L3 NATO Principles
Brian Tolbert, CDR, US Navy, MSC
SHAPE Joint Medical Division (JMED), Medical Intelligence
and CIMIC
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Agenda
 MARITIME C2
NATO Medical Principles
Maritime Challenges
Planning Matrix
Casualty Estimation
Logisitcs
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Command and Control
Current
Organization
Medical Posts in the
NATO Command Structure
Future
Organization
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Releasable for EU, PfP
3
Medical Planning Guidance
 NATO instruction AJP-4.10 (B)
DRAFT
Maritime Medical Planning Guidance
Provides Medical Guidance
Mission Types
Mission/Resource Matrix
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Maritime Missions
 Land Operations
Littoral Operations
Sea based Operations
Supporting distances (time and distance)
Resources (capability and range
limitations)
Secondary Injury
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Planning Matrix
MARITIME
ACTIVITY
SCORE
NATO MARITIME MEDICAL ASSET PLANNING MATRIX
4
4
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
MARITIME INTERDICTIONS
Task Group of 4+ Ships
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Matrix Scores/Planning Requirements
Score 1: Nationally mandated capabilities to
provide primary care, triage, first aid and evacuation
(Role 1)
Score 2-3: Additive of Ships Physician (Role 1)
Score 4-6: Additive of surgical intervention and
limited holding capabilities (Role 2 Light Maneuver)
Score 8-12: Additive surgical capability, greater
diagnostics, ICU, enhanced holding capability (Role 2
Enhanced)
Score 13-16: Enhanced diagnostics and specialty
care, larger holding capacity (Role 3)
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Sea based Operations
 SAG operations
AIREX
UNDEX
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UNDEX Video
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UNDEX Video
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UNDEX PCOF
Percent of
WOUND DESCRIPTION
Occurrences Casualties
Fracture of Vertebral Column Without
805 Mention of Spinal Cord Injury
802.00
13.14
844.9Sprain of Knee & Leg NOS
802.00
13.14
847.2Sprains and Strains of Lumbar
757.00
12.14
824.8FX Ankle NOS-Closed
555.00
9.09
846Sprains and Strains of Sacraliliac Region
450.00
7.37
848.3Other and Ill define sprain and Strain of Ribs
450.00
7.37
959.7Lower Leg Injury NOS
402.00
6.59
843Sprains and Strains of Hip and Thigh
323.00
5.29
851Cerebral Laceration and Contusion
259.00
4.24
845Sprain of Ankle NOS
187.00
3.06
840.9Sprain Shoulder/Arm NOS
173.00
2.83
959.01Head Injury NOS
157.00
2.57
850.9Concussion NOS
145.00
2.38
825Fracture of Calcaneous, Closed
141.00
2.31
847.3Sprains and Strains of Sacrum
109.00
1.79
Closed Dislocation of Elbow; Unspecified
832.01 Site
62.00
1.02
Other and Unspecified Intercranial
853 Hemorrhage following Injury w/o Open
55.00
0.90
836Tear Med Menisc Knee-Cur
41.00
0.67
833Closed Dislocation of Wrist; Unspecified Part
37.00
0.61
800Fracture Of Vault of Skull
34.00
0.56
836.1Tear Lat Menisc Knee-Cur
28.00
0.46
Subarachnoid, Subdural, and Extradural
852 Hemorrhage following Injury
28.00
0.46
Closed Dislocation of Finger; Unspecified
834 part
26.00
0.43
Other and Unspecified Intercranial
853.1 Hemorrhage following Injury with Open
18.00
0.29
ICD-9
ICD-9
WOUND DESCRIPTION
836.2Tear Miniscus Nec-Curren
821.1Femur fx-unspecified site, open
823.9Tibia/fibula fx-unspecified part, open
847Neck sprain
823.32Fibula with tibia shaft fx-open
Skull vault fx-with intracranial injury
800.95 other/unsp, openLOC>24hrs
Thoracic fx-T1-T6 level with complete lesion
806.21 of cord, closed
806.4Lumbar spine fx-closed
846.8Other specified sites of sacroiliac sprain
847.1Thoracic sprain
823.92Fibula with tibia fx-unspecified, open
801Fracture of Base of Skull
802Nasal Bone FX-Closed
Fracture of Vertebral Column with Spinal
806 Cord Injury, Cervical, Closed
Open Fracture of Unspecified Part if Fibula
823 with Tibia
848.5Pelvis sprain(symphysis pubis)
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Percent of
Occurrences Casualties
15.00
0.25
9.00
0.15
6.00
0.10
6.00
0.10
5.00
0.08
3.00
0.05
3.00
3.00
3.00
3.00
2.00
1.00
1.00
0.05
0.05
0.05
0.05
0.03
0.02
0.02
1.00
0.02
1.00
1.00
0.02
0.02
AIREX PCOF
Percent of
WOUND DESCRIPTION
Occurrences Casualties
Injury to Lung w/o Mention of Open Wound
861.2 into Thorax
44.00
7.17
Pneumothorax w/o Mention of Open Wound
860 into Thorax
43.00
7.00
891Open Wound Knee/Leg/Ankle
33.00
5.37
851Cerebral Laceration and Contusion
30.00
4.89
873.4Open Wound of Face NOS
29.00
4.72
850.9Concussion NOS
26.00
4.23
959.01Head Injury NOS
26.00
4.23
879.8Open Wound Site NOS
23.00
3.75
890Open Wound of Hip/Thigh
22.00
3.58
920Contusion of Face, Scalp, and Neck except Eye
20.00
3.26
884Open Wound Arm Mult/NOS
19.00
3.09
924.1Contusion of Knee and Lower Leg
19.00
3.09
Injury to Blood Vessels of Lower Extremity and
904 Unspecified Sites
17.00
2.77
Superficial Injury of Face Neck and Scalp Except
910 Eye with Abrasion or fric
17.00
2.77
882Open Wound of Hand
15.00
2.44
Supericial Injury of Hip Thigh Leg and Ankle with
916 Abrasion or friction bur
15.00
2.44
831.1Dislocation of Shoulder, Open
14.00
2.28
802Nasal Bone FX-Closed
13.00
2.12
959.7Lower Leg Injury NOS
13.00
2.12
941Burn of Face, Head, and Neck
11.00
1.79
844.9Sprain of Knee & Leg NOS
10.00
1.63
Superficial Injury of Hip thigh Leg and Ankle
916.1 with Abrasion of friction bur
9.00
1.47
928Crushing Injury of Lower Limb
9.00
1.47
847.2Sprains and Strains of Lumbar
8.00
1.30
Closed Fracture of Unspecified Part of Fibula
823.82 with Tibia
7.00
1.14
Open Fracture of Unspecified Part of Fibula with
823.92 Tibia
7.00
1.14
825Fracture of Calcaneous, Closed
7.00
1.14
845Sprain of Ankle NOS
7.00
1.14
848.3Other and Ill define sprain and Strain of Ribs
7.00
1.14
ICD-9
ICD-9
WOUND DESCRIPTION
918Superficial Injury of Eye and Adnexa
Fracture of Vertebral Column Without Mention of
805 Spinal Cord Injury
826Closed Fracture of One or More Phalanges of Foot
Hemothorax w/o Mention of Open Wound into
860.2 Thorax
883Open Wound of Finger
Traumatic Amputation of Fingers no mention of
886 Thumbs
Injury of Peripheral Nerves of Shoulder Girdle and
955 Upper Limb
873Other Open Wound of Head
824.8FX Ankle NOS-Closed
873.8Open Wound of Head NEC
879.2Open Wound Anterior Abdomen
Open Wound of Other and Unspecified Parts of
879.6 Trunk
860.1Pneumothorax with Open Wound into Thorax
Injury to Heart w/o Mention of Open Wound into
861 Thorax
863Injury to Gastrointestinal Tract
887Traumatic Amputation of Arm and Hand
894Open Wound of Leg NEC
895Traumatic Amputation of Toe
Open Fracture of Unspecified Part of Fibula with
823 Tibia
897Traumatic Amputation to Leg or Legs
924.2Contusion of Ankle and Foot Excluding Toes
Fracture of Vertebral Column with Spinal Cord
806 Injury, Cervical, Closed
822.1Fracture of Patella, Open
861.1Injury to Heart with open Wound into Thorax
880Open Wound of Shoulder
881Open Wound of Elbow Forearm and Wrist
903Injury to Blood Vessels of Upper Extremity
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Percent of
Occurrences Casualties
7.00
1.14
6.00
6.00
0.98
0.98
6.00
6.00
0.98
0.98
6.00
0.98
6.00
5.00
4.00
4.00
4.00
0.98
0.81
0.65
0.65
0.65
4.00
3.00
0.65
0.49
3.00
3.00
3.00
3.00
3.00
0.49
0.49
0.49
0.49
0.49
2.00
2.00
2.00
0.33
0.33
0.33
1.00
1.00
1.00
1.00
1.00
1.00
0.16
0.16
0.16
0.16
0.16
0.16
Logistics
Communication
Sustainment
Evacuation
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 So What?
Projected missions
Modular capabilities
Modeling and simulation
Augments
Personnel mix
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Questions
…
Brian Tolbert, CDR, US Navy, MSC
SHAPE Joint Medical Division (JMED), Medical Intelligence and CIMIC
+32 65 44 6870 Email: brian.tolbert@shape.nato.int
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