October 1997

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.

  1. 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.
  2. 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.
  3. National 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. Commonality of Plans. Medical support concepts, plans, structures and procedures must be understood and agreed by all involved.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. Medical Standardization. National contingents should strive for standardization.
  16. 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 Multi-national agreement
  17. 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.
  18. Definitive Treatment. Time consuming definitive treatment and rehabilitation will be provided under national responsibility, normally in a Role/Echelon 4 facility in the home nation.
  19. Mobility. Medical units must be as strategically and tactically flexible, mobile and responsive as the force they support.
  20. Medical Liaison. An efficient liaison system between national contingents and theatre medical resources must be established.
  21. 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.
  22. Evacuation 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.
  23. 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.

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