October 1997

Chapter 16: Medical Support

Medical Support Principles

1603. MC 319 states that "General logistics policies apply in most measures to the medical support function. However, medical support guidance must be governed in addition by specific medical factors". Consequently, the Committee of the Chiefs of Military Medical Services in NATO (COMEDS) developed a series of Medical Support Precepts and Guidance for NATO were approved by the Military Committee (MC) and issued as MC 326.

1604. The following are the principles that will govern the planning of medical care during operations. These are related to the code of medical ethics that govern the actions of medical personnel and to the rules of conduct that express the humanitarian conscience of the Alliance's member nations.

  1. Compliance with Humanitarian Conventions. The conduct of medical activities will comply with the rules laid down under the Hague and the Geneva Conventions. In circumstances where the provision of the Conventions may not be directly applicable, these principles will define the minimum acceptable standard. Without discrimination, all entitled sick and injured shall be treated on the basis of their clinical needs and medical resources availability.
  2. Standards of Medical Care. Operational medical support to NATO forces should meet standards acceptable to all participating nations. Even in crisis or war, the aim is to provide a standard of medical care as close as possible to prevailing peacetime medical standards, given the difficulties of doing so in a military setting.
  3. Maintenance of Health and Prevention of Disease. Medical support plans must include detailed measures for the prevention of disease and injury to deployed forces as a key factor of personnel sustainability.
  4. Spectrum of Medical Responsibilities. Medical care is provided on a progressive basis ranging from preventive medicine, first aid, emergency resuscitation and stabilization of vital functions to evacuation and definitive specialized care.
  5. Time-Related Constraints of Medical Care. Resuscitation and stabilization of patients must be performed in a timely manner and be of as high quality as is possible. Planning for medical support must take into account that resuscitation and stabilization may require immediate life saving surgical interventions as well as intensive care procedures. Hence such support should be provided as far forward as possible. Additional emergency surgery and surgery to prevent potentially disabling complications must be available as soon as possible after the health-affecting event.
  6. Triage. Patients are sorted into categories for treatment and evacuation according to the urgency of their clinical needs to ensure medical care of the greatest benefit to the largest number. This is essential when casualties occur simultaneously and in numbers beyond the capacity of the medical facility. It is a process repeated at every opportunity.
  7. Fitness for Evacuation. The clinical condition of the patient will govern the priority, timing, means and destination of evacuation. Coordination by medical regulating staff is required.
  8. Continuity of Care. Patients passing through the medical system must be given care which is continuous, relevant and progressive. In-transit care must be available during evacuation.
  9. Medical Confidentiality. Patient medical information is not to be communicated to any individual or organization who does not have a medical need to know except as required by national policy for that nation's patients.

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