Jez Eden, LtCdr RN

LO2 – Maritime Medical Planning Principles

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SCOPE

Timelines Roles Risk Assessment Questions

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Timelines

70% of battle casualty deaths occur within 5 minutes of wounding 20% are preventable through immediate application of fairly simple

measures

But time is critical– 10-20% will die within 4 hours without surgery

New medical techniques and procedures have reduced battle casualty deaths by 30%

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Clinical Timelines

1-2-4 Hour Principle: [JDP 4-03 Med Sp to Ops] Within 1 hrs = resuscitation and stabilizing treatment

Within 2 hrs = Damage Control Surgery (DCS)

Within 4 hrs = Primary Surgery (PS)

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Timelines

10-1-2 Guidelines: [ACO Dir (AD) 83-1 (Edn 2) dated Oct 10]

Within 10 mins = haemorrhage & airway control

Within 1 hr = MEDEVAC assets reach the casualty

Within 2 hrs = casualties requiring surgery, to be in an operating theatre

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Level

Level 1 Level 2 Level 3 Level 4Level 5

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Role 1

Maritime Medical planning Guidance:

Nationally Mandated Minimum Medical Requirements (NMMMR):

Primary care, Triage, First Aid, Pre Hospital Emergency Care, Evacuation

Personnel – Personnel qualified to the minimum IMO trg level and dedicated personnel to provide care who are current in advanced first aid or medical trg at an agreed level.

It should be possible to provide limited medical treatment, under the guidance of an authorised healthcare professional

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Level 2

MMPG refers to Level 2 as level 1 but would normally include the addition ships Dr

Provide a greater range of diagnoses, with greater confidence and accuracy as well as treating common medical conditions with an increased range of treatment options

The hull should have an authorised independent health practitioner

Should be able to provide triage in MASCAL situations, along with advanced airway access, access for fluid resuscitation and non surgical haemorrhage control

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Level 3

MMPG refers to level 3 as; As level 2 but with access to specialist doctor led resuscitation and damage control surgery within clinical timelines

Maritime equivalent to Role 2 Light Manoeuvre. It is the lowest level where surgery is provided. The minimum level of surgery provided is damage control surgery.

Personnel – Should include one surgeon, one anaesthesia provider and two operating theatre staff. Additional medical staff to fulfill the nursing, laboratory and imaging capabilities

Evacuation – Provide for in transit care of a ventilated patient.

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Level 4

MMPG refers to level 4 as; As level 3 but with access to primary surgery within clinical timelines. Might include 2 x operating tables (OT), 2 surgical teams (ST), 4 x ITU beds, X Ray, Lab, blood bank

Maritime equivalent to Role 2 Enhanced. Should be able to maintain its capability and remain within a TF in the presence of a flow of casualties

Ability to hold one ventilated patient for up to 48 hrs and able to regenerate surgical capability without compromising the mission

Evacuation – Provide in transit care of a ventilated patient without compromising the capabilities of the MTF

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Level 5

MMPG refers to Level 5 as; As level 4 but with access to specialist surgery within clinical timelines. Mission tailored. May include 4 x OT, 4 x ST

8 x ITU beds, CT scanner, O2 production, PECC dedicated medevac capability. This is the maritime equivalent to Role 3

The hull shall be a designated MTF platform designed to receive and hold casualties without compromising the mission. May be a dedicated hospital ship

Sustainability – Ability to hold patients for 7 -10 days or until evacuation to the APOD can be achieved.

Designated medevac teams

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Scheme of Manoeuvre

Level 5

Level 2

Level 3

Level 4

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Risk Assessment

Early in the development of any plan medical planners should draw together all relevant information in order to conduct a risk based evaluation of key factors

An initial broad based assessment of the medical capability required within the deploying force needs to be made. This will be fine tuned as the planning process develops

If sufficient medical capability is not available or the medical plan cannot meet doctrinal clinical timelines then this risk must be highlighted to the Operational commander

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Risk Assessment

Early in the development of any plan medical planners should draw together all relevant information in order to conduct a risk based evaluation of key factors

An initial broad based assessment of the medical capability required within the deploying force needs to be made. This will be fine tuned as the planning process develops

If sufficient medical capability is not available or the medical plan cannot meet doctrinal clinical timelines then this risk must be highlighted to the Operational commander

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Risk Assessment

Overall risk score is based on 3 factors: 1. The operation to be undertaken

2. The relative size of the formation (PAR)

3. The region in which it is to operate

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Risk Assessment

Units & Area of Operation ScoreSingle Ship – Coastal steaming NATO Area (NATO A)1 1

Single Ship – Out of area sailing or trans continental sailing (OA) 2

Task unit of 2 or more ships – NATO A 1

Task unit of 2 or more ships - OA 2

Task Group of 4 ships and at least one major ship (FF, LPD and above) NATO A

2

Task Group of 4 ships and at least one major ship (FF, LPD and above) OA

3

Task Force – Largest formation. May consist of more than one Task Group NATO A

3

Task Force – Largest formation. May consist of more than one Task Group OA

4

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Risk AssessmentMARITIME ACTIVITY RISK CATEGORIES

Routine Operations (Deployments / Transits / Exercises) ScoreTransit Open Waters 1

Amphibious Exercises 2

Neo (permissive environment) 1

Carrier Strike Exercise 1

Low Intensity Operations

Boarding - opposed 3

NEO (Non Permissive) 2

Maritime Interdiction operations 2

Mine Clearance / EOD 2

High Intensity Operations (War fighting) Opposed amphibious landing 4

NEO - Opposed 4

Convoying 3

Sea based support of Joint Operations 4

Risk Assessment

NATO Maritime Medical Asset Planning Matrix

Maritime Activity Score

4 8 8 12 16

3 3 6 9 12

2 2 4 6 8

1 1 2 3 4

1 2 3 4Unit Size and AO Score

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Risk Assessment

Score 1 – (Level 1)

Score 2 – 3 – (Level 2)

Score 4-6 – (Level 3)

Score 8-12 – (Level 4)

Score 16 – (Level 5)

Conclusion

The only certain result of your plan will be casualties - mainly the enemy's if it's a good plan, yours if it is not.  Either way, foremost in your supporting plans must be your medical plan.

Brigadier Rupert SmithDeputy CommandantArmy Staff College 1990