NATO UNCLASSIFIED Releasable to the INTERNET

L3 NATO Principles

Brian Tolbert, CDR, US Navy, MSC SHAPE Joint Medical Division (JMED), Medical Intelligence

and CIMIC

NATO UNCLASSIFIED Releasable to the INTERNET

MARITIME C2NATO Medical Principles

Maritime ChallengesPlanning MatrixCasualty EstimationLogisitcs

Agenda

Current Organization

Future Organization

Medical Posts in theNATO Command Structure

Command and Control

3NATO UNCLASSIFIEDReleasable for EU, PfP

NATO UNCLASSIFIED Releasable to the INTERNET

NATO instruction AJP-4.10 (B) DRAFTMaritime Medical Planning Guidance

Provides Medical GuidanceMission TypesMission/Resource Matrix

Medical Planning Guidance

NATO UNCLASSIFIED Releasable to the INTERNET

Land OperationsLittoral OperationsSea based Operations

Supporting distances (time and distance)Resources (capability and range limitations)Secondary Injury

Maritime Missions

NATO UNCLASSIFIED Releasable to the INTERNET

NATO MARITIME MEDICAL ASSET PLANNING MATRIXMARITIME ACTIVITY SCORE

4 4 8 12 163 3 6 9 122 2 4 6 81 1 2 3 4

1 2 3 4UNIT SIZE AND AO SCORE

Task Group of 4+ Ships

MARITIME INTERDICTIONS

Planning Matrix

NATO UNCLASSIFIED Releasable to the INTERNET

Score 1: Nationally mandated capabilities to provide primary care, triage, first aid and evacuation (Role 1)

Score 2-3: Additive of Ships Physician (Role 1)Score 4-6: Additive of surgical intervention and

limited holding capabilities (Role 2 Light Maneuver)Score 8-12: Additive surgical capability, greater

diagnostics, ICU, enhanced holding capability (Role 2 Enhanced)

Score 13-16: Enhanced diagnostics and specialty care, larger holding capacity (Role 3)

Score 8-12: Additive surgical capability, greater diagnostics, ICU, enhanced holding capability (Role 2 Enhanced)

Matrix Scores/Planning Requirements

NATO UNCLASSIFIED Releasable to the INTERNET

SAG operationsAIREXUNDEX

Sea based Operations

NATO UNCLASSIFIED Releasable to the INTERNET

UNDEX Video

NATO UNCLASSIFIED Releasable to the INTERNET

UNDEX Video

NATO UNCLASSIFIED Releasable to the INTERNET

ICD-9 WOUND DESCRIPTION Occurrences Percent of Casualties

805Fracture of Vertebral Column Without Mention of Spinal Cord Injury 802.00 13.14

844.9Sprain of Knee & Leg NOS 802.00 13.14847.2Sprains and Strains of Lumbar 757.00 12.14824.8FX Ankle NOS-Closed 555.00 9.09

846Sprains and Strains of Sacraliliac Region 450.00 7.37848.3Other and Ill define sprain and Strain of Ribs 450.00 7.37959.7Lower Leg Injury NOS 402.00 6.59

843Sprains and Strains of Hip and Thigh 323.00 5.29851Cerebral Laceration and Contusion 259.00 4.24845Sprain of Ankle NOS 187.00 3.06

840.9Sprain Shoulder/Arm NOS 173.00 2.83959.01Head Injury NOS 157.00 2.57

850.9Concussion NOS 145.00 2.38825Fracture of Calcaneous, Closed 141.00 2.31

847.3Sprains and Strains of Sacrum 109.00 1.79832.01Closed Dislocation of Elbow; Unspecified Site 62.00 1.02

853Other and Unspecified Intercranial Hemorrhage following Injury w/o Open 55.00 0.90

836Tear Med Menisc Knee-Cur 41.00 0.67833Closed Dislocation of Wrist; Unspecified Part 37.00 0.61800Fracture Of Vault of Skull 34.00 0.56

836.1Tear Lat Menisc Knee-Cur 28.00 0.46

852Subarachnoid, Subdural, and Extradural Hemorrhage following Injury 28.00 0.46

834Closed Dislocation of Finger; Unspecified part 26.00 0.43

853.1Other and Unspecified Intercranial Hemorrhage following Injury with Open 18.00 0.29

ICD-9 WOUND DESCRIPTION Occurrences Percent of Casualties

836.2Tear Miniscus Nec-Curren 15.00 0.25821.1Femur fx-unspecified site, open 9.00 0.15823.9Tibia/fibula fx-unspecified part, open 6.00 0.10

847Neck sprain 6.00 0.10823.32Fibula with tibia shaft fx-open 5.00 0.08

800.95Skull vault fx-with intracranial injury other/unsp, openLOC>24hrs 3.00 0.05

806.21Thoracic fx-T1-T6 level with complete lesion of cord, closed 3.00 0.05

806.4Lumbar spine fx-closed 3.00 0.05846.8Other specified sites of sacroiliac sprain 3.00 0.05847.1Thoracic sprain 3.00 0.05

823.92Fibula with tibia fx-unspecified, open 2.00 0.03801Fracture of Base of Skull 1.00 0.02802Nasal Bone FX-Closed 1.00 0.02

806Fracture of Vertebral Column with Spinal Cord Injury, Cervical, Closed 1.00 0.02

823Open Fracture of Unspecified Part if Fibula with Tibia 1.00 0.02

848.5Pelvis sprain(symphysis pubis) 1.00 0.02

UNDEX PCOF

NATO UNCLASSIFIED Releasable to the INTERNET

ICD-9 WOUND DESCRIPTION Occurrences Percent of Casualties

861.2Injury to Lung w/o Mention of Open Wound into Thorax 44.00 7.17

860Pneumothorax w/o Mention of Open Wound into Thorax 43.00 7.00

891Open Wound Knee/Leg/Ankle 33.00 5.37851Cerebral Laceration and Contusion 30.00 4.89

873.4Open Wound of Face NOS 29.00 4.72850.9Concussion NOS 26.00 4.23

959.01Head Injury NOS 26.00 4.23879.8Open Wound Site NOS 23.00 3.75

890Open Wound of Hip/Thigh 22.00 3.58920Contusion of Face, Scalp, and Neck except Eye 20.00 3.26884Open Wound Arm Mult/NOS 19.00 3.09

924.1Contusion of Knee and Lower Leg 19.00 3.09

904Injury to Blood Vessels of Lower Extremity and Unspecified Sites 17.00 2.77

910Superficial Injury of Face Neck and Scalp Except Eye with Abrasion or fric 17.00 2.77

882Open Wound of Hand 15.00 2.44

916Supericial Injury of Hip Thigh Leg and Ankle with Abrasion or friction bur 15.00 2.44

831.1Dislocation of Shoulder, Open 14.00 2.28802Nasal Bone FX-Closed 13.00 2.12

959.7Lower Leg Injury NOS 13.00 2.12941Burn of Face, Head, and Neck 11.00 1.79

844.9Sprain of Knee & Leg NOS 10.00 1.63

916.1Superficial Injury of Hip thigh Leg and Ankle with Abrasion of friction bur 9.00 1.47

928Crushing Injury of Lower Limb 9.00 1.47847.2Sprains and Strains of Lumbar 8.00 1.30

823.82Closed Fracture of Unspecified Part of Fibula with Tibia 7.00 1.14

823.92Open Fracture of Unspecified Part of Fibula with Tibia 7.00 1.14

825Fracture of Calcaneous, Closed 7.00 1.14845Sprain of Ankle NOS 7.00 1.14

848.3Other and Ill define sprain and Strain of Ribs 7.00 1.14

ICD-9 WOUND DESCRIPTION Occurrences Percent of Casualties

918Superficial Injury of Eye and Adnexa 7.00 1.14

805Fracture of Vertebral Column Without Mention of Spinal Cord Injury 6.00 0.98

826Closed Fracture of One or More Phalanges of Foot 6.00 0.98

860.2Hemothorax w/o Mention of Open Wound into Thorax 6.00 0.98

883Open Wound of Finger 6.00 0.98

886Traumatic Amputation of Fingers no mention of Thumbs 6.00 0.98

955Injury of Peripheral Nerves of Shoulder Girdle and Upper Limb 6.00 0.98

873Other Open Wound of Head 5.00 0.81824.8FX Ankle NOS-Closed 4.00 0.65873.8Open Wound of Head NEC 4.00 0.65879.2Open Wound Anterior Abdomen 4.00 0.65

879.6Open Wound of Other and Unspecified Parts of Trunk 4.00 0.65

860.1Pneumothorax with Open Wound into Thorax 3.00 0.49

861Injury to Heart w/o Mention of Open Wound into Thorax 3.00 0.49

863Injury to Gastrointestinal Tract 3.00 0.49887Traumatic Amputation of Arm and Hand 3.00 0.49894Open Wound of Leg NEC 3.00 0.49895Traumatic Amputation of Toe 3.00 0.49

823Open Fracture of Unspecified Part of Fibula with Tibia 2.00 0.33

897Traumatic Amputation to Leg or Legs 2.00 0.33924.2Contusion of Ankle and Foot Excluding Toes 2.00 0.33

806Fracture of Vertebral Column with Spinal Cord Injury, Cervical, Closed 1.00 0.16

822.1Fracture of Patella, Open 1.00 0.16861.1Injury to Heart with open Wound into Thorax 1.00 0.16

880Open Wound of Shoulder 1.00 0.16881Open Wound of Elbow Forearm and Wrist 1.00 0.16903Injury to Blood Vessels of Upper Extremity 1.00 0.16

AIREX PCOF

NATO UNCLASSIFIED Releasable to the INTERNET

CommunicationSustainmentEvacuation

Logistics

NATO UNCLASSIFIED Releasable to the INTERNET

So What?Projected missionsModular capabilities

Modeling and simulationAugments

Personnel mix

NATO UNCLASSIFIED Releasable to the INTERNET

Brian Tolbert, CDR, US Navy, MSC SHAPE Joint Medical Division (JMED), Medical Intelligence and CIMIC

+32 65 44 6870 Email: brian.tolbert@shape.nato.int

Questions…