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NATO UNCLASSIFIED AMedP-27
ORIGINAL NATO UNCLASSIFIED
MEDICAL EVALUATION MANUAL
AMedP-27
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ORIGINAL NATO UNCLASSIFIED
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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
i iii v vii ix x xii 1-1 1-2 1-2 1-3 2-1 2-1 2-2 3-1 3-1 3-1 3-1 3-2 4-1 4-1 4-1 4-2 4-2 4-2 4-3 5-1 5-1 5-1
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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
Personnel Material Procedures
3
Personnel Material Procedures
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№ Area Observations Explanation Recommendations
4
Personnel Material Procedures
5
Personnel Material Procedures
6
Personnel Material Procedures
7
Personnel Material Procedures
…
Personnel Material Procedures
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 ...
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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.
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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
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ANNEX D MAIN QUESTIONS DURING EVALUATION
No. Supporting Question Mission essential?
FC C
CL
Risks Identified Recommendations
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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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
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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
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STANAG 2931 Orders for the Camouflage of the Red Cross and the Red Crescent on Land in Tactical Operations Ed. 2
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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ANNEX F FORWARD AEROMEDICAL EVACUATION
Module Forward Aero medical Evacuation module
Capability Provide pre-hospital emergency care
Key Question: Is the module able to provide pre-hospital emergency care
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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? 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
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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 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
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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ANNEX G MEDICAL EMERGENCY RESPONSE TEAM
Module Medical Emergency Response Team module
Capability Provide pre-hospital emergency care
Key Question: Is the module able to provide pre-hospital emergency care
No. Supporting Question Mission
essential?
FC
C
CL
Risks Identified Recommendations
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?
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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 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
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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?
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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
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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 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?
(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?
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
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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?
1.d Are personnel properly trained to operate the module equipment?
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
troops supported, with other medical elements and with command level?
Yes
3. Procedures 3.a Can the command and control module meet the demands
based on the mission medical estimate?
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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?
(e.g. job descriptions) Yes
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)
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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?
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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? 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?
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3.e Are personnel aware of the unit MASCAL plan and their responsibility in its execution?
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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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?
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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
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?
(e.g. job descriptions) Yes
3.d Are the C2 arrangements for the module published and are
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all personnel aware of them? 3.e Are personnel aware of the unit MASCAL plan and their
responsibility in its execution?
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
Summary: FC: Fully Capable/no risks identified
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C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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?
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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
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
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(e.g. job descriptions) 3.d Does personnel work according special safety regulations
regarding imaging?
3.e Are the C2 arrangements for the module published and are all personnel aware of them?
3.f Are personnel aware of the unit MASCAL plan and their responsibility in its execution?
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
Summary: FC: Fully Capable/no risks identified
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C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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
No. Supporting Question Mission
essential? FC C
CL
Risks identified Recommendations
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? 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
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all personnel aware of them? 3.e Are personnel aware of the unit MASCAL plan and their
responsibility in its execution?
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
Summary: FC: Fully Capable/no risks identified
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M - 3 ORIGINAL
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C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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?
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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 be 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
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?
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N - 2 ORIGINAL
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3.e Are personnel aware of the unit MASCAL plan and their responsibility in its execution?
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
Summary: FC: Fully Capable/no risks identified
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N - 3 ORIGINAL
NATO UNCLASSIFIED
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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O - 1 ORIGINAL
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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?
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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
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
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all personnel aware of them? 3.e Are personnel aware of the unit MASCAL plan and their
responsibility in its execution?
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
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O - 3 ORIGINAL
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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P - 1 ORIGINAL
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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
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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
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 Is there no crossing of contaminated and sterilised items?
Reference standards:
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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?
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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? 2.c Is there a system in place to ensure medical supplies are
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?
(e.g. job descriptions) Yes
3.d Are the C2 arrangements for the module published and are
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Q - 2 ORIGINAL
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all personnel aware of them? 3.e Are personnel aware of the unit MASCAL plan and their
responsibility in its execution?
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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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?
No. Supporting Question Mission
essential?
FC
C
CL
Risks Identified Recommendations
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
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 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?
NATO UNCLASSIFIED AMedP - 27
R - 2 ORIGINAL
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2.f Are facilities available for filling oxygen bottles?
3. Procedures
3.a Are there agreed SOPs including national resupply? 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 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?
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 2178 Compatibility of Medical Tubing and Connectors in the Field STANAG 2408 NATO Blood Brochure - AMedP-12
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R - 3 ORIGINAL
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STANAG 2541 Medical Waste Management during NATO led Operations – AMedP-20 STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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S - 1 ORIGINAL
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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?
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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
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?
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S - 2 ORIGINAL
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3.e Are personnel aware of the unit MASCAL plan and their responsibility in its execution?
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
NATO UNCLASSIFIED AMedP - 27
S - 3 ORIGINAL
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STANAG 2939 Medical Requirements for Blood, Blood Donors and Associated Equipment
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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T - 1 ORIGINAL
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ANNEX T WARD MODULE
Module Ward Module
Capability Provide nursed beds
Key Question: Is the module able to provide nursed beds?
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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? 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?
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T - 2 ORIGINAL
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3.e Are personnel aware of the unit MASCAL plan and their responsibility in its execution?
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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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U - 1 ORIGINAL
NATO UNCLASSIFIED
ANNEX U ENHANCED DIAGNOSTIC MODULE
Module Enhanced Diagnostic module
Capability Provide enhanced imaging
Provide enhanced field laboratory testing
Key Question: Is the module able to provide the capability?
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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 Is protection equipment for imaging in place (including mobile aprons)?
3. Procedures 3.a Are there agreed SOPs? Yes
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U - 2 ORIGINAL
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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 Does personnel work according special safety regulations regarding imaging?
3.e Are the C2 arrangements for the module published and are all personnel aware of them?
3.f Are personnel aware of the unit MASCAL plan and their responsibility in its execution?
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
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U - 3 ORIGINAL
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Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
NATO UNCLASSIFIED AMedP - 27
V - 1 ORIGINAL
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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?
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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. 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 Is there a system in place for re-supply of lower roles? Yes
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V - 2 ORIGINAL
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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
Summary: FC: Fully Capable/no risks identified
NATO UNCLASSIFIED AMedP - 27
V - 3 ORIGINAL
NATO UNCLASSIFIED
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
NATO UNCLASSIFIED AMedP - 27
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
No. Supporting Question Mission
essential?
FC
C
CL
Risks Identified Recommendations
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
3. Procedures
3.a Are there agreed SOPs? Yes
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W - 2 ORIGINAL
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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 Are personnel aware of CBRN procedures and their responsibility
in its execution?
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) STANAG 2278 Medical Advice on Restriction of Movement STANAG 2409 NATO Glossary of Medical Terms and Definitions – AMedP-13
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W - 3 ORIGINAL
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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X - 1 ORIGINAL
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ANNEX X DENTAL MODULE
Module Dental module
Capability Provide primary dental care
Key Question: Is the module able to provide primary dental care?
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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
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
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X - 2 ORIGINAL
NATO UNCLASSIFIED
all personnel aware of them? 3.e Are personnel aware of the unit MASCAL plan and their
responsibility in its execution?
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
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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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
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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
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?
(e.g. job descriptions) Yes
3.d Are the C2 arrangements for the module published and are
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Y - 2 ORIGINAL
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all personnel aware of them? 3.e Are personnel aware of the unit MASCAL plan and their
responsibility in its execution?
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
Summary: FC: Fully Capable/no risks identified
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Y - 3 ORIGINAL
NATO UNCLASSIFIED
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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Z - 1 ORIGINAL
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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
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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 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
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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?
(e.g. job descriptions) Yes
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
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Z - 3 ORIGINAL
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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)
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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AA - 1 ORIGINAL
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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
No. Supporting Question Mission
essential? FC C CL
Risks Identified Recommendations
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 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
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AA - 2 ORIGINAL
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communicate internally? 2.h Is communications equipment sufficient to communicate 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.d Is it easy to bring the patient onboard? 3.f Are personnel aware of the unit MASCAL plan and their
responsibility in its execution?
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
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AA - 3 ORIGINAL
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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AB - 1 ORIGINAL
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ANNEX AB STRATEGIC AEROMEDICAL EVACUATION MODULE
Module Strategic Aeromedical Evacuation module
Capability Provide pre-hospital emergency care
Key Question: Is the module able to provide pre-hospital emergency care
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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 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
communicate internally?
2.h Is communications equipment sufficient to communicate with Yes
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AB - 2 ORIGINAL
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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?
(e.g. job descriptions) Yes
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.f Are personnel aware of the unit MASCAL plan and their responsibility in its execution?
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
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AB - 3 ORIGINAL
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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AC - 1 ORIGINAL
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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
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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 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 critical 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
communicate internally?
2.h Is communications equipment sufficient to communicate with Yes
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AC - 2 ORIGINAL
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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?
(e.g. job descriptions) Yes
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
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AC - 3 ORIGINAL
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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AD - 1 ORIGINAL
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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
Key Question: Is the module able to provide the capability?
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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 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?
2.b Is the equipment fit for purpose? Yes
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AD - 2 ORIGINAL
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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?
(e.g. job descriptions) Yes
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 Is there a CBRN medical plan available? 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 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
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AD - 3 ORIGINAL
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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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
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AD - 4 ORIGINAL
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CL: Capable with Limitations/major risks identified
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AE - 1 ORIGINAL
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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
Key Question: Is the module able to provide the capability?
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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 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
troops supported, with other medical elements and with command level?
Yes
2.d Is a Casualty Rate Estimate tool available? yes 3. Procedures
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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?
(e.g. job descriptions) Yes
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
troops, with other medical elements and with higher formations (language skills, radio procedures)
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
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AE - 3 ORIGINAL
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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
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AE - 4 ORIGINAL
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Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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AF - 1 ORIGINAL
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ANNEX AF HYPERBARIC MODULE
Module Hyperbaric module
Capability Provide hyperbaric medicine
Key Question: Is the module able to provide hyperbaric medicine?
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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
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
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AF - 2 ORIGINAL
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all personnel aware of them? 3.e Are personnel aware of the unit MASCAL plan and their
responsibility in its execution?
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
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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AG - 1 ORIGINAL
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ANNEX AG FINAL EXERCISE REPORT
Module Preventive Medicine module
Capability Provide preventive healthcare
Key Question: Is the module able to provide preventive healthcare
No. Supporting Question Mission
essential? FC C
CL
Risks Identified Recommendations
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 and veterinary 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
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
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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:
Summary: FC: Fully Capable/no risks identified
C: Capable/minor risks identified
CL: Capable with Limitations/major risks identified
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AH - 1 ORIGINAL
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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
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AH - 2 ORIGINAL
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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 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 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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AH - 3 ORIGINAL
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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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AH - 4 ORIGINAL
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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
Capable of supporting joint and combined ops in most terrains under austere conditions
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Capable of providing an appropriate level of force protection for assigned personnel and equipment
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
Number Performance Standard
Personnel Identified by
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
Number Performance Standard
Personnel Identified by
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)
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 Perform immobilization
2.3 Manage patient tracking and transfer to higher MTF level.
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
Management Capability, i.e. decon or casualty bags) and should administer antidotes
2.4 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 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
Number Performance Standard
Personnel Identified by
nation
2.5 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 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
2.9 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, 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
Number Performance Standard
Personnel Identified by
nation
3.1 Manage severe Casualties (Trauma and wound injuries) on the field
a. Assess a patient b. Establish monitoring and specialised first aid
(Advanced Trauma Life Support and Battle ATLS)
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
Management Capability, i.e. decon or casualty bags) and should administer antidotes
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
Prepare patient for evacuation
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
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Module 3: Incidence Response team
Task/Sub Task
Number Performance Standard
Personnel Identified by
nation
3.5 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
3.6 Perform administrative tasks
a. Know command procedures b. Understand the use of maps, gps and radio
3.7 Supervise stock levels in transport assets and manage stores
a. Control stocks of drugs and other materiel b. Control oxygen stock c. Manage stores
3.8 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 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
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Role 1 / Module 1: Primary Health Care capabilities
Task/Sub Task
Number Performance Standard
Personnel Identified by
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
1.5 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
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Role 1 / Module 1: Primary Health Care capabilities
Task/Sub Task
Number Performance Standard
Personnel Identified by
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
1.9 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.
1.10 Manage transport
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
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Role 1 / Module 1: Primary Health Care capabilities
Task/Sub Task
Number Performance Standard
Personnel Identified by
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
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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
Number Performance Standard
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
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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
1.7 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
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
1.12 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
1.13 Manage transport
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
Number Performance Standard
Personnel Identified by nation
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.
a. Receive contaminated equipment b. Clean and disinfect equipment c. Inspect and service equipment d. Pack and sterilise equipment e. Maintain stock levels
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Role 2LM / Module 3: Diagnosis module’s capabilities
Task/Sub Task
Number Performance Standard
Personnel Identified by nation
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
Number Performance Standard
Personnel Identified by nation
4.1
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 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
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)
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
4.5 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.
4.6 Manage transport
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
Number Performance Standard
Personnel Identified by nation
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
Number Performance Standard
Personnel Identified by
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
Number Performance Standard
Personnel Identified by nation
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
Number Performance Standard
Personnel Identified by
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
Personnel Identified by nation
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
Number Performance Standard
Personnel Identified by
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
Number Performance Standard
Personnel Identified by nation
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
Manage post-operative nursing care.
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
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)
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
7.6 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.
7.7 Manage transport
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
Number Performance Standard
Personnel Identified by
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
Number Performance Standard
Personnel Identified by
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
Number Performance Standard
Personnel Identified by
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
Number Performance Standard
Personnel Identified by
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
Number Performance Standard
Personnel Identified by nation
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
Number Performance Standard
Personnel Identified by nation
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
Number Performance Standard
Personnel Identified by nation
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
Number Performance Standard
Personnel Identified by nation
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
4.0 Manage patient transfer
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
Number Performance Standard
Personnel Identified by nation
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
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
NATO PHYSIOTHERAPIST capabilities
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Task/Sub Task
Number Performance Standard
Personnel Identified by nation
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
Number Performance Standard
Personnel Identified by
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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GROUND MEDEVAC (Transfer Ambulance) Capabilities
Task/Sub Task
Number Performance Standard
Personnel Identified by
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
3.0 Manage nursing care.
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
Prepare patient for evacuation
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
5.0 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
6.0 Perform administrative tasks
a. Know command procedures b. Understand the use of maps, gps and radio
7.0 Supervise stock levels in transport assets and manage stores
a. Control stocks of drugs and other materiel b. Control oxygen stock c. Manage stores
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GROUND MEDEVAC (Transfer Ambulance) Capabilities
Task/Sub Task
Number Performance Standard
Personnel Identified by
nation 8.0 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