LO2 – Maritime Medical
Planning Principles
Jez Eden, LtCdr RN
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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 4
Level 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 4
Level 3
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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
Score
Single 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 Assessment
MARITIME ACTIVITY RISK CATEGORIES
Routine Operations (Deployments / Transits / Exercises)
Score
Transit 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
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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
4
Unit Size and AO Score
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)
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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 Smith
Deputy Commandant
Army Staff College 1990