Chapter 16: Medical Support
Medical Operational Principles
1605. Listed below are the principles of medical support
that relate to operational support, from the NATO policy level to
the planning constraints level.
- Authority. The medical resources provided by the
nations are integral to the forces assigned to NATO. Under
normal circumstances, nations must have first call on their
own medical support. Units should deploy and re-deploy
with a coherent medical structure tailored to their
anticipated employment. However, the Force Commander must
be authorized to take appropriate action in order to cope
with casualty peaks within his force.
- Planning. Planning for medical support must be part
of generic and contingency operational planning.
Planning cells must include appropriate numbers of
experienced medical staff supported by an operational
medical intelligence system.
responsibility. Nations retain the ultimate responsibility for
the provision of medical support to their forces allocated to NATO, but, on transfer of authority,
the Force Commander will share the responsibility for
the health and medical support of assigned forces.
- Required Medical
Support. The medical resources required at the onset
of any operation are those sufficient to collect, evacuate, treat and hospitalize casualties occurring at agreed daily rates. Factors such as
geographical and military environment, climatic conditions,
possible hostile interference and the availability of medical
resources must be taken into account in the medical support
concept and the planning process.
- Risk Related Planning of Medical
Support. Medical capabilities must be in balance with the assessed risks
to the deployed forces. The estimation of risks and
the production of predicted casualty rates are the
responsibility of the operational staffs.
- Statement of
Requirements. The appropriate NATO Commander
in consultation with contributing nations and medical planning staff is responsible for ensuring that
the medical support requirements are fully met.
- Preservation of National
Structures. National medical systems of care
and evacuation should be retained as much as possible. However, advantages
of economies of scale which could be accrued from multinationality and coordination of
medical services should be realized whenever possible.
- Fitness and Health
Standards. Individuals assigned to NATO
operations must achieve, prior to deployment, the basic standards of individual fitness and
health predetermined by national policy. Appropriate
immun-isations must be given to all deployed personnel,
as guided by medical intelligence estimate of the
infectious health risks.
- NATO and National
Cooperation. Coordination and cooperation
between NATO and national military and civilian authorities is essential and must be carried out
at all appropriate levels to ensure optimized medical
support. Such cooperation can be bi- or multilateral, and
should include the military and civil authorities not only of
Alliance nations, but of Partner, host, and non-NATO nations as well.
- Commonality of
Plans. Medical support concepts, plans, structures
and procedures must be understood and agreed by all involved.
- Medical Support
Expansion. Medical resources in theatre must be
designed to provide, from the onset of the mission, sufficient capabilities to adequately
provide all required levels of support. Medical support
must expand progressively as force strength expands and
risks increase and should have a surge capability to deal
with peak casualty rates in excess of expected daily
rates, understanding that the peaks will be beyond
the capability to provide normal care.
- Readiness and
Flexibility. Medical units and staff must be at the
same state of readiness and availability as the force they support with the flexibility to meet
the demands of evolving operational scenarios.
- Transition from Peace to Crisis or
War. The medical support in crisis and wartime must originate
from peacetime military health care systems by a
progressive reinforcement. Medical readiness and availability
must be sufficient to allow for the smooth transition
from peacetime to crisis or wartime posture.
- Medical Materiel Readiness and
Sustainability. Levels and distribution of medical materiel must be
sufficient to achieve and maintain designated levels of
readiness, sustainability and mobility to provide the
required military capability during peace, crisis and war.
Standardization. National contingents should strive for
- Levels of Medical
Support. Levels of medical support will be
provided appropriate to each NATO operation but will include at least Role 1 to Role 3 in theatre.
Role 4 facilities will normally not be located in an
operational area. Medical staffs may promote the advantages
of economies of scale from role specialization, lead
nation responsibility and bi- or multinational agreements,
but policies for national contributions will generally be:
Role/Echelon 1 National responsibility
Role/Echelon 2 National or Lead Nation responsibility
Role/Echelon 3 National or Lead Nation
responsibility (may be multinational)
Role/Echelon 4 National responsibility or Bi- or
- Provision of Non-emergency
Treatment. Policy must be established regarding the entitlement of
non-military staffs and other authorized personnel for all
non-emergency medical care.
Treatment. Time consuming definitive treatment and
rehabilitation will be provided under national responsibility, normally in a Role/Echelon
4 facility in the home nation.
- Mobility. Medical units must be as strategically and
tactically flexible, mobile and responsive as the force they support.
- Medical Liaison. An efficient liaison system
between national contingents and theatre medical resources
must be established.
- Medical Supply Rates and
Standards. National medical support contingents must deploy with agreed
quantities of medical supplies as identified by medical
planners and based on casualty estimates. Nations must
use medical materiel, particularly blood and blood
products, which meets internationally recognized quality
assurance standards for the care of their patients. Policy
and planning for the resupply of medical materiel must
be developed in the planning process, making
maximum use of multinational mechanisms.
Resources. Evacuation policy will be established by
the operational commander after consultation with the medical planning staff and in
concert with the operational and logistic staff and
contributing nations. Evacuation resources must be provided by
the nations as appropriate to a particular operation.
- Harmonized Management
Procedures. The Force Commander will, in coordination with medical staff
of participating nations contingents, establish
harmonized procedures for the administration, management
and reporting of medical support and casualty evacuation.