module, unit or force component can provide the defined capability agreed by nations or, if it cannot, documents the residual risk and required mitigation. 0103. SCOPE a. Usage. The NATO MEM should be utilised as the tool to provide the structure for the evaluation of multinational medical capabilities. While this is the primary focus, the evaluation of modules and individual personnel clearly needs a common basis as well. Therefore the framework for the evaluation and certification that takes place under national responsibilities has also been included. The NATO MEM can be applied to multinational medical forces either prior to deployment or, for validation purposes, to medical capabilities as part of a deployed multinational force. The tool will serve as a reference for common standards, procedures, and terminology. Hence it supports the overarching goal of achieving best medical practice. The NATO MEM is designed as a stand-alone document, which includes basic supporting references. The structure of the NATO MEM allows the user to select only the relevant sections (key questionnaires, medical skill sets) to meet the


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requirements of the mission related medical capability (Module, Unit). It should be noted that the process of medical governance of the Multinational Medical Unit (MMU) remains the responsibility of the LN and should be in accordance with emerging NATO governance policy. b. Application. The NATO MEM has been developed as a toolbox for evaluating authorities. It can be applied either as a whole or for the evaluation and certification of single capabilities. Nations are encouraged to use the skill sets provided within Annex AI for the evaluation and certification of individuals and modules. In this way the reference to common standards prior to the handover of solely national modules to a multinational medical force will be ensured. The NATO MEM is primarily aimed at those personnel involved in evaluating MMU assigned to a NATO Command. However, anyone involved with medical education, training and evaluation may find the NATO MEM a useful reference. c. Principles. The NATO MEM reinforces the principles that effective multinational medical support can only be achieved through effective training. It builds upon the responsibility of individual medical knowledge and skills based on agreed standards enabling the individual to be part of a medical capability working in a national or multinational medical environment (Module or Unit). d. Lessons Learned Process. As an evaluation tool, the NATO MEM must remain current and applicable to the forces to be evaluated. This means that the tool will be dynamic in nature and content and that the evaluation issues will be contextual with circumstances, operational experiences and doctrinal developments. The method for achieving effective currency with changes in medical practice within NATO, is the Lessons Learned process. The evaluation of operational developments by the Joint Analysis and Lessons Learned Centre (JALLC) serves as the formal route for ensuring NATO gains maximum advantage from the recorded events of note. It is therefore imperative that the NATO MEM review process incorporates a formal methodology for incorporating Lessons Learned into the text of the NATO MEM.

0104. EVALUATION a. Levels. By using the NATO MEM, evaluation of multinational medical forces takes place at four different levels (individual, module, unit, medical support system). Definitions of these levels are provided in Chapter 2 - 2. b. Multinational Evaluation Team (MET). The evaluation of units and the medical support system requires the input from a range of Subject Matter Experts (SME). Consequently the LN prior to deployment and the Commander after TOA will set up a team of SMEs in order to conduct the evaluation. It will be composed of SMEs from the NATO Command Structure, LN and TCNs. Depending on the purpose of the evaluation, the parties represented in the team will take part either as members who actually conduct the evaluation or as observers who do not contribute to the generation of the evaluation results. d. Evaluation procedure. The evaluation procedure is based on a system of key questions and supporting questions. Some of the supporting questions address mission essential issues. All types of questions are either related to personnel, equipment or procedures. Each module will be evaluated by posing a key question aiming at the overall capability of that module. Supporting questions focus at sub-capabilities and performances which altogether describe


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the capability. The questions should be answered in such a way that the risk can be fully articulated and recommendations can be made for mitigating capability gaps. The same systematic approach to questions can also be used for the evaluation of medical units and the medical system as a whole. Following the evaluation a report will be raised summarizing findings. This will take the form of a risk assessment that will describe the capability in terms of ‘fully capable/no risks identified’, ‘capable/minor risks identified’ or ‘capable with limitations/major risks identified’1 (details in Chapter 5). The evaluator/evaluation team may use any suitable description system they choose (i. e. colour code/traffic light system) in order to achieve the summarized findings.

1 This description will regularly not occur if national preparation has successfully followed the self assessment

process depicted in chapter 3 of this manual.


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CHAPTER 2

DEFINITIONS

0201. GENERAL DEFINITIONS As detailed in reference B, in the context of military forces, the hierarchical relationship in logical sequence is: assessment, analysis, evaluation, validation and certification. Analysis: The study of a whole by examining its parts and their interactions. Assessment: The process of estimating the capabilities and performance of organizations, individuals, materiel or systems. Evaluation: The structured process of examining activities, capabilities and performance against defined standards of criteria. Validation: The confirmation of the capabilities and performance of organizations, individuals, materiel or systems and the degree to which they meet defined standards or criteria, through the provision of objective evidence. Certification: The process of officially recognizing that organizations, individuals, materiel or systems meet defined standards or criteria and the areas in which these standards are met, as well as the degree to which they are met. Capability: The ability of an item to meet a service demand of given quantitative characteristics under given internal conditions (Ref F The military medical capability describes the functions offered as part of a medical unit). Military Medical Module: A separable medical component, interchangeable with others, for assembly into medical units of different size, complexity, or function. Unit: A military element whose structure is prescribed by a competent military authority. Military Medical Unit: A military medical element whose structure is prescribed by a competent military authority.

0202. EVALUATION LEVELS The evaluation of multinational medical forces takes place at four different levels: Level I: The individual level of evaluation deals with the representation of skill-sets among medical personnel. It is a national responsibility prior to handover to a multinational medical force. Level II: The module level of evaluation deals with the evaluation of modules as a contribution to a multinational medical force. As for Level I evaluation, it is a national responsibility. Level III: The unit level of evaluation deals with the evaluation of MMUs. The evaluation will be performed by a MET under the responsibility of the LN. Level IV: The medical support system as a whole may be evaluated and validated during a combined joint exercise under the responsibility of the Joint Force Commander or upon receipt of the Level III evaluation reports from the deploying MMUs.


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0203. EVALUATION OUTCOME

Fully capable/no risks identified: The combination of personnel, equipment and procedures deliver the required capabilities. No risks could be identified. Capable/minor risks identified: The combination of personnel, equipment and procedures deliver the required capabilities in general. Recognized risks are not mission essential. They are likely to be minor in nature or unlikely to affect capability in most circumstances. Capability gaps should be resolved. Capable with limitations/major risks identified: The combination of personnel, equipment and procedures deliver the required capabilities with limitations. Recognized risks are mission essential. They are likely to be major in nature and likely to affect capability in most circumstances. Capability gaps must be resolved prior to deployment, or the receiving Commander must certify that he can address the residual risk by using other in-theatre resources. .


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CHAPTER 3

APLICATION OF THE TOOL

0301. INTRODUCTION a. Definition. MP activities are enabling functions that are conducted by designated military a. The aim of the NATO MEM is to provide the structure for the evaluation of multinational medical capabilities. While this is the primary focus, the evaluation of modules, medical units, the medical system as a whole and individual medical personnel requires a common standard. Therefore the framework for the evaluation that takes place under national responsibilities has also been included. b. The NATO MEM can be applied for the evaluation and certification of multinational medical forces prior to deployment or for the evaluation and validation during deployment. It has been specifically designed to allow interpretation and usage over all levels of medical capabilities (medical modules, military medical units and the medical system as a whole. The NATO MEM has been developed as a TOOLBOX for evaluating capabilities. c. The tool should NOT be viewed as a checklist. It should be utilized in conjunction with Annex AH which describes the capabilities of medical modules in full detail. This chapter details the recommended usage of the tool but does not aim to be prescriptive; usage of the manual should be determined by the LN in conjunction with the MET. 0302. RESPONSABILITIES The LN and all TCN have a national responsibility to prepare their contingents for deployment to meet the medical care capabilities required for the specific mission. Annex AI provides detailed information about the skill sets required to meet the stated module capabilities. The LN and each TCN have shared responsibility for the quality of medical care according to the agreed standards and in accordance with emerging NATO governance policy.

0303. EVALUATION / VALIDATION / CERTIFICATION AUTHORITY The LN is authorised to asses and evaluate the MMU prior to deployment. To assist this process, the NATO MEM has been developed to be used as a guide for evaluating each MMU in preparation for validation and certification to take place. Based on the recommendations of the evaluation team, the LN will provide the Commander with a risk assessment regarding the MMU to validate the units against operational requirements. Certification will be the responsibility of either of the lead Joint Force Commander (JFC) or Allied Command Operations (ACO).

0304. EVALUATION PROCESS a. MMU need a set of agreed standards. These standards must be included in the Memorandum of Understanding (MOU) or Technical Arrangement (TA) between the participating nations. Another possibility is to use a set of agreed NATO standards e.g. this


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NATO MEM including the skill set matrix to determine the individual skills required. National procedures and training policies require time to train a MMU. In these cases certification should be a two-step approach. The first step is national certification of the personnel or elements that will form part of the MMU. The second step is the integration and certification of national elements within the MMU. Within this step it must be assured that modules which are providing capabilities have no overlap with other provided modules to the MMU. b. National Level. The evaluation process starts at national level. Individual nations are responsible for the training of their own medical personnel and modules prior to transfer to a LN. Besides training, TCN are also responsible for the national evaluation and certification at level 1 (individuals) and at level 2 (module). The main focus of this evaluation and certification is the individual skill of each medical professional. Nations are encouraged to use this NATO MEM for their national evaluation and certification. Nations who are unable to contribute a complete module can also contribute individual medical personnel. These personnel will be trained, evaluated and certified by the nation hosting those individuals. This certification will mainly focus on level 2. c. LN Level. On an agreed date, the LN will receive the contributions of all TCN and commence the integration of the MMU. After the integration, a period of training will start. This training is focussed on level 3 (unit). After the training period the unit will be evaluated by a multinational evaluation team using the NATO MEM. All TCN are invited to contribute to the evaluation team. The outcome of the evaluation will be detailed in an evaluation report. This report will assess the MMU and will identify the capability deficiencies to be resolved prior to or during deployment. d. Formation Level. At formation level (level 4 – medical support system) the MMUs will be integrated into the NATO force. The Force Commander will use the final evaluation report (FER) for level 4 validation. e. JFC/ACO Level. The final certification will be at JFC/ACO level.

0305. APPLICATION OF THE NATO MEM a. Following the decision to commence a NATO operation, ACO med staff will clearly articulate the medical capability requirements. A LN will be identified and will be tasked with identifying and coordinating the required medical modules from TCNs. In tandem, a Medical Evaluation Team (MET) will be formed (details of composition and training are contained in Chapter 4). Whilst nations are generating and evaluating the required medical modules, the MET will adapt to the NATO MEM to meet the specific requirements. b. When the LN has integrated the various modules to form the MMU the MET will forward the tailored evaluation manual for use as a self assessment tool. Once complete this self assessment will be returned to the team for analysis and review including the outline organization, equipment table, SOP’s and job descriptions. When this process is complete a formal evaluation visit will be arranged. In preparation for this visit the MET will carefully consider the capabilities to be evaluated. They will rely heavily on (Annex AI) which describes in detail the capabilities of each medical module. It should be noted that the physical evaluation should be conducted during a pre-deployment exercise; however, if this is not practicable, it may be undertaken via an appropriate staff check although this will significantly affect the degree of assurance that can be provided.


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c. The evaluation of a MMU is summarized at Fig. 2.

Fig 2 - Evaluation of a MMU

Med capability requirements set by

ACO

LN and TCNs identify modules and evaluate

MET formed under command of LN

Modules integrated under LN Command

MET adapt the NATO MEM to meet

capability requirements

Formation of MMU

Self assessment utilizing NATO MEM

returned to MET

MET review self assessment

Evaluation of MMU

Report forwarded to ACO for onward

transmission to NATO Commander

NATO Supported Operation


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CHAPTER 4

EVALUATION TEAM

0401. INTRODUCTION In order to conduct the evaluation the LN will set up a MET prior to deployment. After TOA the Commander may establish a MET for further evaluation. The MET will be formed by appropriately qualified SMEs from the NATO Command Structure (NCS), LN and TCNs. The composition of the multinational evaluation team is shown in Table 1. The MET will use the NATO MEM for evaluating capabilities (modules, MMU’s or a medical system as a whole). Nations are encouraged to use the NATO MEM for evaluating individuals and medical modules. 0402. RESPONSIBILITIES The following details the evaluation responsibilities at each Level:

Levels I and II (individuals and medical modules) – TCNs Level III (unit) – LNs Level IV (medical support system) – Formation Commander

0403. COMPOSITION a. As a guide, MET size should be no less than 6 evaluators. The MET Leader may additionally appoint administrative support.

b. Teams will be under the direction of the LN appointed MET Leader. Ideally, he/she should be of a higher or at least the same rank as the commander of the evaluated unit.

c. The recommended composition of the MET is as follows:

LN TCN ACO Medical

ACT Medical

JFC Medical

CJTF/DJTF Cdr

Lead X Member X X X

Pre-deployment evaluation (Level III) Observer X X

Lead X Member X X

Evaluation (Level IV)

Observer X X Table 1: Composition of a MET.

d. The tables show the key representative bodies that share responsibility for the delivery of effective medical capability and ideally the teams should consist of representatives from all areas. However, in consideration of the competing pressures on time and resources, this aspiration may not always be achievable. Therefore, as a minimum, the METs should comprise the LN and TCN representatives for the Level III and Level IV (deployed) evaluation.


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0404. TEAM ROLES a. The MET has the clear role during pre-deployment, to provide:

1) The medical capability requirements.

2) Evaluation of overall capability.

3) Identification of capability deficiencies and assessment of impact (degree of risk).

4) Advice and direction to achieve compliance (risk mitigation).

b. This process is the first stage of assessment and is deliberately low-key with the emphasis on internal appreciation of the NATO values. The intent is to explore where there are differences or lack of understanding and to obtain guidance and advice, aimed at progressing the unit towards validation. This is seen as a helpful and confidence-building process between multinational contributors, where shared appreciation and cooperation can develop the proposed MTF or medical capability. c. The MET at the Level IV evaluation, is responsible for building upon the Level III evaluation phase by transferring the unit confidence in capability to the operational commander that will hold responsibility for the unit. The MET at this stage holds the responsibility to provide:

1) Reiteration of the medical capability requirements. 2) Resolution of capability deficiencies. 3) Assessment reporting of medical capabilities for the Commanders validation.

0405. EVALUATORS ROLES a. Lead. The lead role will be drawn from the LN and is to provide the focus for initiation of the pre-evaluation process. This role includes coordinating with contributing nations on the evaluation and establishing the support of ACO/JFC medical staff for completion. The lead role will also act as the focus for informing ACT medical and the Commander of the evaluation. b. Members. The members of the MET will be drawn from the TCNs and NCS. They will be appropriately qualified individuals who will be responsible for conducting the evaluation under the direction of the Lead Evaluator and iaw the NATO MEM.

c. Observers. The participation of observers from different NCS bodies should be encouraged in order to ensure transparancy and compare methods and procedures within the overall framework of the medical capability evaluation. The attendance of observers depends on the approval of the LN.

0406. EVALUATORS QUALIFICATIONS a. All members of the MET must be appropriately qualified. This requirement ensures that the capability will be examined by personnel who hold an appreciation of the medical values that would apply to the unit. The NATO MEM and the evaluation process should be understood in detail by all national military medical staff and in outline by military commanders


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b. Potential evaluation team members (SME) are to undertake and successfully complete NATO MEM implementation training, aimed at ensuring validity, credibility and consistency in application of the NATO MEM tool. As a caveat, it is accepted that this requirement is neither valid nor practical for the CJTF/DJTF Commander. The nature of this implementation training and the source of delivery are beyond the scope of this document2.

0407. TASKS The evaluation of the unit will take place at the end or after the mission orientated training. The effectiveness aspect of the performance is reflected in a ‘key question’ for the execution of an ‘operational evaluation’. This key question (Annex E – AG) can be explored further by asking supporting questions in ‘evaluation guidance’ to each key question. These supporting questions are divided into three areas, personnel, material and procedures. Each question must be answered with supporting documentary evidence or observational reports where appropriate. On completion of the evaluation the Lead Evaluator will be responsible for the formal reporting (details in Chapter 5).

2 This task could be given to the NATO Centre of Excellence for Military Medicine (MILMED COE)


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CHAPTER 5

REPORTING

0501. INTRODUCTION The aim of reporting is to provide the commander with a risk assessment and recommendations. a. The reporting described in this chapter is designed for level III and IV Medical Evaluation. It may also serve as template for level I and II. b. The reporting is to be based on the outcome of key questions (Annex E – AG), mission essential questions and supporting questions (Annex D). All types of questions are either related to personnel, equipment or procedures. The reporting is to be based on the outcome of key questions and supporting questions, some of them addressing mission essential issues. All types of questions are either related to personnel, equipment or procedures. The results should be collectively evaluated by the MET leader and members using all available evaluation data to develop an (as objective as possible) evaluation of the unit’s overall capability to accomplish the task. The MET will identify to the MMU commander any deficiencies or risk to providing the required capability and allow the MMU commander the opportunity to address, or indicate how he will address any deficiencies. The MET will then provide a written evaluation on the defined capability of the MMU. It is the responsibility of the member representatives of the team to formulate and complete the evaluation report, and the responsibility of the LN to approve the report and certify the MMU. 0502. TYPES OF REPORTS MET leader and members will report the results of the evaluation in two different reports. a. First Impression Report (FIR) The FIR has to be written on site and serves as immediate feedback for the complete evaluated MMU. It should comprise of observations, major findings, recommendations (Reporting format at Annex A). The MMU commander has the opportunity to respond to the MET within a week how he will address any deficiencies / shortfalls or how he will mitigate the identified risks. This comment can be inserted in the FER or even appended to it. b. Final Evaluation Report (FER) The FER has to be finished and transmitted to ACO not later then four weeks after finishing the evaluation. It serves as feedback to ACO and to the CJTF/DJTF Commander and should comprise of executive summary, introduction, pre-evaluation information, assumptions, methodology, findings, conclusion, recommendations (Reporting format at Annex B).


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0503. TIMELINES Timelines have to be met in preparation, execution, self assessment and reporting of the level III and IV - Medical evaluation. a. Preparation

1. Nomination of the MET Leader: not later than 4 months prior to the evaluation. 2. Nomination of the MET members (SME’s): not later than 3 months prior to the evaluation. 3. Notification of evaluation to the CJTF/DJTF Commander of the MMU: not later than 3 month prior to the evaluation. 4. Team briefing for the MET: not later than 2 month prior to the evaluation.

b. Self-assessment 1. Delivery of the Self assessment utilizing NATO MEM returned from the MMU to MET: not later than 1 month prior to the evaluation by the MET 2. MET review of the self assessment: finished not later than 2 weeks prior to the evaluation, see Annex C

c. Execution 1. Time frame has to be agreed between the MET leader and the CJTF/DJTF Commander of the MMU 4 weeks prior to the evaluation.

d. Reporting 1. Ad hoc feedback during the evaluation is to be encouraged. 2. Delivery of the FIR: on site at the end of the evaluation.

3. Delivery of the draft FER: after two weeks to the Commander of the MMU for comments using silence procedure of one week. 4. Final delivery of the final FER: not later than four weeks after finishing the evaluation.

0504. DISTRIBUTION a. The FIR has to be delivered on site to the Commander of the MMU.

b. The FER has to be formally forwarded to ACO for onward transmission to the CJTF/DJTF Commander, a copy must be sent to the Commander of the MMU directly.


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CHAPTER 6

GLOSSARY

This Glossary contains abbreviations used in this document. Definitions used in this document as well needed in the evaluation process are depicted in Chapter 2. AAP Allied Administrative Publication ACO Allied Command Operations ACT Allied Command Transition AJP Allied Joint Publication AJMedP Allied Joint Medical Publication AMedP Allied Medical Publication CCAST Critical Care Aero medical Surgical Team CJTF Combined Joint Task Force CJSOR Combined Joint Statement of Requirement COE Centre of Excellence CR Combat Ready DJTF Deployable Joint Task Force JFC / JC Joint Force Command / Joint Command LCR Limited Combat Ready LL Lessons Learned LN Lead Nation MC Military Committee MD Medical Doctor MEM Medical Evaluation Manual MET Medical Evaluation Team MHC WG Military Health Care Working Group MMU Multinational Medical Unit MN Multi National MSO Medical Support Officer / Medical Service corps Officer NATO North Atlantic Treaty Organisation NCR Not Combat Ready MOU Memorandum of Understanding NRF NATO Reaction Force SME Subject Matter Expert SOP Standard Operational Procedure STANAG Standard NATO Agreement TA Technical Agreement TCN Troop Contributing Nation TOA Transfer of Authority


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REFERENCE PUBLICATIONS

a. MC 326/2 NATO Principles and Policies of Operational Medical Support

b. MC 458/1 The NATO Education, Training, Exercise and Evaluation Policy

c. AAP-6 NATO Glossary of Terms and Definitions

d. AJP 4.10(A) Allied Joint Medical Support Doctrine

e. AMedP-13 NATO Glossary of Medical Terms and Definitions

f. ACT Directive 75-2 Medical Joint Functional Area Training Guide

g. MC-551 Medical Support Concept for NATO Response Force Operations

h. HATrainP-1 Education and Training for Peace Support Operations

i. AAP-31(A) NATO Glossary of Communication and Information systems terms and definitions

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ANNEX A

FIRST IMPRESSION REPORT

MMU

MET LEADER

DATE OF EVALUATION

№ Area Observations Explanation Recommendations

1

Personnel Material Procedures

2


3



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№ Area Observations Explanation Recommendations

4


5


6


7


…


Location, date Signature


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ANNEX B FINAL EXERCISE REPORT

Final Evaluation Report TO: ACO COPY Commander MMU SUBJECT: Final Evaluation Report of [MMU] DATE: REFERENCE: STANAG 2560 / AMedP – 27 NATO Medical Evaluation Manual (MEM) 1. Executive Summary 2. Introduction 3. Pre-evaluation information 4. Assumptions 5. Methodology 6. Findings 7. Conclusion 8. Recommendations Signature Block for: MET Leader


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3 ”Fully capable/no risks identified” ”Capable/minor risks identified” ”Capable with limitations/major risks identified” The evaluator/evaluation team may use any suitable desciption system they prefer (i. e. colour code/traffic light system).

MODULE CAPABILITY ASSESSMENT

MEDICAL MODULES ASSESSMENT OF CAPABILITY3 OVERALL MODULE

OUTCOME

Serial Module Title Personnel Equipment / Material

Procedures

1 2 3 4 5 6 7 8 9 ...


B - 3 ORIGINAL

NATO UNCLASSIFIED

FINAL EVALUATION REPORT (FIR) explanatory notes 1. EXECUTIVE SUMMARY. Unit-description, evaluation team details, summary of findings and recommendations. (Maximum one page) 2. INTRODUCTION. The introduction provides a brief background of the requirement to include at which level of training and preparation of the MMU the ME has been conducted. It may also provide the context under which the ME has been conducted such as unit-description, mission needed capabilities, major stakeholders, level of urgency, political environment, etc. 3. PRE-EVALUATION ASSESSMENT. What stage of pre-operational preparations the units were in? Summary of the pre-evaluation self-assessment. What limitations were identified including their potential effects on the evaluation outcome? 4. ASSUMPTIONS. This is different from the First Impression Report. State the actual assumptions that were made in order to execute the ME. 5. METHODOLOGY. How was the ME conducted? Each methodology used should be briefly described, although the main instrument is the assessment of capabilities. Examples include composition of the MET, documentation review, questionnaires, interviews, group discussions/brainstorming, etc. Where there any limitations identified during the evaluation? 6. FINDINGS. Findings for a ME are normally described in terms of the need or deficiency within three main categories. They are personnel, equipment and procedures. The findings should be presented in a concise form supported by data contained in Annexes. 7. CONCLUSION. Conclusion should state an overall assessment grading for the MMU. The assessment grading is to be justified by reference to the appropriate findings. 8. RECOMMENDATIONS. The recommendations should be directly linked to the findings of the evaluation and should be supported by appropriate data and analysis. No new information should be included. 9. ANNEXES.

A. First impression report: a copy of the FIR submitted to the MMU Commander is to be included. B. Module Capability Assessment: a summary table detailing individual module capability assessment by personnel, equipment and procedures

supported by appendices containing completed module questionnaires.


C - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX C QUESTIONS PRIOR TO EVALUATION

No. Supporting Question Mission

essential? FC C

CL

Risks Identified Recommendations

1. Personnel 1.a Provide the MN evaluation team with the personnel

establisment of all units which will be part of the medical system.

Yes

1.b Provide the MN evaluation team with all job descriptions. Yes 1.c Provide the MN evaluation team with the training program of

all units which will be part of the medical system Yes

2. Equipment/material 2.a Provide the MN evaluation team with the material

establisment of all units which will be part of the medical system.

Yes

3. Procedures 3.a Provide the MN evaluation team with the SOP’s of all units

which will be part of the medical system. Yes

3.b Provide the MN evaluation team with the MASCAL plan. Yes 3.c Provide the MN evaluation team with the Command and

Control structure. Yes

Summary: FC: Fully Capable/no risks identified

C: Capable/minor risks identified

CL: Capable with Limitations/major risks identified


D - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX D MAIN QUESTIONS DURING EVALUATION

No. Supporting Question Mission essential?

FC C

CL


1. Personnel 1.a Is the medical mission clearly defined and understood? 1.b Is there an appropiate replacement and rotation policy? Yes 2. Equipment/material 2.a Is an overview (list or graphic) available of all medical assets in theatre? Yes 2.b Is a communications list available of all medical assets in theatre

(including civilian)? Yes

2.c Does the infrastructure meet with the needs of the unit? 2.d Is an energy plan for MTF put in place (including heating and cooling)? 3. Procedures 3.a Do the medical units comply with the Geneva Convention? Yes 3.b Does the medical system provide care within given timelines? Yes 3.c Are all units aware of the procedures for requesting medical care

(methane, 9-liner etc)? Yes

3.d Is a Trauma Registration system in place and does personnel know how to insert data?

4. Main 4.a Is Host Nation Support available and of acceptable quality and reliability? Yes 4.b Is there an adequate reporting format (EPINATO, MEDASSESREP, etc)? Yes





E - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX E RESPONSE AMBULANCE

Module Response ambulance module

Capability Provide pre-hospital emergency care

Key Question: Is the module able to provide pre-hospital emergency care


essential? FC C

CL


1. Personnel 1.a How is the module staffed? 1.b How is the staffing of the module organized? 1.c Are the individuals certified at level 1 to perform the required

medical skills and can it been proved? Yes

1.d Are personnel properly trained to operate the module equipment?

Yes

2. Equipment/material 2.a What equipment is available to support the module? 2.b Is the equipment fit for purpose? Yes 2.c Is there a system in place to ensure medical supplies are

maintained to agreed levels? Yes

2.d Are patient transfer specific items available? 2.e Can vehicle use NATO standard stretchers? 2.f Is communications equipment sufficient to communicate with

troops supported, with other medical elements and with command level?

Yes

3. Procedures


E - 2 ORIGINAL

NATO UNCLASSIFIED

3.a Are there agreed SOPs? Yes 3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities?

(e.g. job descriptions) Yes

3.d Are the C2 arrangements for the module published and are all personnel aware of them?

3.e Is crew able to communicate with troops supported, with other medical elements and with command level?

Yes

3.f Are personnel aware of the unit MASCAL plan and their responsibility in its execution?

3.g Is crew able to orientate and navigate? Yes 3.h Is the crew able to evacuate contaminated patients? Reference standards: STANAG 2040 Stretchers, Bearing Brackets and Attachment Supports Ed. 6 STANAG 2060 Identification of Medical Material for Field Medical Installations Ed. 4 STANAG 2121 Cross-servicing of Medical Gas Cylinders Ed. 3 STANAG 2128 Medical and Dental Supply Procedures Ed. 4 STANAG 2342 Minimum Essential Medical Equipment and Supplies for Military Ambulances at all levels Ed. 2 STANAG 2872 Medical Design Requirements for Military Motor Ambulances Ed. 3 STANAG 2132 Documentation Relative to Medical Evacuation, Treatment and Cause of Death of Patients Ed. 2 STANAG 2347 Medical Warning Tag Ed. 2 STANAG 2126 First Aid Kits and Emergency Medical Care Kits Ed. 5 STANAG 2350 Morphia Dosage and Casualty Markings Ed. 3 STANAG 2087 Medical Employment of Air Transport in the Forward Area Ed. 6


E - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations Ed. 2





F - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX F FORWARD AEROMEDICAL EVACUATION

Module Forward Aero medical Evacuation module




essential? FC C

CL





Yes



2.d Are patient transfer specific items available? 2.e Can the AE asset use NATO standard stretchers? 2.f Is communications equipment available on board to

communicate internally?

2.g Is communications equipment sufficient to communicate with troops supported, with other medical elements and with command level?

Yes

3. Procedures


F - 2 ORIGINAL

NATO UNCLASSIFIED

3.a Are there agreed SOPs? Yes 3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities?



3.e Are personnel aware of the unit MASCAL plan and their responsibility in its execution?

3.f Is crew able to communicate with troops supported, with other medical elements and with command level?

Yes

Reference standards: STANAG 2040 Stretchers, Bearing Brackets and Attachment Supports STANAG 2060 Identification of Medical Material for Field Medical Installations STANAG 2121 Cross-servicing of Medical Gas Cylinders STANAG 2128 Medical and Dental Supply Procedures STANAG 2132 Documentation Relative to Medical Evacuation, Treatment and Cause of Death of Patients STANAG 2347 Medical Warning Tag STANAG 2126 First Aid Kits and Emergency Medical Care Kits STANAG 2350 Morphia Dosage and Casualty Markings STANAG 2087 Medical Employment of Air Transport in the Forward Area STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations STANAG 3114 Aeromedical Training of Flight Personnel STANAG 3198 Functional Requirements of Aircraft Oxygen Equipment and Pressure Suits


F - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 3204 Aeromedical Evacuation STANAG 3526 Interchangeability of of NATO Aircrew Medical Categories STANAG 3527 Aircrew Fatigue Management STANAG 3745 Medical Training and Equipment Requirements for Search and Rescue (SAR) and Combat Search and Rescue (CSAR) Missions STANAG 1412 Transfer Litter Ship-to-Ship or Ship-to-Air





G - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX G MEDICAL EMERGENCY RESPONSE TEAM

Module Medical Emergency Response Team module




essential?

FC

C

CL


1. Personnel 1.a How is the module staffed?

1.b How is the staffing of the module organized?

1.c Are the individuals certified at level 1 to perform the

required medical skills and can it been proved?

Yes

1.d Are personnel properly trained to operate the module

equipment?

Yes

2. Equipment/material 2.a What equipment is available to support the module?

2.b Is the equipment fit for purpose? Yes

2.c Is there a system in place to ensure medical supplies

are maintained to agreed levels?

Yes

2.d Are patient transfer specific items available?

2.e Can the AE asset use NATO standard stretchers?


G - 2 ORIGINAL

NATO UNCLASSIFIED

2.f Is communications equipment available on board to


2.g Is communications equipment sufficient to

communicate with troops supported, with other

medical elements and with command level?

Yes

3. Procedures 3.a Are there agreed SOPs? Yes

3.b Are personnel working according to the SOP? Yes

3.c Are personnel aware of their responsibilities?

(e.g. job descriptions)

Yes

3.d Are the C2 arrangements for the module published and

are all personnel aware of them?

3.e Are personnel aware of the unit MASCAL plan and their

responsibility in its execution?

3.f Is crew able to communicate with troops supported,

with other medical elements and with command level?

Yes

Reference standards:

STANAG 2040 Stretchers, Bearing Brackets and Attachment Supports STANAG 2060 Identification of Medical Material for Field Medical Installations STANAG 2121 Cross-servicing of Medical Gas Cylinders STANAG 2128 Medical and Dental Supply Procedures STANAG 2132 Documentation Relative to Medical Evacuation, Treatment and Cause of Death of Patients


G - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2347 Medical Warning Tag STANAG 2126 First Aid Kits and Emergency Medical Care Kits STANAG 2350 Morphia Dosage and Casualty Markings STANAG 2087 Medical Employment of Air Transport in the Forward Area STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations STANAG 3114 Aeromedical Training of Flight Personnel STANAG 3198 Functional Requirements of Aircraft Oxygen Equipment and Pressure Suits STANAG 3204 Aeromedical Evacuation STANAG 3526 Interchangeability of of NATO Aircrew Medical Categories STANAG 3527 Aircrew Fatigue Management STANAG 3745 Medical Training and Equipment Requirements for Search and Rescue (SAR) and Combat Search and Rescue (CSAR) Missions





H - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX H PRIMARY HEALTH CARE

Module Primary Healthcare module

Capability

Provide primary healthcare

Provide Pre-hospital emergency care

Optional:

Provide patient holding (use patient holding annex)

Provide basic laboratory testing

Provide initial stress management

Key Question: Is the module able to provide the required capability?


essential? FC C

CL





Yes

2. Equipment/material


H - 2 ORIGINAL

NATO UNCLASSIFIED

2.a What equipment is available to support the module? 2.b Is the equipment fit for purpose? Yes 2.c Is there a system in place to ensure medical supplies are


2.d Is the module able to transport the module with own transportation means (only at role 1)

Yes

2.e Are patient transfer specific items available? 3. Procedures 3.a Are there agreed SOPs? Yes 3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities?




Reference standards: STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2060 Identification of Medical Materiel for Field Medical Installations STANAG 2061 Procedures for Disposition of Allied Patients by Medical Installations STANAG 2121 Cross-Servicing of Medical Gas Cylinders STANAG 2128 Medical and Dental Supply Procedures STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients STANAG 2179 Minimum Requirements for medical care of Women in joint/combined operations


H - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2347 Medical Warning Tag Ed. 2 STANAG 2350 Morphia Dosage and Casualty Markings Ed. 3 STANAG 2481 Medical Information Collection and Reporting STANAG 2541 Medical Waste Management during NATO led Operations – AMedP-20 STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations Ed. 2 STANAG 1208 Minimum Requirements of Emergency Medical Supplies on Board Ships STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11





I - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX I COMMAND AND CONTROL

Module Command & Control

Capability Provide leadership

Provide co-ordination with higher level and supported unit

Provide communication with supported unit(s) and other MTFs

Key Question: Is the module able to provide adequate Command & Control to the unit


essential? FC C

CL


1. Personnel 1.a How is the module staffed? 1.b How is the staffing of the module organized? 1.c Are personnel aware of NATO operational command

structure?


Yes

2. Equipment/material 2.a What communication equipment is available to support the

module?

2.b Is the equipment fit for purpose? Yes 2.c Is communications equipment sufficient to communicate with


Yes

3. Procedures 3.a Can the command and control module meet the demands

based on the mission medical estimate?


I - 2 ORIGINAL

NATO UNCLASSIFIED

3.b Are there agreed SOPs? Yes 3.c Are personnel working according to the SOP? Yes 3.d Are personnel aware of their responsibilities?


3.e Are the C2 arrangements for the module published and are all personnel aware of them?

3.f Is there a MASCAL plan and is it promulgated? Yes 3.g Are the personnel able to communicate with supported

troops, with other medical elements and with higher formations (language skills, radio procedures)

Yes

3.h Are any MOU/TA in place and available? 3.i Is there a CBRN Medical plan available? 3.j Are processes in place for personnel to maintain situational

awareness?

Reference standards: STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2060 Identification of Medical Materiel for Field Medical Installations STANAG 2061 Procedures for Disposition of Allied Patients by Medical Installations STANAG 2128 Medical and Dental Supply Procedures STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients STANAG 2179 Minimum Requirements for medical care of Women in joint/combined operations STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2228 Allied Joint Medical Support Doctrine AJP-4.10 (A)


I - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2278 Medical Advice on Restriction of Movement STANAG 2409 NATO Glossary of Medical Terms and Definitions – AMedP-13 STANAG 2475 Planning Guide for the Estimation of NBC Battle Casualties (Nuclear) – AMedP-8(A) Vol I STANAG 2476 Medical Planning Guide for the Estimation of NBC Battle Casualties (Biological) – AMedP-8(B) Vol II STANAG 2477 Planning Guide for the Estimation of NBC Battle Casualties (Chemical) – AMedP-8(A) Vol III STANAG 2478 Medical Support Planning for Nuclear, Biological and Chemical Environments STANAG 2481 Medical Information Collection and Reporting STANAG 2513 Comparative Tables of Medical Treatment Facilities - AMedP-16 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2542 Allied Joint Medical Planning Doctrine – AJMedP-1 STANAG 2546 Allied Joint Medical Doctrine for Medical Evacuation - AJMedP-2 STANAG 2547 Allied Joint Medical Doctrine for Medical Intelligence - AJMedP-3 STANAG 2553 NATO planning guide for the estimation of CBRNMed casualties - AMedP-8(C) STANAG 2873 Concept of Operations of Medical Support in Nuclear, Biological and Chemical Environments – AMedP-7(D) STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations Ed. 2





J - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX J RESUSCITATION

Module Resuscitation module

Capability Provide specialist medical officer led resuscitation

Key Question: Is the module able to provide specialist medical officer led resuscitation?


essential? FC C

CL





Yes



2.d Are patient transfer specific items available? 3. Procedures 3.a Are there agreed SOPs? Yes 3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities?




J - 2 ORIGINAL

NATO UNCLASSIFIED


Reference standards: STANAG 2068 Emergency War Surgery STANAG 2121 Cross-Servicing of Medical Gas Cylinders STANAG 2126 First-Aid Kits and Emergency Medical Care Kits STANAG 2178 Compatibility of Medical Tubing and Connectors in the Field STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2350 Morphia Dosage and Casualty Markings STANAG 2408 NATO Blood Brochure - AMedP-12 STANAG 2453 The Extent of Dental and Maxillofacial Treatment at Roles 1-3 Medical Support. STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment





K - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX K DAMAGE CONTROL SURGERY

Module Damage control surgery module

Capability Provide damage control surgery with pre-/post operative care

Key Question: Is the module able to provide DCS with pre-/post operative care?


essential? FC C

CL





Yes



3. Procedures 3.a Are there agreed SOPs, including specific areas of interest

(e.g. sterilization, blood products etc)? Yes

3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities?


3.d Are the C2 arrangements for the module published and are


K - 2 ORIGINAL

NATO UNCLASSIFIED

all personnel aware of them? 3.e Are personnel aware of the unit MASCAL plan and their


Reference standards: STANAG 1208 Minimum Requirements of Emergency Medical Supplies on Board Ships STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2068 Emergency War Surgery STANAG 2121 Cross-Servicing of Medical Gas Cylinders STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2408 NATO Blood Brochure - AMedP-12 STANAG 2453 The Extent of Dental and Maxillofacial Treatment at Roles 1-3 Medical Support. STANAG 2469 External Fixation Devices for Bone Injuries STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment



K - 3 ORIGINAL

NATO UNCLASSIFIED




L- 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX L DIAGNOSTIC MODULE

Module Diagnostic module

Capability Provide field laboratory testing

Provide basic imaging

Key Question: Is the module able to provide field laboratory testing and basic imaging?


essential? FC C CL



medical skills and can it been proved?

Yes


Yes



3. Procedures 3.a Are there agreed SOPs? Yes 3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities? Yes


L- 2 ORIGINAL

NATO UNCLASSIFIED

(e.g. job descriptions) 3.d Does personnel work according special safety regulations

regarding imaging?



Reference standards: STANAG 2068 Emergency War Surgery STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2474 Determination and Recording of Ionising Radiation Exposure for Medical Purposes STANAG 2481 Medical Information Collection and Reporting STANAG 2517 Development and Implementation of Teleconsultation Systems STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2551 Regulations for establishment and employment of MRIIT(Medical Radiological Incident Investigation Team) STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11



L- 3 ORIGINAL

NATO UNCLASSIFIED




M - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX M

PATIENT HOLDING MODULE

Module Patient holding module

Capability Provide temporary medical care for treated patients prior to evacuation

Key Question: Provide temporary medical care for treated patients prior to evacuation


essential? FC C

CL

Risks identified Recommendations




Yes







M - 2 ORIGINAL

NATO UNCLASSIFIED



3.f What is the capacity of the module? Reference standards: STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2068 Emergency War Surgery STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2350 Morphia Dosage and Casualty Markings STANAG 2458 Heat stress control and heat casualty management - AMedP-14 Vol 1 STANAG 2539 Prevention and Management of cold weather injury – AMedP-14 Vol 2 STANAG 2540 Prevention and Management of High Altitude Injuries – AMedP -14 Vol 3 STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation



M - 3 ORIGINAL

NATO UNCLASSIFIED




N - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX N SURGICAL MODULE

Module Surgical module

Capability Provide primary surgery with pre-/post operative care

Key Question: Is the module able to provide primary surgery with pre-/post operative care?


essential? FC C CL



medical skills and can it be proved? Yes


Yes



3. Procedures 3.a Are there agreed SOPs? Yes 3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities?




N - 2 ORIGINAL

NATO UNCLASSIFIED


Reference standards: STANAG 1208 Minimum Requirements of Emergency Medical Supplies on Board Ships STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2068 Emergency War Surgery STANAG 2121 Cross-Servicing of Medical Gas Cylinders STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2408 NATO Blood Brochure - AMedP-12 STANAG 2453 The Extent of Dental and Maxillofacial Treatment at Roles 1-3 Medical Support. STANAG 2469 External Fixation Devices for Bone Injuries STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment



N - 3 ORIGINAL

NATO UNCLASSIFIED




O - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX O INTENSIVE CARE UNIT MODULE

Module ICU module

Capability Provide medical intensive care

Key Question: Is the module able to provide medical intensive care?


essential? FC C CL





Yes







O - 2 ORIGINAL

NATO UNCLASSIFIED



3.f What is the capacity of the module? Reference standards: STANAG 1208 Minimum Requirements of Emergency Medical Supplies on Board Ships STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2068 Emergency War Surgery STANAG 2121 Cross-Servicing of Medical Gas Cylinders STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of Patients STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2408 NATO Blood Brochure - AMedP-12 STANAG 2453 The Extent of Dental and Maxillofacial Treatment at Roles 1-3 Medical Support STANAG 2458 Heat stress control and heat casualty management - AMedP-14 Vol 1 STANAG 2539 Prevention and Management of cold weather injury – AMedP-14 Vol 2 STANAG 2540 Prevention and Management of High Altitude Injuries – AMedP -14 Vol 3 STANAG 2549 Emergency care in the Operational Environment – AMedP 24


O - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment





P - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX P STERILIZATION MODULE

Module Sterilization module

Capability Provide sterile medical and surgical equipment

Key Question: Is the module able to provide sterile medical and surgical equipment


essential? FC C CL





Yes





3.d Is there no crossing of contaminated and sterilised items?



P - 2 ORIGINAL

NATO UNCLASSIFIED

STANAG 2136 Minimum Standards of Water Potability During Field Operations and in Emergency Situations – AmedP-18 STANAG 2541 Medical Waste Management during NATO led Operations – AMedP-20 STANAG 2906 Essential Physical Requirements and Performance Characteristics of Field Type High Pressure Steam Sterilizers





Q - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX Q MOBILE MENTAL HEALTH MODULE

Module Mobile Mental Health module

Capability Provide stress management

Key Question: Is the module able to provide stress management?


essential? FC C CL





Yes

2. Equipment/material 2.a What equipment is available to support the module? 2.b Is the equipment fit for purpose? 2.c Is there a system in place to ensure medical supplies are

maintained to agreed levels?





Q - 2 ORIGINAL

NATO UNCLASSIFIED



3.f

Is the module able to operate mobile?

Reference standards: STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2548 Prevention of Postdeployment somatoform complaints





R - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX R FORWARD MEDICAL EQUIPMENT MODULE

Module Forward medical equipment module

Capability Provide Pharmacy

Provide maintenance for medical and surgical equipment

Provide blood and blood products

Key Question: Is the module able to provide the capability?


essential?

FC

C

CL


1. Personnel

1.a How is the module staffed?


1.c Are the individuals certified at level 1 to perform the required

skills and can it been proved?

Yes


Yes


2.a What equipment is available to support the module?


2.c Are storage facilities available to store temperature related

pharmaceuticals?

Yes

2.d Are direct exchange items available to replace disfunctional

medical equipment?

2.e Is all documentation available?


R - 2 ORIGINAL

NATO UNCLASSIFIED

2.f Are facilities available for filling oxygen bottles?

3. Procedures

3.a Are there agreed SOPs including national resupply? Yes




Yes

3.d Is there a system in place to ensure that medical and non‐medical

equipment are maintained to agreed levels?

Yes

3.d Are procedures available regarding blood storage and supply?

3.e Are procedures available for the disposal of medical

(contaminated) waste?

3.f Is a quility program used for the storage and distribution of

medical supplies and blood?

3.g Is a list of equivalent pharmaceuticals of other nations available?

3.h Is the cold chain (including blood supply) put in place?


STANAG 1208 Minimum Requirements of Emergency Medical Supplies on Board Ships STANAG 2040 Stretchers, Bearing Brackets and Attachment Supports STANAG 2060 Identification of Medical Materiel for Field Medical Installations STANAG 2121 Cross-Servicing of Medical Gas Cylinders STANAG 2128 Medical and Dental Supply Procedures STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2178 Compatibility of Medical Tubing and Connectors in the Field STANAG 2408 NATO Blood Brochure - AMedP-12


R - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2541 Medical Waste Management during NATO led Operations – AMedP-20 STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment





S - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX S HIGH DEPENDENCY UNIT MODULE

Module HDU module

Capability Provide medical intensive care

Key Question: Is the module able to provide medical intensive care?


essential? FC C CL





Yes



Yes





S - 2 ORIGINAL

NATO UNCLASSIFIED


3.f What is the capacity of the module? Reference standards: STANAG 1208 Minimum Requirements of Emergency Medical Supplies on Board Ships STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2068 Emergency War Surgery STANAG 2121 Cross-Servicing of Medical Gas Cylinders STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of Patients STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2408 NATO Blood Brochure - AMedP-12 STANAG 2453 The Extent of Dental and Maxillofacial Treatment at Roles 1-3 Medical Support STANAG 2458 Heat stress control and heat casualty management - AMedP-14 Vol 1 STANAG 2539 Prevention and Management of cold weather injury – AMedP-14 Vol 2 STANAG 2540 Prevention and Management of High Altitude Injuries – AMedP -14 Vol 3 STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation


S - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment





T - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX T WARD MODULE

Module Ward Module

Capability Provide nursed beds

Key Question: Is the module able to provide nursed beds?


essential? FC C CL





Yes







T - 2 ORIGINAL

NATO UNCLASSIFIED


Reference standards: STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2068 Emergency War Surgery STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of Patients STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2350 Morphia Dosage and Casualty Markings STANAG 2458 Heat stress control and heat casualty management - AMedP-14 Vol 1 STANAG 2539 Prevention and Management of cold weather injury – AMedP-14 Vol 2 STANAG 2540 Prevention and Management of High Altitude Injuries – AMedP -14 Vol 3 STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation





U - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX U ENHANCED DIAGNOSTIC MODULE

Module Enhanced Diagnostic module

Capability Provide enhanced imaging

Provide enhanced field laboratory testing



essential? FC C CL





Yes



2.d Is protection equipment for imaging in place (including mobile aprons)?

3. Procedures 3.a Are there agreed SOPs? Yes


U - 2 ORIGINAL

NATO UNCLASSIFIED



3.d Does personnel work according special safety regulations regarding imaging?



Reference standards: STANAG 2068 Emergency War Surgery STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of Patients STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2474 Determination and Recording of Ionising Radiation Exposure for Medical Purposes STANAG 2481 Medical Information Collection and Reporting STANAG 2517 Development and Implementation of Teleconsultation Systems STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2551 Regulations for establishment and employment of MRIIT(Medical Radiological Incident Investigation Team) STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11


U - 3 ORIGINAL

NATO UNCLASSIFIED





V - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX V ENHANCED SUPPORT

Module Enhanced support module

Capability Provide medical and logistic support to lower roles

Key Question: Is the module able to provide medical and logistic support to lower roles?


essential? FC C CL


1. Personnel 1.a How is the module staffed? 1.b How is the staffing of the module organized? 1.c Are personnel properly trained to operate the module

equipment? Yes

2. Equipment/material 2.a What equipment is available to support the module? 2.b Is the equipment fit for purpose? Yes 2.c Are storage facilities available to store temperature related

pharmaceuticals?

2.d Are direct exchange items available to replace disfunctional medical equipment?



3.d Is there a system in place for re-supply of lower roles? Yes


V - 2 ORIGINAL

NATO UNCLASSIFIED

3.e Are procedures available for the disposal of medical (contaminated) waste?

3.f Is a procedure for re-supply of water to lower roles put in place?

Reference standards: STANAG 1208 Minimum Requirements of Emergency Medical Supplies on Board Ships STANAG 2040 Stretchers, Bearing Brackets and Attachment Supports STANAG 2060 Identification of Medical Materiel for Field Medical Installations STANAG 2121 Cross-Servicing of Medical Gas Cylinders STANAG 2128 Medical and Dental Supply Procedures STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2136 Minimum Standards of Water Potability During Field Operations and in Emergency Situations – AmedP-18 STANAG 2178 Compatibility of Medical Tubing and Connectors in the Field STANAG 2408 NATO Blood Brochure - AMedP-12 STANAG 2541 Medical Waste Management during NATO led Operations – AMedP-20 STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment



V - 3 ORIGINAL

NATO UNCLASSIFIED




W - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX W FINAL EXERCISE REPORT

Module Enhanced C4I module

Capability Capability

Provide Leadership

Provide co-ordination with higher level and supported unit

Provide IT support to MTF

Provide communication with other MTFs and higher command level

Key Question: Is the module able to provide the capability


essential?

FC

C

CL


1. Personnel

1.a How is the module staffed?


1.c Are personnel properly trained to operate the module equipment?

Yes


2.a What equipment is available to support the module?

2.b Is the equipment fit for purpose?

Yes

3. Procedures

3.a Are there agreed SOPs? Yes


W - 2 ORIGINAL

NATO UNCLASSIFIED




Yes

3.d Are the C2 arrangements for the module published and are all

personnel aware of them?



3.f Are personnel aware of CBRN procedures and their responsibility

in its execution?


STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2060 Identification of Medical Materiel for Field Medical Installations STANAG 2061 Procedures for Disposition of Allied Patients by Medical Installations STANAG 2128 Medical and Dental Supply Procedures STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of Patients STANAG 2179 Minimum Requirements for medical care of Women in joint/combined operations STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2228 Allied Joint Medical Support Doctrine AJP-4.10 (A) STANAG 2278 Medical Advice on Restriction of Movement STANAG 2409 NATO Glossary of Medical Terms and Definitions – AMedP-13


W - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2475 Planning Guide for the Estimation of NBC Battle Casualties (Nuclear) – AMedP-8(A) Vol I STANAG 2476 Medical Planning Guide for the Estimation of NBC Battle Casualties (Biological) – AMedP-8(B) Vol II STANAG 2477 Planning Guide for the Estimation of NBC Battle Casualties (Chemical) – AMedP-8(A) Vol III STANAG 2478 Medical Support Planning for Nuclear, Biological and Chemical Environments STANAG 2481 Medical Information Collection and Reporting STANAG 2513 Comparative Tables of Medical Treatment Facilities - AMedP-16 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2542 Allied Joint Medical Planning Doctrine – AJMedP-1 STANAG 2546 Allied Joint Medical Doctrine for Medical Evacuation - AJMedP-2 STANAG 2547 Allied Joint Medical Doctrine for Medical Intelligence - AJMedP-3 STANAG 2553 NATO planning guide for the estimation of CBRNMed casualties - AMedP-8(C) STANAG 2873 Concept of Operations of Medical Support in Nuclear, Biological and Chemical Environments – AMedP-7(D) STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations Ed. 2





X - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX X DENTAL MODULE

Module Dental module

Capability Provide primary dental care

Key Question: Is the module able to provide primary dental care?


essential? FC C

CL





Yes



Yes





X - 2 ORIGINAL

NATO UNCLASSIFIED



Reference standards: STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2453 The Extent of Dental and Maxillofacial Treatment at Roles 1-3 Medical Support STANAG 2464 The Military Dental Field Identification Services STANAG 2465 Tasks for the Appropriate Staffing and Training of Dental Officers and Dental Ancillary Personnel for Wartime Operations and Operational Deployments STANAG 2466 Dental Fitness Standards for Military Personnel and a Dental Fitness Classification System STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2906 Essential Physical Requirements and Performance Characteristics of Field Type High Pressure Steam Sterilizers Summary: FC: Fully Capable/no risks identified




Y - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX Y CLINICAL SPECIALIST MODULE

Module Clinical Specialist module

Capability Provide mission tailored clinical expertise

Key Question: Is the module able to provide mission tailored clinical expertise


essential? FC C

CL





Yes



3. Procedures 3.a Are there agreed SOPs, including specific areas of interest

(e.g. sterilization, blood products etc)? Yes





Y - 2 ORIGINAL

NATO UNCLASSIFIED



Reference standards: STANAG 1208 Minimum Requirements of Emergency Medical Supplies on Board Ships STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2050 Statistical Classification of Diseases, Injuries and Causes of Death STANAG 2068 Emergency War Surgery STANAG 2121 Cross-Servicing of Medical Gas Cylinders STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of d eath of patients STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2348 Basic Military Hospital (Clinical) Records STANAG 2408 NATO Blood Brochure - AMedP-12 STANAG 2453 The Extent of Dental and Maxillofacial Treatment at Roles 1-3 Medical Support. STANAG 2469 External Fixation Devices for Bone Injuries STANAG 2549 Emergency care in the Operational Environment – AMedP 24 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment



Y - 3 ORIGINAL

NATO UNCLASSIFIED




Z - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX Z CBRN MEDICAL MODULE

Module CBRN Medical module

Capability Provide patient decontamination support to the MTF

Key Question: Is the module able to provide patient decontamination support to the MTF


essential? FC C CL



(medical) skills and can it been proved? Yes

1.d Are personnel properly trained for decontaminating patients? 1.e Are personnel properly trained for decontaminating wounds? 1.f Are personnel properly trained to operate the module

equipment?

Yes

2. Equipment/material 2.a What equipment is available to support the module? 2.b Is equipment available for a Casualty Decontamination

Station?

2.c Is equipment available equipment for transportation of patients in contaminated / vapour hazardous environments?

2.d Is equipment available for Collective Protection of MTF’s? 2.e Is the equipment fit for purpose? Yes 2.f Is there a system in place to ensure (medical) supplies are Yes


Z - 2 ORIGINAL

NATO UNCLASSIFIED

maintained to agreed levels? 3. Procedures 3.a Are there agreed SOPs? Yes 3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities?


3.d Are personnel aware of the unit MASCAL plan and their responsibility in its execution?

3.e Is there no crossing of contaminated and non contaminated patients at the clean / dirty line??

3.f Is there no crossing of contaminated and non contaminated material at the clean / dirty line?

3.g Are procedures in place regarding contaminated waste management?

3.h Are quarantine procedures for biological patients established?

Reference standards: STANAG 2228 Allied Joint Medical Support Doctrine AJP-4.10 (A) STANAG 2242 Policy for the Chemoprophylaxis and Immunotherapy of NATO personnel against Biological Warfare Agents STANAG 2409 NATO Glossary of Medical Terms and Definitions – AMedP-13 STANAG 2461 NATO Handbook on the Medical Aspects of CBRN Defensive Operations (Nuclear) AMedP-6(C) Vol I STANAG 2462 NATO Handbook on the Medical Aspects of CBRN Defensive Operations (Biological) AMedP-6(C) Vol II STANAG 2463 NATO Handbook on the Medical Aspects of CBRN Defensive Operations (Chemical) AMedP-6(C) Vol III STANAG 2474 Determination and Recording of Ionising Radiation Exposure fro Medical Purposes STANAG 2475 Planning Guide for the Estimation of NBC Battle Casualties (Nuclear) – AMedP-8(A) Vol I


Z - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2476 Medical Planning Guide for the Estimation of NBC Battle Casualties (Biological) – AMedP-8(B) Vol II STANAG 2477 Planning Guide for the Estimation of NBC Battle Casualties (Chemical) – AMedP-8(A) Vol III STANAG 2478 Medical Support Planning for Nuclear, Biological and Chemical Environments STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2491 Policy for the Immunisation of NATO Personnel against Biological Warfare Agents STANAG 2553 NATO planning guide for the estimation of CBRNMed casualties - AMedP-8(C) STANAG 2871 First Aid Materiel for Chemical Injuries STANAG 2873 Concept of Operations of Medical Support in Nuclear, Biological and Chemical Environments – AMedP-7(D)





AA - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX AA TACTICAL AEROMEDICAL EVACUATION MODULE

Module Tactical Aeromedical Evacuation Module

Capability Provide medical care for stable patients during air transport between MTFs within the Joint area of operations

Key Question: Is the module able to provide medical care for stable patients during air transport between MTFs within the Joint area of operations


essential? FC C CL




1.d Are personnel properly trained to operate the module equipment and onboard the aircraft?

Yes

2. Equipment/material 2.a What equipment is available to support the module? 2.b Is the equipment fit for purpose? Yes 2.c How many places are available for lying and for sitting

patients?

2.d Is there a system in place to ensure medical supplies are maintained to agreed levels?

Yes

2.e Are patient transfer specific items available? 2.f Can the AE asset use NATO standard stretchers? 2.g Is communications equipment available on board to


AA - 2 ORIGINAL

NATO UNCLASSIFIED

communicate internally? 2.h Is communications equipment sufficient to communicate with

other medical elements and with command level? Yes




3.d Is it easy to bring the patient onboard? 3.f Are personnel aware of the unit MASCAL plan and their


3.g Is crew able to communicate with other medical elements and with command level?

Yes

Reference standards: STANAG 2040 Stretchers, Bearing Brackets and Attachment Supports STANAG 2060 Identification of Medical Material for Field Medical Installations STANAG 2121 Cross-servicing of Medical Gas Cylinders STANAG 2128 Medical and Dental Supply Procedures STANAG 2132 Documentation Relative to Medical Evacuation, Treatment and Cause of Death of Patients STANAG 2347 Medical Warning Tag STANAG 2126 First Aid Kits and Emergency Medical Care Kits STANAG 2350 Morphia Dosage and Casualty Markings


AA - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2087 Medical Employment of Air Transport in the Forward Area STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations STANAG 3114 Aeromedical Training of Flight Personnel STANAG 3198 Functional Requirements of Aircraft Oxygen Equipment and Pressure Suits STANAG 3204 Aeromedical Evacuation STANAG 3526 Interchangeability of of NATO Aircrew Medical Categories STANAG 3527 Aircrew Fatigue Management STANAG 1412 Transfer Litter Ship-to-Ship or Ship-to-Air





AB - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX AB STRATEGIC AEROMEDICAL EVACUATION MODULE

Module Strategic Aeromedical Evacuation module




essential? FC C

CL





Yes

2. Equipment/material 2.a What equipment is available to support the module? 2.b Is the equipment fit for purpose? Yes 2.c How many places are available for lying and for sitting

patients?

2.d Is there a system in place to ensure medical supplies are maintained to agreed levels?

Yes



2.h Is communications equipment sufficient to communicate with Yes


AB - 2 ORIGINAL

NATO UNCLASSIFIED

other medical elements and with command level? 3. Procedures 3.a Are there agreed SOPs? Yes 3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities?


3.d Is it easy to bring the patient onboard? 3.e Are the C2 arrangements for the module published and are

all personnel aware of them?


3.g Is crew able to communicate with other medical elements and with command level?

Yes

Reference standards: STANAG 2040 Stretchers, Bearing Brackets and Attachment Supports STANAG 2060 Identification of Medical Material for Field Medical Installations STANAG 2121 Cross-servicing of Medical Gas Cylinders STANAG 2128 Medical and Dental Supply Procedures STANAG 2132 Documentation Relative to Medical Evacuation, Treatment and Cause of Death of Patients STANAG 2347 Medical Warning Tag STANAG 2126 First Aid Kits and Emergency Medical Care Kits STANAG 2350 Morphia Dosage and Casualty Markings STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations STANAG 3114 Aeromedical Training of Flight Personnel


AB - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 3198 Functional Requirements of Aircraft Oxygen Equipment and Pressure Suits STANAG 3204 Aeromedical Evacuation STANAG 3526 Interchangeability of of NATO Aircrew Medical Categories STANAG 3527 Aircrew Fatigue Management STANAG 1412 Transfer Litter Ship-to-Ship or Ship-to-Air





AC - 1 ORIGINAL

NATO UNCLASSIFIED

Annex AC STRATEGIC AEROMEDICAL EVACUATION WITH CCAST MODULE

Module Strategic Aeromedical Evacuation with CCAST module

Capability Provide medical care for critical care patients during air transport to MTFs outside the Joint area of operations

Key Question: Is the module able to provide medical care for critical care patients during air transport to MTFs outside the Joint area of operations


essential? FC C

CL





Yes

2. Equipment/material 2.a What equipment is available to support the module? 2.b Is the equipment fit for purpose? Yes 2.c How many places are available for critical patients? 2.d Is there a system in place to ensure medical supplies are




2.h Is communications equipment sufficient to communicate with Yes


AC - 2 ORIGINAL

NATO UNCLASSIFIED

other medical elements and with command level? 3. Procedures 3.a Are there agreed SOPs? Yes 3.b Are personnel working according to the SOP? Yes 3.c Are personnel aware of their responsibilities?


3.d Is it easy to bring the patient onboard? 3.e Is there good access all around the patient? 3.f Are the C2 arrangements for the module published and are

all personnel aware of them?

3.g Are personnel aware of the unit MASCAL plan and their responsibility in its execution?

3.h Is crew able to communicate with other medical elements and with command level?

Yes

Reference standards: STANAG 2040 Stretchers, Bearing Brackets and Attachment Supports STANAG 2060 Identification of Medical Material for Field Medical Installations STANAG 2121 Cross-servicing of Medical Gas Cylinders STANAG 2128 Medical and Dental Supply Procedures STANAG 2132 Documentation Relative to Medical Evacuation, Treatment and Cause of Death of Patients STANAG 2347 Medical Warning Tag STANAG 2126 First Aid Kits and Emergency Medical Care Kits STANAG 2350 Morphia Dosage and Casualty Markings STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations


AC - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 3114 Aeromedical Training of Flight Personnel STANAG 3198 Functional Requirements of Aircraft Oxygen Equipment and Pressure Suits STANAG 3204 Aeromedical Evacuation STANAG 3526 Interchangeability of of NATO Aircrew Medical Categories STANAG 3527 Aircrew Fatigue Management STANAG 1412 Transfer Litter Ship-to-Ship or Ship-to-Air





AD - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX AD PATIENT EVACUATION COORDINATION CENTRE MODULE

Module PATIENT EVACUATION COORDINATION CENTRE module

Capability

Provide patient tracking and regulating

Provide co-ordination of patient evacuation

Provide blue-light matrix co-ordination

Provide co-ordination with other functions



essential? FC C

CL




1.d Are personnel properly trained to operate the module communication equipment?

Yes

1.d Are personnel aware of NATO operational command structure?

2. Equipment/material 2.a What communication equipment is available to support the

module?



AD - 2 ORIGINAL

NATO UNCLASSIFIED

2.c Is communications equipment sufficient to communicate with troops supported, with other medical elements and with command level?

Yes

3. Procedures 3.a Is the module located in the JOC? Yes 3.b Are there agreed SOPs? Yes 3.c Are personnel working according to the SOP? Yes 3.d Are personnel aware of their responsibilities?



3.f Is there a MASCAL plan and is it promulgated? Yes 3.g Is there a CBRN medical plan available? 3.g Are the personnel able to communicate with supported


Yes

3.h Are processes in place for personnel to maintain situational awareness (available assets in theatre)?

3.i Are contingency plans in place? Reference standards: STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2060 Identification of Medical Materiel for Field Medical Installations STANAG 2061 Procedures for Disposition of Allied Patients by Medical Installations STANAG 2128 Medical and Dental Supply Procedures STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients STANAG 2179 Minimum Requirements for medical care of Women in joint/combined operations


AD - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2228 Allied Joint Medical Support Doctrine AJP-4.10 (A) STANAG 2278 Medical Advice on Restriction of Movement STANAG 2409 NATO Glossary of Medical Terms and Definitions – AMedP-13 STANAG 2475 Planning Guide for the Estimation of NBC Battle Casualties (Nuclear) – AMedP-8(A) Vol I STANAG 2476 Medical Planning Guide for the Estimation of NBC Battle Casualties (Biological) – AMedP-8(B) Vol II STANAG 2477 Planning Guide for the Estimation of NBC Battle Casualties (Chemical) – AMedP-8(A) Vol III STANAG 2478 Medical Support Planning for Nuclear, Biological and Chemical Environments STANAG 2481 Medical Information Collection and Reporting STANAG 2513 Comparative Tables of Medical Treatment Facilities - AMedP-16 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2542 Allied Joint Medical Planning Doctrine – AJMedP-1 STANAG 2546 Allied Joint Medical Doctrine for Medical Evacuation - AJMedP-2 STANAG 2547 Allied Joint Medical Doctrine for Medical Intelligence - AJMedP-3 STANAG 2553 NATO planning guide for the estimation of CBRNMed casualties - AMedP-8(C) STANAG 2873 Concept of Operations of Medical Support in Nuclear, Biological and Chemical Environments – AMedP-7(D) STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations Ed. 2




AD - 4 ORIGINAL

NATO UNCLASSIFIED



AE - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX AE MEDICAL OPS AND PLANS MODULE

Module Medical Ops and Plans module

Capability

Provide coherent medical planning to support operations

Provide the execution of medical plans in support of operations



essential? FC C

CL




1.d Are personnel properly trained to operate the module communications equipment?

Yes

1.c Are personnel aware of NATO operational command structure?

2. Equipment/material 2.a What equipment is available to support the module? 2.b Is the equipment fit for purpose? Yes 2.c Is communications equipment sufficient to communicate with


Yes

2.d Is a Casualty Rate Estimate tool available? yes 3. Procedures


AE - 2 ORIGINAL

NATO UNCLASSIFIED

3.a Is the module located in the JOC? Yes 3.b Are there agreed SOPs? Yes 3.c Are personnel working according to the SOP? Yes 3.d Are personnel aware of their responsibilities?


3.e Can the Ops & Plans module meet the demands based on the mission medical estimate?

3.f Are the C2 arrangements for the module published and are all personnel aware of them?

3.g Is there a MASCAL plan and is it promulgated? Yes 3.h Is there a CBRN medical plan available? 3.i Are the personnel able to communicate with supported


Yes

3.j Are processes in place for personnel to maintain situational awareness (available assets in theatre)?

3.k Are contingency plans in place (e.g. exit strategy)? 3.l Are any MOU/TA in place and available? 3.m Are adequate reporting procedures available

(MEDASSESSREP, MEDSITREP, EPINATO)?

3.n Are plans for HNS available? Reference standards: STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11 STANAG 2060 Identification of Medical Materiel for Field Medical Installations STANAG 2061 Procedures for Disposition of Allied Patients by Medical Installations STANAG 2128 Medical and Dental Supply Procedures STANAG 2131 Multilingual Phrase Book for use by the NATO Medical Services - AMedP-5 STANAG 2132 Documentation Relative to Medical Evacuation, treatment, and causes of death of patients


AE - 3 ORIGINAL

NATO UNCLASSIFIED

STANAG 2179 Minimum Requirements for medical care of Women in joint/combined operations STANAG 2227 Military Medical Support in Humanitarian and Disaster Relief - AMedP-15 STANAG 2228 Allied Joint Medical Support Doctrine AJP-4.10 (A) STANAG 2278 Medical Advice on Restriction of Movement STANAG 2409 NATO Glossary of Medical Terms and Definitions – AMedP-13 STANAG 2475 Planning Guide for the Estimation of NBC Battle Casualties (Nuclear) – AMedP-8(A) Vol I STANAG 2476 Medical Planning Guide for the Estimation of NBC Battle Casualties (Biological) – AMedP-8(B) Vol II STANAG 2477 Planning Guide for the Estimation of NBC Battle Casualties (Chemical) – AMedP-8(A) Vol III STANAG 2478 Medical Support Planning for Nuclear, Biological and Chemical Environments STANAG 2481 Medical Information Collection and Reporting STANAG 2513 Comparative Tables of Medical Treatment Facilities - AMedP-16 STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation STANAG 2542 Allied Joint Medical Planning Doctrine – AJMedP-1 STANAG 2546 Allied Joint Medical Doctrine for Medical Evacuation - AJMedP-2 STANAG 2547 Allied Joint Medical Doctrine for Medical Intelligence - AJMedP-3 STANAG 2553 NATO planning guide for the estimation of CBRNMed casualties - AMedP-8(C) STANAG 2873 Concept of Operations of Medical Support in Nuclear, Biological and Chemical Environments – AMedP-7(D) STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations Ed. 2


AE - 4 ORIGINAL

NATO UNCLASSIFIED





AF - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX AF HYPERBARIC MODULE

Module Hyperbaric module

Capability Provide hyperbaric medicine

Key Question: Is the module able to provide hyperbaric medicine?


essential? FC C

CL





Yes



Yes



Yes



AF - 2 ORIGINAL

NATO UNCLASSIFIED



Reference standards: STANAG 1185 Minimum Essential Medical and Survival Equipment for Ship Life Rafts Including Guidelines for Survival at Sea STANAG 1208 Minimum Requirements of Emergency Medical Supplies on Board Ships STANAG 1269 NATO Handbook on Maritime Medicine - AMedP-11





AG - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX AG FINAL EXERCISE REPORT

Module Preventive Medicine module

Capability Provide preventive healthcare

Key Question: Is the module able to provide preventive healthcare


essential? FC C

CL



medical and veterinary skills and can it been proved? Yes


Yes








AG - 2 ORIGINAL

NATO UNCLASSIFIED

responsibility in its execution? 3.f Are preventive measures prior to deployment distributed to

all units?

3.g Are preventive measures during deployment available? Reference standards:





AH - 1 ORIGINAL

NATO UNCLASSIFIED

ANNEX AH CAPABILITY MATRIX

1. Annex AH has been provided by Committee of the chiefs of Military Medical Services in NATO (COMEDS) Military Medical Structures, Operation and Procedures Working Group (MMSOP WG), and it are the MMSOP WG responsibility to keep this Annex updated. It is the intension that this Annex will be turned into a separate STANAG in 2010. 2. This annex describes the individual Medical Modules necessary to form the different Medical Treatment Facilities (MTF). Fore each module there is a short description of the medical capability the Module shall be able to provide. Under Remarks more details are mentioned. 3. The Modular Capability Matrix has been used as template for Annex AI when describing the skill sets per Module, and in Annex E – AG to describe the Key Questions per Module

Unit Module Capability Remarks

Response ambulance Response ambulance Provide pre‐hospital emergency care Trained medical personnel and appropriate medical equipment with blue‐light matrix capability

Capable of responding to incidents along LOC or covering the AOR in order to achieve clinical timelines

Capable of supporting joint and combined ops in most terrains under austere conditions

Capable of providing an appropriate level of force protection for assigned personnel and equipment

Capable of providing on‐board medical treatment and patient surveillance


AH - 2 ORIGINAL

NATO UNCLASSIFIED

Aeromedevac helicopter Forward AE Provide pre‐hospital emergency care Trained medical personnel and appropriate medical equipment with blue‐light matrix capability

Capable of responding to incidents along LOC or covering the AOR in order to achieve clinical timelines



Capable of providing in‐flight medical treatment and patient surveillance

Medical Emergency Response Team

Forward AE Provide pre‐hospital emergency care As above

Tailor‐made team with highly trained medical personnel and appropriate medical equipment

Role 1 Primary Healthcare Provide primary healthcare Provide pre‐hospital emergency care Optional: Provide patient holding Provide basic laboratory testing Provide initial stress management

Command & Control Provide leadership Provide co‐ordination with higher level and supported unit Provide communication with supported unit and other MTFs


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Role 2 Light Manoeuvre Resuscitation & Pre/post operative module

Provide specialist led resuscitation

DCS module Provide Damage Control Surgery

Diagnostic module Provide field laboratory testing Provide basic imaging

Equipment must at least sustain the capability DCS

Patient Holding Provide temporary care for treated patients prior to evacuation

Less than 24 hours

Role 2 Enhanced Surgical Module Provide primary surgery

ICU Provide surgical and medical intensive care

Capable of treating patients after surgical intervention

Sterilisation Provide sterile medical and surgical equipment

According to the need driven by the patient load

Mobile Mental Health module

Provide stress management Trained mental healthcare professionals able to provide peripatetic service

Forward Medical Equipment Module

Provide Pharmacy Provide maintenance for medical and surgical equipment Provide blood and blood products

High Dependency Unit

Ward Provide nursed beds

Enhanced Diagnostic Module

Provide enhanced imaging Provide field laboratory testing

Equipment must at least sustain the capability primary surgery

Enhanced Support Module

Provide medical logistic support to lower roles

Enhanced C4I Provide leadership Provide co‐ordination with higher level and supported unit

Including telemedicine May include PECC


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Provide IT support to MTF Provide communication with other MTFs, higher command level

Dental module Provide primary dental care Can be attached to lower roles

Role 3 Clinical Specialist Module Provide mission tailored clinical expertise May include:

Neurosurgery

Ophthalmology

OMFS

Burns expertise

Paediatrics

Obstetrics

Gynaecology

etc

Preventive medicine Preventive Medicine Module

Provide preventive healthcare Provide Environmental healthcare

Can be attached to a role 2E / 3

Capable of supporting joint and combined ops as a stand‐alone capability

Including:

performing epidemiological and environmental survey

Veterinary service

Ensuring hygiene and sanitation in a deployed environment

Assessing health risks

CBRN Medical Module Provide patient decontamination support to MTF

Can be attached to lower roles depending the mission

Patient transport Unit In‐transit Ambulance Provide medical support for stable patients during ground transport between MTFs



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Tactical AE Provide medical support for stable patients during air transport between MTFs within the JAO

Strategic AE Provide medical support for stable patients during air transport to MTF outside the JAO

Strategic AE with CCAST Provide medical support for critical care patients during air transport to MTF outside the JAO

CSU Patient Holding Module Provide temporary care for treated patients

Must be able to incorporate additional ward capability Usually located near a MTF (R2E or R3) or co‐located with a MTF

MedCC PECC module Provide patient tracking and regulating Provide co‐ordination of ground evacuation and AE Provide blue‐light matrix co‐ordination Provide co‐ordination with other functions

Staffed on a 24/7 basis

Medical Ops and Plans Provide coherent medical planning to support Ops

Hyperbaric module Provide hyperbaric medicine


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ANNEX AI CAPABILITY MATRIX

1. Annex AI has been provided by Committee of the chiefs of Military Medical Services in NATO (COMEDS) Military HealthCare Working Group (MHC WG), and it is the MHC WG responsibility to keep this Annex updated. It is the intension that this Annex will be turned into a separate STANAG in 2010. 2. This annex describes the Skill Sets associated to the individual Medical Modules defined in Medical Structures, Operation and Procedures Working Group (MMSOP WG) Modular Capability matrix (Annex AG). Not all of the MMSOP WG defined Modules are mentioned with a full capability description concerning Performance and Standards in this Annex. The Annex AI is a living document which has to be updated regularly. 3. The Capability Matrix has been used as template for writing the Key questionnaire in Annex E – AG, with reference to the defined skill sets per Module. 4. The different capabilities for skill sets are organized into 5 parts in each module:

1- Pre-hospital and arrival of patient (assessment) 2- Treatment 3- Post-treatment (post-operative) care 4- Transfer (communication, preparation and practical conduct) 5- Logistic and administrative tasks

These modules and skill sets could be the basis for training and education of medical personnel prior to deployment 5. Here is an overview of the Medical Capabilities for which MHC WG has defined performance and standards, Skill set.


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Role/Capability Module Remarks Pre-hospital Emergency Care

Provision of incident response and ‘blue-light’ matrix capability

1- Response Ambulance Trained medical personnel and appropriate medical equipment with ‘blue-light’ matrix capability

2- Forward AE Trained medical personnel and appropriate medical equipment (AJP 4.10.2)

3- Incident response team Tailor-made team Trained medical personnel and appropriate medical equipment

Role 1 1- Primary Health Care (medical)

Provides PHC, specialized first aid, triage, resuscitation and stabilization, may provide primary dental care*, minimum patient holding capacity, basic laboratory testing*, initial stress management*

4- Command, Control Communications, Computers and Information capability Reception/Administration, Logistic support

Role 2 LM 1- Resuscitation and Pre-/post-operative Module

Provides specialist led resuscitation

2- DCS Module Provides equipment to undertake DCS 3- Diagnostic Module Provides field laboratory and basic

imaging capability to support DCS 4- Patient holding

Limited holding capacity

Role 2 E 1- Surgical Module Provides equipment to undertake primary surgery

2- ICU Provides surgical and medical intensive care capability

3- Sterilisation

4- Mobile Mental Health Module

Capable of providing peripatetic services*

5- Forward Medical Equipment Module

Pharmacy, maintenance, blood provision

6- CBRN Med Module Decontamination of casualties prior to treatment Mission dependent

7- Ward

nursed beds

8- Diagnostic Module Enhanced Diagnostics to support primary surgery and other specialties May include Telemedicine

Higher Roles consists of capabilities of lower Roles


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Role/Capability Module Remarks Enhanced Support

Capability to support lower Roles

Enhanced C4I

May include PECC

Role 3 (in addition to Role 2 E)

Clinical Specialist Modules Mission tailored Neurosurgical, Ophthalmology, OMFS, Burns, Paediatrics, Obstetrics/Gynaecology, Mental Health Care

Enhanced Holding capacity

Preventive Medicine

Preventive Medicine Team and Environmental health capability

May be attached to Role 2 E or Role 3

Ground MEDEVAC

Transfer Ambulance Includes appropriate in-transit medical support for stabilised patients

AE (same capabilities than Forward AE)

Tactical AE Trained medical personnel and appropriate medical equipment (AJP 4.10.2)

Strategic AE With and without CCAST

Trained medical personnel and appropriate medical equipment Provision of specialist in transit support for critical care patients (AJP 4.10.2)

CSU Patient holding Capable of holding a number of patients equivalent to the maximum aircraft load in a 24 hr period, capable of holding a small number of ICU patients Co-located to another MTF

Patient Evacuation Coordination,

PECC Directing/co-coordinating blue-light’ matrix capability Co-ordination of ground evacuation and AE (forward, tactical and strategic) Patient Regulation, Patient Tracking Coordination with other functions (Engineers/MP etc)

Medical C2, Ops/Plans

MedDir/MEDAD/Ops/Plans Medical Information Collection Advice to commanders on health risks Establishment and management of multinational epidemiological surveillance system Establishment and conduct of a preventive medicine information exchange and education system Conduct of medical force protection Assessment of medical support readiness Medical emergency response


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Role/Capability Module Remarks organisation Development and establishment of medical policies and plans for the theatre Medical interface/liaison with relevant local authorities, IOs and NGOs Development and establishment of MASCAL plan Provide CBRN Med advice

Custodian: France

Supporting Nations: Hungary, Latvia, Poland, United Kingdom


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PRE-HOSPITAL EMERGENCY CARE

This role, according to the MMSOP matrix (annex ah), is defined as the provision of incident response and a ‘blue-light’ matrix capability. Trained medical personnel and the appropriate medical equipment are often included in role 1, 2 or 3. Medical capabilities and general requirements of this module are the same in all the other roles. For response ambulance, the personnel may be drawn from role 1 (see role 1).

For forward aeromedical evacuation, capabilities are the same as for response ambulance, but enhanced by adequate qualification/training in aeromedicine.

For Incidence Response Team (IRT), Capabilities needed by Mobile Emergency Response Team (MERT), to take care the casualties before transport to a treatment facility (airway support, haemorrhage control, pneumothorax management, … etc) for resuscitation and stabilization. The personnel could be the personnel of different MTF or sometimes a specific team.

This level contains 3 modules:

1- Response ambulance 2- Forward aero-Medevac 3- Incidence response team 4- Incidence response team


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Module 1: Response ambulance capabilities

Task/Sub Task

Number Performance Standard

Personnel Identified by

nation

1.1 Manage pre hospital care

and life support

a. Pre hospital advance life support procedures b. Minor Incident Medical Management and Support (MIMMS) organisation c. Knowledge of : triage, radio operations, decontamination procedures (contaminated and infectious) and medevac d. Medical record keeping including procedures to be followed in case of death e. give appropriate vaccination to patient

1.2 Manage severe Casualties (Trauma and wound injuries) from field or MTF1 to Role 2LM/E or Role 3 (directly)

a. Assess a patient b. Establish monitoring and specialised first aid

(Advanced Trauma Life Support and Battle ATLS)

c. Conduct resuscitation d. Perform general anaesthesia e. Perform analgesia (intravenous) and femoral

nerve block f. Perform immobilization g. Perform triage

1.3 Manage patient tracking and transfer to higher MTF level.

a. Inform higher MTF level and commanders (MEDEVAC procedure)

b. Prepare patient for transfer c. Complete medical records and transfer

documentation d. Be able to manage CBRN’ patient (Hazard

Management Capability, i.e. decon or casualty bags) and should administer antidotes

1.4 Manage nursing care.

a. Assist and inform physician b. Assess patient and deliver nursing care c. Dress and bandage wounds d. Manage clinical waste e. Check comfort and fit of plasters and splints f. Prepare and administer medical treatment and blood packing (compression) to avoid haemorrhage g. Ensure cleanliness and comfort of patient h. Provide adequate pain relief


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Module 1: Response ambulance capabilities

Task/Sub Task



nation

1.5 Manage field sterile services.

a. Receive contaminated equipment b. Clean and disinfect equipment c. Inspect and service equipment d. Pack and sterilise equipment e. Maintain stock levels

1.6

Prepare patient for evacuation

a. Assist physician in medical and care recording before evacuation b. Assist in preparation of equipment for casualty evacuation d. Assist in preparation of packing and movement of casualties

1.7 Manage transport

a. Hold an appropriate driving licence b. Control state and revise vehicles (minimum mechanic vehicle control) c. Basic knowledge of medevac d. Know techniques for immobilization, mobilization and transport of patients

1.8 Perform administrative tasks

a. Record medical activities b. Know command procedures c. Understand the use of maps, gps and radio

1.9 Supervise stock levels in transport assets and manage stores

a. Control stocks of drugs and other materiel b. Control oxygen stock c. Manage stores

1.10 MASCAL and MEDEVAC procedures

a. Understand the functions and actions of the Medical Incident Officer in Major Incident or MASCAL

b. Knowledge of the use and limitations medical transport (ground, air and sea)

c. Explain transport procedures to patients


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Module 2: Forward aero medevac capabilities

Task/Sub Task



nation

2.1 Manage pre hospital care and

life support

a. Pre hospital advance life support procedures b. Minor Incident Medical Management and

Support (MIMMS) organisation c. Knowledge of: triage, radio operations,

decontamination procedures (contaminated and infectious) and medevac

d. Medical record keeping, including procedures to be followed in case of death

e. Give appropriate vaccination to patient

2.2 Manage severe Casualties (Trauma and wound injuries) from field or MTF1 to Role 2LM/E or Role 3 (directly)



c. Conduct resuscitation d. Perform general anaesthesia e. Perform analgesia (intravenous) and femoral

nerve block Perform immobilization


e. Inform higher MTF level and commanders (MEDEVAC procedure)

f. Prepare patient for transfer g. Complete medical records and transfer

documentation h. Be able to manage CBRN’ patient (Hazard



a. Assist and inform physician b. Assess patient and deliver nursing care c. Dress and bandage wounds d. Manage clinical waste e. Check comfort and fit of plasters and splints f. Prepare and administer medical treatment and blood transfusion g. Ensure cleanliness and comfort of patient h. Provide adequate pain relief


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Module 2: Forward aero medevac capabilities

Task/Sub Task



nation


a. Receive contaminated equipment b. Clean and disinfect equipment c. Inspect and service equipment d. Pack and sterilise equipment e. Maintain stock levels f. Manage stores

2.6 Prepare patient for evacuation

a. Assist physician in documenting medical care given before evacuation b. Assist in preparation of equipment for casualty evacuation d. Assist in preparation and movement of casualties

2.7 conduct administrative tasks

a. Record medical activities b. Know command procedures c. Understand the use of maps, gps and radio

2.8 Supervise stock levels in transport assets

a. Control stocks of drugs and other materiel b. Control oxygen stocks


a. Understand the functions and actions of the Medical Incident Officer in Major Incident or MASCAL. b- Knowledge of the use, rules and limitations medical transport (ground, air and sea). c- Explain transport procedures to patients.

2.10 Conduct Aero-medical Transfer

a. Aero-medical transport qualification or training


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Module 3: Incidence Response team

Task/Sub Task



nation

3.1 Manage severe Casualties (Trauma and wound injuries) on the field



c. Conduct resuscitation - airway support - haemorrhage control - pneumothorax management

d. Perform general anaesthesia e. Perform analgesia (intravenous) and femoral

nerve block (i.e. femoral fracture) f. Perform immobilization g. Perform triage

-

3.2 Manage patient tracking and transfer to MTF

a. Inform MTF level and commanders b. Prepare patient for transport c. Knowledge Minimum core medical data

documentation d. Be able to manage CBRN’ patient (Hazard


3.3 Manage nursing

care. a. Assist and inform physician b. Assess patient and deliver nursing care c. Dress and bandage wounds d. Manage clinical waste e. Check comfort and fit of plasters and splints f. Prepare and administer medical treatment and

blood packing (compression) to control haemorrhage

g. Ensure cleanliness and comfort of patient h. h. Provide adequate pain relief

3.4


a. Assist physician in medical and care recording before evacuation

b. Assist in preparation of equipment for casualty evacuation

c. Assist in preparation of packing and movement of casualties


AI - 11 ORIGINAL

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Module 3: Incidence Response team

Task/Sub Task



nation


a. Hold an appropriate driving licence b. Control state and revise vehicles

(minimum mechanic vehicle control) c. Basic knowledge of medevac d. Know techniques for immobilization,

mobilization and transport of patients


a. Know command procedures b. Understand the use of maps, gps and radio








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DRAFT

OPERATIONAL PERFORMANCE STATEMENT

IN ROLE 1


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ROLE 1 MTF:

1- Medical capabilities derived from the matrix provided by MMSOP: The Role 1 MTF provides primary health care, specialised first aid, triage, resuscitation and stabilisation. Also included within the basic Role 1, are a basic occupational and preventive medical advice service to the chain of command, a routine sick call and the management of minor sick and injured personnel for immediate return to duty, as well as casualty collection from the point of wounding and preparation of casualties for evacuation to the higher level MTF. In accordance with the mission, Role 1 medical capabilities may include:

a. Minimal patient holding capacity b. Primary dental care (probably only medical treatment) “ c. Basic laboratory testing* (in fact only stick or hemocue test)

d. Initial stress management. (diagnosis and medical treatment, no psychiatrist) * defined by the DS EP, MP EP, EM EP and MMMP EP. To above-mentioned tasks it is necessary to add decontamination of the Chemical Warfare (CW) and Biological Warfare (BW) contaminated patients.

2- General requirements of module Conditions Unless otherwise stated, the terms and conditions of the individual nations, together with the following conditions apply throughout the document: Physical Environment As an individual or as part of a team. Worldwide. In all operational environments. Possibly at sea or CBRN environment. In a mobile operating theatre. With or without access to references. Social/Political Conditions At Role 1 In an operational theatre Utilising equipment in module for role 1 Any scaled module for Role 1. Orders Manufacturer’s instructions. NATO References and STANAGS. National Doctrine, standards and subordinate publications. Formation Standing Operating Procedures and References. Knowledge of English According STANAG 6001 Officers level: 3-3-3-2 SNCO’s level: 2-2-2-1 Junior ranks level according NATO requirements


AI - 14 ORIGINAL

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Role 1 / Module 1: Primary Health Care capabilities

Task/Sub Task



nation 1.1

Provision of basic occupational medical advice

a. Assess a patient. b. Manage minor sickness c. Treat a minor injury d. Prescribe medical treatment e. Deliver preventive medical treatment f. Control and realize tetanos vaccination g. Organize the MTF, preparing and training the medical team

1.2 Manage pre hospital care

and life support

a. Pre hospital advance life support procedures b. Minor Incident Medical Management and Support (MIMMS) organisation c. Knowledge of: triage, radio operations, decontamination procedures (contaminated and infectious) and medevac d. Medical record keeping, including procedures to be followed in case of death

1.3

Assist in pre hospital care and life support

a. Basic Life Support (BLS) b. Basic knowledge of decontamination procedures (contaminated and infectious) c. Assist in patient tracking d. Assist medical personnel in Advance Life Support (Trauma)

1.4 Manage severe Casualties (Trauma and wound injuries)

a. Assess a patient b. Establish monitoring and specialised first aid (Advanced Trauma Life Support and Battle ATLS)

c. Conduct resuscitation d. Perform general anaesthesia e. Perform analgesia (intravenous and femoral nerve block )

f. Perform immobilization


a. Inform higher MTF level and commanders (MEDEVAC procedure) b. Prepare patient for transfer c. Complete medical records and transfer documentation d. Be able to manage CBRN’ patient (Hazard Management Capability, i.e decon or casualty bags) and should administer antidotes


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Task/Sub Task



nation 1.6 Manage nursing

care. a. Assist and inform physician b. Assess patient and deliver nursing care c. Dress and bandage wounds d. Manage clinical waste e. Check comfort and fit of plasters and splints f. Prepare and administer medical treatment and blood packing (compression) to avoid haemorrhage g. Ensure cleanliness and comfort of patient h. Provide adequate pain relief

1.7 Assist in hospital care

a. Assist in nursing care and immobilization b. Basic knowledge of radio operations

1.8 Manage field sterile services and manage store

a. Receive contaminated equipment b. Clean and disinfect equipment c. Inspect and service equipment d. Pack and sterilise equipment e. Maintain stock levels f. Manage store


a. Assist physician in documenting medical care given before evacuation b. Assist in preparation of equipment for casualty evacuation. d. Assist in preparation and movement of casualties.


a. Hold an appropriate driving licence b. Control state and revise vehicles (minimum knowledgment on repairing and revising on vehicle (oil, wheels, ...) c. Basic knowledge of medevac d. Know techniques for immobilization, mobilization and transport of patients.

1.11 Conduct administrative tasks

a. Produce all technical and administrative documents for patient (minimum core data, epidemiologic table) b. Record medical activities c. Issue medical certificates d. Understand procedures to be followed in case of death e. Knowledge of command procedures f. Inform PECC g. Understand the use of maps, gps and radio

1.12 Supervise stocks level of R1

a. Control stocks of drugs and other materiel stock b. Control oxygen stocks


AI - 16 ORIGINAL

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Task/Sub Task



nation 1.13 MASCAL and

MEDEVAC procedures

a. Understand the functions and actions of the Medical Incident Officer in Major Incident or MASCAL.

b. Knowledge of the use and limitations medical transport (ground, air and sea).

c. Explain transport procedures to patients.


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DRAFT

OPERATIONAL PERFORMANCE STATEMENT

IN ROLE 2 LM AND 2 E


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ROLE 2LM MTF:

1- Medical capabilities derived from the matrix provided by MMSOP: The Role 2LM MTF provides specialist-led resuscitation and stabilisation with adequate equipment to undertake and support DCS (surgical treatment), including field laboratory and basic imaging capabilities. Role 2 LM MTF also includes also the capabilities of role 1 facility, a limited holding capacity and can prepare and conduct evacuation to a higher level MTF.

2- General requirements of module Conditions Unless otherwise stated, the terms and conditions of the individual nations, together with the following conditions apply throughout the document:

Physical Environment As an individual or as part of a team. Worldwide. In all operational environments. Possibly at sea or CBRN environment. In a mobile operating theatre. With or without access to references.

Social/Political Conditions At Role 2LM, Role 2E and Role 3 In an operational theatre. Utilising equipment in modules for Forward Surgical Team, Intensive Care, Anaesthesia,

Recovery Any scaled module for Role 2LM, Role 2E and Role 3 facilities.

Orders Manufacturer’s instructions. NATO References and STANAGS. National Doctrine, standards and subordinate publications. Formation Standing Operating Procedures and References. Knowledge of English According STANAG 6001 Officers level: 3-3-3-2 SNCO’s level: 2-2-2-1 Junior ranks level according NATO requirements


AI - 19 ORIGINAL

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In Role 2LM, 4 modules are identified:

1- Resuscitation and Pre / Post-operative Module 2- Damage Control Surgery 3- Diagnosis Module 4- Patient Holding

ROLE 2 LM / Module 1 : Resuscitation and Pre / Post operative module’s capabilities

Task/Sub Task


Personnel Identified by nation

1.1 Manage critically ill patients or critically wounded casualties

a. Recognise critically ill patients b. Treat critically ill patients c. Manage critically ill patients in ICU d. Perform blood transfusion and control blood bank e. Provide general ward clinical support f. Maintain communications

1.2 Manage nursing intensive care

a. Assist and inform intensive care Consultant b. Assess patient and deliver nursing care c. Conduct resuscitation (Oro Tracheal Intubation) d. Manage clinical waste e. Understand and manage monitoring equipment and respiratory support (including ventilators) and other technical equipment as required (haemofiltration, haemodialysis, cell saver etc) f. Prepare and administer medical treatment and blood transfusion g. Ensure cleanliness and comfort of patient h. Provide adequate pain relief and adjust treatment as necessary

1.3

Manage post-operative nursing care.

a. Assist and inform physician b. Assess patient and deliver nursing care c. Dress and bandage wounds d. Manage clinical waste e. Check comfort and fit of plasters and splints f. Prepare and administer medical


AI - 20 ORIGINAL

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treatment and blood transfusion g. Ensure cleanliness and comfort of patient h. Provide adequate pain relief

1.4

Assist in pre, per and post hospital

care and life support

Manage transport

a. Perform Basic Life Support (BLS) b. Basic knowledge of triage procedures c. Basic knowledge of decontamination procedures (contaminated and infectious) d. Assist medical personnel in Advance Life Support (Trauma)

1.5 Manage post-operative casualties with limb injury

a. Immobilise with splint or plaster of Paris b. Dress and bandage wounds c. Assist in preparation and movement of casualties

1.6 Supervise stock levels

a. Maintain adequate stock levels of: blood and blood products oxygen drugs ( all types)

b. Manage stores


a. Assist physician in documenting medical care given before evacuation b. Assist in preparation of equipment for casualty evacuation d. Assist in preparation and movement of casualties

1.8

Manage patient transfer (MEDEVAC)

a. Knowledge of the use and limitations medical transport (ground, air and sea). b. Explain transport procedures to patients. c. Capability to undertake transfer of critically ill patients d. Prepare patient for transfer. e. Produce all technical and administrative documents (general ward clinical support, operative report) f. Manage an in-hospital transfer g. Manage an inter-hospital transfer h. Manage a pre-hospital transfer

1.9 MASCAL procedures

a. Understand the functions and actions of the Medical Incident Officer in Major Incident or MASCAL.

b. be able to take command in a MASCAL situation

1.10

Prepare the movement of packed field anaesthetic

a. Produce a manifest for the movement of anaesthetic modules by air, sea or land

b. Identify, pack and mark dangerous air


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modules. cargo c. Mark refrigerated items d. Pack, mark and document controlled

drugs e. Supervise packaging, movement and

reception of scaled anaesthetic items 1.11

Prepare the movement of packed field surgical modules.

a. Produce a manifest for the movement of surgical modules by air, sea or land

b. Pack, mark and document controlled drugs

c. Supervise packaging, movement and reception of scaled surgical items




a. Hold and apropriate driving licence b. Control state and revise vehicles (minimum knowledgment on repairing and revising on vehicle (oil, wheels ...) c. Basic knowledge of medevac d. Know techniques for immobilization, mobilization and transport of patients.


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ROLE 2 LM / Module 2 : DCS Module’s capabilities

Task/Sub Task



2.1

Manage Trauma. a. Assess a patient. b. Manage a trauma patient. c. Perform triage

2.2

Assist in peri-operative care management.

a. Prepare and/or supervise the preparation of the operating room b. Assist surgeon in pre and post operative care c. Assist in preparation and movement of casualties

2.3 Anaesthetise a patient. a. Perform pre-operative assessment b. Perform general anaesthesia c. Perform local anaesthetic technique d. Perform regional anaesthesia e. Manage peri-operative analgesia f. Manage care in the recovery area g. Manage post-operative ward care h. Prescribe medical treatment

2.4

Manage peri-operative care and advanced life support

a. Assist anaesthetist. b. Perform basic airway techniques and provide support for advanced airway techniques and casualty resuscitation c. Assist in preparation of equipment for casualty evacuation d. Assist in preparation and movement of casualties e. Assist in provision of analgesia and assessment of its efficiency

2.5 Manage critically injured trauma patient in operating room

a. Assess a critically injured patient b. Perform ultrasonography c. Perform damage control surgery including: 1. insertion of thoracic drain and control of thoracic haemorrhagae 2. vascular haemostasis and external haemorrhage control 3. intestinal exclusion and derivation, bile and pancreatic drainage, intestinal clamp and/or stomia, drain for pancreatic and/or hepatic secretion


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4. solid organ inspection and abdominal packing (liver, splenic, retroperitoneal and pelvic haemorrhage) 5. DC orthopaedic surgery - limb (parage and external fixation) - spine (parage and external spine stabilization - external bone fixation - amputation d. Perform second look surgery

2.6 Manage operating room (OR).

a. Organize OR equipment and stores b. Prepare specific equipment for casualty treatment c. Assist surgeon during operation d. Control and dispose of contaminated waste and equipment e. Maintain and clean OR f. Maintain stock levels (drugs, blood and materials)

2.7 Manage field sterile services for anaesthesia

a. Receive contaminated equipment. b. Control, clean and disinfect equipment. c. Inspect and service equipment. e. Maintain stores (drugs, blood & materials) f. Manage clinical waste

2.8 Manage field sterile services for operating room.



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Role 2LM / Module 3: Diagnosis module’s capabilities

Task/Sub Task



3.1

Provide field radiography and echo ultrasonography services.

a. Basic knowledge in radiography, imaging and radio protection

b. Provide standard x-ray views c. Develop x-ray films d. Ensure supply of consumables e. Control and dispose of contaminated

waste and equipment

3.2 Provide field laboratory service

a. Basic knowledge of field laboratory procedures

b. Collect clinical samples c. Analyse clinical samples d. Ensure supply of consumables e. Basic maintenance of laboratory

equipment f. Dispose of biological waste correctly

ROLE 2 LM / Module 4 : Holding patient’s capabilities

Task/Sub Task



4.1


a. Assist and inform physician b. Assess patient and deliver nursing care c. Dress and bandage wounds d. Manage clinical waste e. Check comfort and fit of plasters and splints f. Prepare and administer medical treatment and blood perfusion g. Ensure cleanliness and comfort of patient h. Provide adequate pain relief


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4.2

Assist in holding care and transport


4.3

Conduct administrative tasks

a. Record medical activities b. Knowledge of the command procedures c. Understand the use of maps, gps and radio

4.4 Supervise stock levels in transport asset

a. Control stocks of drugs and other materiel b. Control oxygen stock




a. Hold an appropriate driving licence b. Control state and revise vehicles (minimum knowledgment on repairing and revising on vehicle (oil, wheels ...) c. Basic knowledge of medevac d. Know techniques for immobilization, mobilization and transport of patients.


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ROLE 2 ENHANCED MTF:

1- Medical capabilities derived from the matrix provided by MMSOP: The Role 2 Enhanced MTF provides specialist-led resuscitation and stabilisation with adequate equipment and specialist personnel to undertake and support DCS, including a field laboratory, basic imaging capability and may include Telemedicine. The capabilities include those of role 1 and role 2 LM for surgical treatment of casualties, with nursed beds, a mobile mental health module, an Intensive Care Unit, and sterilisation, pharmacy, blood bank and maintenance services. Role 2 Enhanced MTF must be able to prepare and conduct evacuation to a higher level MTF.

2- General requirements of module Conditions Unless otherwise stated, the terms and conditions of the individual nations, together with the following conditions apply throughout the document:

Physical Environment As an individual or as part of a team. Worldwide. In all operational environments. Possibly at sea or CBRN environment. In a mobile operating theatre. With or without access to references.

Social/Political Conditions At Role 2E and Role 3 In an operational theatre. Utilising equipment in modules for Forward Surgical Team, Intensive Care, Anaesthesia,

Recovery Any scaled module for Role 2E and Role 3 facilities.

Orders Manufacturer’s instructions. NATO References and STANAGS. National Doctrine, standards and subordinate publications. Formation Standing Operating Procedures and References. Knowledge of English According STANAG 6001 Officers level: 3-3-3-2 SNCO’s level: 2-2-2-1 Junior ranks level according NATO requirements


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Modules in R2Enhanced include all modules in R2 LM (with enhancements to ….as appropriate.), a Mobile mental health module and whichever other modules are new at R2E: STERILISATION AND FORWARD MEDICAL EQUIPMENT

CAPABILITY (PHARMACY, BLOOD AND MAINTENANCE) MOBILE MENTAL HEALTH CAPABILITY CBRN MEDICAL MODULE WARD MODULE WITH NURSED BEDS

O INTERNIST PRACTITIONER CAPABILITY O EMERGENCY PRACTITIONER CAPABILITY O GENERAL NURSING CAPABILITY (R2 LM) O MEDICAL ASSISTANT CAPABILITY (R2 LM)

DIAGNOSTIC MODULE


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ROLE 2 E / Module 1 : Surgical Module’s capabilities

Task/Sub Task



1.1

Manage Trauma. a. Assess a patient b. Manage a trauma patient c. Perform triage

1.2 Anaesthetise a patient. a. Perform pre-operative assessment b. Perform general anaesthesia c. Perform local anaesthetic technique d. Perform regional anaesthesia e. Manage peri-operative analgesia f. Manage care in the recovery area g. Manage post-operative ward care h. Prescribe medical treatment

1.3

Manage peri-operative care and advanced life support

a. Assist anaesthetist. b. Perform basic airway techniques and provide support for advanced airway techniques and casualty resuscitation c. Assist in preparation of equipment for casualty evacuation. d. Assist in preparation and movement of casualties. e. Assist in provision of analgesia and assessment of its efficiency

1.4

Assist in Management in peri-operative care.

a. Prepare and/or supervise the preparation of the operating room b. Assist surgeon in pre and post operative care c. Assist in preparation and movement of casualties.

1.5 Manage critically injured trauma patient in operating room

a. Assess a critically injured patient b. Perform ultrasonography c. Perform damage control surgery including: 1. insertion of thoracic drain and control of thoracic haemorrhagae 2. vascular haemostasis and external haemorrhage control 3. intestinal exclusion and derivation, bile and pancreatic drainage, intestinal clamp and/or stomia, drain for pancreatic


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and/or hepatic secretion 4. solid organ inspection and abdominal packing (liver, splenic, retroperitoneal and pelvic haemorrhage) 5. DC orthopaedic surgery - limb (parage and external fixation) - spine (parage and external spine stabilization - external bone fixation - amputation d. Perform second look surgery

1.6 Manage primary surgery

a. Perform pre-operative assessment b. Perform primary general surgery - soft tissue - abdominal - thoracic - vascular - uro-genital - amputation c. Brain trauma (trepanation, drain

haematoma) d. Manage post-operative ward care e. Prescribe medical treatment

1.7 Manage trauma patient a. Perform pre-operative assessment. b. Perform emergency orthopaedic surgery - soft tissues - limb (parage and external bone fixation) - spine(parage and external spine stabilization) - vascular - brain trauma (trepanation, drain haematoma) - amputation c. Perform all bone trauma treatment (included all surgical osteosynthesis) d. Manage and treat sport injuries e. Manage post-operative trauma ward care f. Prescribe medical treatment

1.8 Manage operating room (OR).

a. Organize OR equipment and stores b. Prepare specific equipment for casualty treatment c. Assist surgeon during operation d. Control and dispose of contaminated waste and equipment e. Maintain and clean OR f. Maintain other stock levels (drugs, blood and materials)


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1.9 MASCAL procedures c. Understand the functions and actions of the Medical Incident Officer in Major Incident or MASCAL.

d. Be able to take command in a MASCAL situation

1.10

Manage trauma patient transfer (MEDEVAC)

a. Prepare patient for transfer. b. Manage an in-hospital transfer. c. Manage an inter-hospital transfer. d. Manage a pre-hospital transfer. e. Produce all technical and administrative documents (general ward clinical support, operative report)

R2E / Module 2: Intensive Care Unit Module’s capabilities

Task/Sub Task



nation

2.1

Manage Trauma. a. Assess a patient b. Manage a trauma patient c. Perform triage d. Pre-hospital life support

2.2 Manage critically ill patient.

a. Recognise a critically ill or injured trauma patient b. Treat a critically ill patient. c. Manage a critically ill or injured patient in ICU d. Perform blood suppleance (transfusion) e. Provide general ward clinical support f. Maintain communications

2.3 Provide sedative care a. Perform patient assessment b. Prescribe sedative regime c. Monitor level of sedation and adjust regime, if necessary

2.4

Manage patient transfer. a. Prepare patient for transfer b. Manage an in-hospital transfer c. Manage an inter-hospital transfer d. Manage a pre-hospital transfer


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2.5 MEDEVAC a. Knowledge of the use and limitations medical transport (ground, air and sea). b. Explain transport procedures to patients. c. Capability to undertake transfer of critically ill patients

2.6 Provide pre-hospital care.

a. Manage pre-hospital response team. b. Manage incident response in disaster medicine (mass casualties incident, decontamination unit for CBRN attack) c. Manage patient.

2.7 Supervise stock levels. a. Ensure adequate stock levels of: Blood and blood products Oxygen Drugs (all types)

2.8 MASCAL procedures a. Understand the functions and actions of the Medical Incident Officer in Major Incident or MASCAL. b. Be able to take command in a MASCAL situation


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R2E / Module 3: sterilisation module’s capabilities

Task/Sub Task



3.1 Manage field sterile services for anaesthesia

a. Receive contaminated equipment. b. Control, clean and disinfect equipment. c. Inspect and service equipment. d. Maintain stock (drugs, blood & materials) levels. e. Manage clinical waste.

3.2 Manage field sterile services for the operating room.

a. Receive contaminated equipment. b. Clean and disinfect equipment. c. Inspect and service equipment. d. Pack and sterilise equipment. e. Maintain stock levels.

3.3 Manage equipment. a. agent holder of materials of operating room theatre b. Store and operate operating room equipment correctly c. Ensure equipment is maintained and defects are rectified


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Role 2E / Module 4 : Mobile Mental Health Module ‘s capabilities

Task/Sub Task



nation

4.1

Provision of operational Mental Health (MH) advice to the Chain of Command (CoC)

a. Assess operational MH issues b. Brief CoC

4.2

Provision of Liaison Service to medical, nursing and paramedical colleagues.

a. Assess operational MH issues b. Brief medical chain of command and medical personnel

4.3

Provision of operational MH briefings to military forces

a. Understand scope of available briefing materials b. Brief military forces as required

4.4

Manage MH problems in military forces

4.5

Manage violent mentally disturbed patient

4.6

Manage substance related problems

4.7 Manage suicidal patient

4.8 Manage depressed patient

4.9 Manage acute psychotic patient

4.10 Manage acute stress reaction and PTSD

4.11

Manage any other mental health problems

a. Assess referred patients b. Formulate problem c. Apply general principles of

management of mentally disturbed patients in accordance with PIE principles

d. Include evidence based pharmacological, psychological, social methods.

e. Decide management/ treatment plan. f. Deliver management/ treatment plan.

4.12

Contribute to Aero-medical Evacuation (AE) Procedures.

a. Assess need for AE of patients b. Produce required documentation c. Provide treatment for patient to

ensure fitness for AE


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R2E / Module 5: forward medical equipment module’s capabilities

Task/Sub Task Number Performance Standard


5.1 Manage all drugs and medical devices

a. Hold adequate stocks of drugs and medical devices b. Dispense of drugs and medical devices c. Maintain stock levels of in-date drugs and medical devices appropriate to the operational circumstances (DOS) d. Establish re-supply chain

5.2

Manage oxygen stocks

a. Hold adequate stocks of oxygen b. Dispense oxygen as required c. Establish re-supply chain/ cylinder re-fill facility

5.3 Manage clinical waste

a. Ensure correct disposal

5.4 Manage short shelf-life blood products

a. Receive short shelf-life blood products and dispense to anaesthetist b. Ensure correct disposal of out-of-date or out-of-limits blood products

5.5 Manage blood a. Receive blood products and dispense to anaesthetist b. Ensure correct disposal of out-of-date blood products c. Control, document and ensure resupply of blood stocks

5.6 Manage equipment a- agent holder of materials of operating room theatre b- Store and install equipment correctly c- ensure equipment is maintained and defects are rectified

5.7 Manage medical devices maintenance (sterile or not) related to the medical field settlement

a. In charge of preventive maintenance : Medical devices control and checkout in order to assert a good troubleshooting

b. In charge of corrective maintenance : Medical devices reparation

c. Medical devices to support are limited to the health service supply catalogue

d. Awry devices elimination e. Manage equipment swapping

5.8 Working field a. Electronic and biomedical devices used in the


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medical field settlement

b. Gas producing and distribution networks c. sterilization devices d. Assay office devices e. Air conditioning and heaters systems f. Blood and drugs refrigeration systems

5.9 Administration tools

a. Manage and maintain a medical equipment maintenance database

5.10 Advising users a. Provide user training b. Provide risk training

5.11 Measuring devices a. Undertake regular calibration of measuring devices b. Participate in Quality Assurance processes

5.12 Manage medical devices maintenance (sterile or not) related to the medical field settlement

a. In charge of preventive maintenance : Medical devices control and checkout in order to assert a good troubleshooting

b. In charge of corrective maintenance : Medical devices reparation

c. Medical devices to support are limited to the health service supply catalogue

d. Awry devices elimination e. Manage equipment swapping

5.13

Working field


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R2E / Module 6: CBRN decon capabilities

Task/Sub Task



nation

6.1

Manage Trauma and intoxication under IPE.

a. Assess a CBRN patient. b. Manage an R, C, B or N

patient. c. Perform appropriate triage d. Provide Pre hospital live

supports and stabilization

6.2 Manage contamination risk

a. perform decon and shower b. Provide appropriate antidotes c. Perform appropriate initial

samples or detection

6.3 Manage critically ill patient.

a. Recognise critically intoxicated or trauma patient.

b. Treat patient under CBRN threat

6.4 Supervise stocks level a. Control oxygen stock b. Control antidotes and

anaesthetics, haemodynamic and analgesic drugs stocks

6.5 Manage equipment and personnel

a. store and manage operational equipment

b. ensure control procedures, and detector reliability

c. manage human resources

6.6 CBRN MASCAL procedures

a. Knowledge of Weapons Mass Destruction

b. Knowledge about functions and actions Medical Incident Officer CBRN incident

c. To have capability to command in MASCAL CBRN situation

6.7

Logistic and administrative functions

a. Supply consumables (water, soap, etc.) b. Provide activity reports c. Provide traceability for reported


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results

ROLE 2 E / Module 7: Ward module’s capabilities

Task/Sub Task



7.1 Manage patient before and after treatment

a. Assess patient b. Recognize a critically ill patient and inform appropriate physician c. Manage patients in post-operative recovery area d. Perform resuscitation e. Perform blood suppleance (transfusion) and control blood stock f. Provide general clinical support t ward o and organize patient holding g. Prepare patients for medevac h. Maintain communications

7.2


a. Assist and inform physician b. Assess patients and deliver nursing care c. Dress and bandage wounds d. Manage clinical waste e. Check comfort and fit of plasters and splints f. Prepare and administer medical treatment and blood transfusion g. Ensure cleanliness and comfort of patient h. Provide adequate pain relief

7.3

Assist in holding care and transport


7.4

Conduct administrative tasks

a. Record medical activities b. Knowledge of command procedures c. Understand the use of maps, gps and radio


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7.5 Supervise stock levels in ward

a. Control stock levels of drugs and other materiel b. Control oxygen stock




a. Hold an appropriate driving licence b. Control state and revise vehicles c. Basic knowledge of medevac d. Know techniques for immobilization, mobilization and transport of patients.

7.8

Manage trauma patient transfer (MEDEVAC)

a. Prepare patient for transfer. b. Manage an in-hospital transfer. c. Manage an inter-hospital transfer. d. Manage a pre-hospital transfer. e. Produce all technical and administrative documents (general ward clinical support, operative report)


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R2E / Module 8: Diagnostic module’s capabilities

Task/Sub Task



nation

8.1

Biological sampling

a. Collect clinical samples b. Develop sampling protocols c. Process samples (shipment, storage) according to international regulations d. Develop sample processing procedures

8.2 Biological analysis

a. Analyse clinical samples b. Analyse water samples c. Undertake quality assurance procedures d. Provide technical validation of results e. Provide auditable record of reported results f. Maintain communication with reference laboratories g. Provide laboratory support for food inspection

8.3

Logistic and administrative functions for biomedical laboratory

a. Ensure adequate supply of consumables b. Maintain laboratory equipment (first echelon) c. Dispose of biological waste correctly. d. Provide biological activity reports

8.4

Radiological examination services

a. Provide standard x-ray views b. Develop x-ray films c. Give intravenous contrast d. Perform fluoroscopy examination e. Perform CT-scan examination e. Perform ultrasonography examination

8.5

Logistic functions for radiological services

a. Ensure adequate supply of consumables b. Organize maintenance of radiological equipment c. Provide radiological activity reports d. Maintain communications e. Provide reporting service for x-ray findings

8.6 Manage radiology room

a. Organize x-ray room and control entry during radiological exposure b. Prepare equipment for special radiological examinations c. Assist radiologist during special procedures d. Control and dispose of contaminated


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waste and equipment d. Maintain and clean x-ray room and equipment e. Manage stock levels

8.7 Manage telemedicine

a. Organize telemedicine service b. Control technical validation of results c. Provide auditable record of reported results d. Maintain communication with reference laboratories


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LIST OF SPECIALITIES REQUIRING OPERATIONAL PERFORMANCE STATEMENT FOR CERTIFICATION PURPOSES.

In role 3

Capabilities of R2E and Subsequent Specialities: NATO Biologist/ Preventist Capabilities NATO Neurosurgery Capabilities NATO Ophthalmic Capabilities NATO Paediatrics Capabilities NATO Internist and Tropical Medicine Capabilities NATO Head and Neck surgery Capabilities NATO Burns, Plastic surgery and Oral Facial Maxillary surgery NATO Gynaecology and Obstetrics Capabilities


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NATO BIOLOGIST/PREVENTIST (MD) Capabilities

Task/Sub Task



nation

1.0

Biological sampling a. Collect clinical samples b. Develop sampling protocols c. Process samples (shipment, storage) according to international regulations d. Develop sample processing procedures

2.0 Biological analysis a. Analyse clinical samples b. Analyse water samples c. Undertake quality assurance procedures d. Provide technical validation of methods and results e. Provide auditable record of reported results

3.0 Medical adviser a. Develop requirements for biological analysis b. Provide advice for transfusion management c. Provide advice for infectious diseases management to commanders at all levels d. Provide advice for defence against toxins and biological weapons to commanders at all levels e. Provide biological information within theatre f. Maintain communication with reference laboratories

4.0

Supervision Organization

a. Supervision of laboratory team b. Supervision of laboratory equipment c. Supervision of consumable re-supply d. Redaction of procedures and protocols e. Provide activity reports

Point 1.0 & 2.0 are included in skill set “laboratory capability” and point 3.0 & 4.0 could correspond to skill set “Preventive MD capability”. In ROLE 3, a biologist MD could be


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present and have a preventive function with or without laboratory function, depending on laboratory staff presence. NATO NEUROSURGERY Capabilities

Task/Sub Task



nation

1.0

Manage Trauma. a. Perform triage b. Assess a patient. c. Manage a trauma patient.

2.0 Emergency management of a patient

a. Perform pre-operative assessment b. Perform emergency neurosurgical procedures including: - management of wounds of the scalp and skull - cranio-cerebral wound (open or closed) : extradural haematomas subdural haematomas penetrating wound of the brain intracerebral haematomas sinus wounds cerebrospinal fluid leaks c. Perform spinal surgery (included cervical, dorsal and lumbar spine) : laminectomy spinal instrumentation spinal fusion management of penetrating spinal

cord injury d. Management of cerebral oedema and hydrocephalus e. Manage post-operative ward care. f. Prescribe medical treatment

3.0 Manage critically injured trauma patient.

a. Thoracic drain insertion b. Perform tracheotomy

4.0

Manage patient transfer.

a. Prepare patient for transfer b. Manage and in-hospital transfer. c. Manage an inter-hospital transfer d. Manage a pre-hospital transfer


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NATO OPHTALMIC capabilities

Task/Sub Task



nation

1.0

Manage Trauma. (contusion of eye and annex)

a. Assess a patient b. Perform ultrasonography examination of ocular lesions c. Manage a trauma patient

2.0 Emergency management of a patient

a. Perform pre-operative assessment and ocular ultrasonography b. Perform emergency ophthalmic surgery for : - Corneal or scleral laceration or rupture - Lens dislocation - injuries to eyelids and/or lachrymal ducts c. Manage post-operative ward care. d. Prescribe medical treatment

3.0 Manage critically injured trauma patient (severe open globe injury with foreign body in posterior segment, retinal detachment )

a. Perform damage control surgery 1. Closure of open globe injuries 2. Intravitreal antibiotics injection

4.0

Manage patient transfer. a. Prepare patient for transfer. b. Manage an in-hospital transfer. c. Manage an inter-hospital transfer. d. Manage a pre-hospital transfer.


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NATO HEAD and NECK SURGERY capabilities

Task/Sub Task



1.0 Manage trauma a. Assess a patient b. Manage a trauma patient

2.0 Manage patient in emergency

a. Perform pre-operative assessment b. Perform emergency surgery for

- Cervical - Oral – facial - Laryngo- tracheal injuries

c. Manage post operative ward care d. Prescribe medical treatment

3.0 Manage critically injured trauma patient

a. Perform damage control surgery 1. Cervical vascular haemostasis 2. Tracheotomy 3. Emergency airway management

b. Perform second look surgery

4.0 Manage patient transfer

a. Prepare patient for transfer b. Manage an in-hospital transfer c. Manage an inter-hospital transfer d. Manage pre-hospital transfer


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NATO INTERNIST and TROPICAL MEDECINE PHYSICIAN capabilities

Task/Sub Task



1.0

Manage medical emergencies

a. Perform triage b. Assess a patient c. Deal with medical patient

2.0 Medical consultations a. Diagnose infectious diseases including: - tropical diseases (malaria, arboviral

infections, diarrhea) - sexually transmitted diseases - respiratory tract infections)

b. Provide humanitarian assistance and paediatric primary health care

c. Prescribe medical treatment d. Manage heat and cold injuries e. Manage battle stress and psychiatric casualties f. Manage decontamination (contaminated or infected patient)

3.0

Preventive Medicine Organization

a. Perform vaccinations b. Supervise of malaria chemoprophylaxis c. Advise on the prevention of vector borne diseases

1. Supervision of the medical team 2. Perform telemedicine 3. Redaction of guidelines 4. Provide medical surveillance data

4.0

Manage medical patient transfer.

a. Prepare patient for medical evacuation b. Produce all technical and administrative documents (general ward clinical support, operative report)


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NATO PAEDIATRIC capabilities

Task/Sub Task



1.0 Manage ill or injured child

a) Perform triage b) Assess a patient c) Refer a trauma or surgical patient to appropriate surgical staff

2.0 Manage child in emergency

a) Perform clinical assessment b) Perform critical care : - intravenous infusion - ventilation - cardio vascular and respiratory monitoring c) Prescribe medical treatment

3.0 Manage critically ill child

Undertake critical care management for: - shock - coma - respiratory distress - acute renal failure

4.0 Manage child transfer

a) Prepare child for transfer b) Manage an in-hospital transfer c) Manage an inter-hospital transfer d) Manage a pre-hospital transfer


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NATO BURN PLASTIC SURGERY and ORAL FACIAL MAXILLARY SURGERY capabilities

Task/Sub Task



1.0 Manage Maxillofacial trauma

a. Assess a patient b. Manage a trauma patient

2.0 Manage burn patient in emergency

a. Perform pre-operative assessment b. Perform emergency surgery for

-. Necrosectomy/escharotomy -. Tracheotomy

c. Burn dressing

3.0 Plastic surgery management of critically injured trauma patient

a. Perform damage control surgery 1. Tracheotomy 2. Fasciotomy

b. Perform second look surgery 1. graft 2. flaps


a. Prepare patient for transfer b. Manage in-hospital transfer c. Manage an inter-hospital transfer d. Manage pre-hospital transfer

NATO GYNAECOLOGY AND OBSTETRICS capabilities


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Task/Sub Task



1.0 Manage pregnancy or gynaecology

a. Assess a patient b. Manage the pre-partum, inter-partum and post-partum care of a pregnant woman c. Diagnose and manage gynaecologic disease

2.0 Manage patient in emergency

a. Perform pre-operative assessment b. Perform emergency surgery for: curettage abcess incision total hysterectomy ectopic pregnancy acute ovarian cyst or tumour caesarean section haemostatic hysterectomy c. Manage post operative ward care d. Prescribe medical treatment

3.0 Manage critically ill patient

a. Perform second look surgery b. Achieve haemostasis in an obstetric or gynaecological emergency


a. Prepare patient for transfer b. Manage an in-hospital transfer c. Manage an inter-hospital transfer d. Manage pre-hospital transfer

NATO PHYSIOTHERAPIST capabilities


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Task/Sub Task



1.0 Medical consultations a. Perform clinical assessment b. Diagnose functional disease or post

casualty dysfunction c. Prescribe medical and paramedical

treatment d. Control and value the result of

rehabilitation and physiotherapy

2.0

Manage rehabilitation a. Realize an initial functional check-up b. Perform and/or control physiotherapy and

exercises of rehabilitation c. Record physiotherapy ‘activities d. Manage store and technical materials e. Control technical materials and drugs

3.0 Manage patient. a. Prepare patient for medical evacuation b. Produce all technical documents c. Manage store and maintain stock level

GROUND MEDEVAC (Transfer Ambulance) Capabilities

Task/Sub Task



nation 1.0 Control

stabilized casualties and ill-patient during the transit

a. Assess a patient b. Control and/or establish monitoring and

specialised first aid (Advanced Trauma Life Support and Battle ATLS)

c. Control and/or conduct resuscitation - airway support - haemorrhage control


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Task/Sub Task



nation - pneumothorax management

d. Control and Perform general anaesthesia e. Realize and/or control analgesia and other

medication

2.0 Manage patient tracking and transfer to MTF

a. Inform MTF level and commanders b. Prepare patient for transport c. Knowledge Minimum core medical data

documentation and all transit’ documents required


a. Assist and inform physician b. Assess patient and deliver nursing care c. Control dress and bandage wounds d. Manage clinical waste e. Check comfort and fit of plasters and

splints f. Prepare and administer medical treatment g. Ensure cleanliness and comfort of patient h. Provide adequate pain relief

4.0


a. Assist physician in medical and care recording before evacuation

b. Assist in preparation of equipment for casualty evacuation

c. Assist in preparation of packing and movement of casualties


a. Hold an appropriate driving licence b. Control state and revise vehicles

(minimum mechanic vehicle control) c. Basic knowledge of medevac d. Know techniques for immobilization,

mobilization and transport of patients


a. Know command procedures b. Understand the use of maps, gps and radio




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Task/Sub Task



nation 8.0 MASCAL and

MEDEVAC procedures




nato medical evaluation manual - amedp-27-2010

Documents

blank nato unclassified

nato unclassified publication

diagnostic annex

glossary annex

evaluation annex d questions

multinational evaluation

damage control surgery

mem chapter