INTF MEDICAL SERVICES TACTICAL FORWARD OPERATIONS STANDARD OPERATING PROCEDURES

INTF MEDICAL SERVICES TACTICAL FORWARD OPERATIONS STANDARD OPERATING PROCEDURES 1. SITUATION. It is assumed that IAF has limited organic medical capability to perform Battalion Aid Station (BAS) responsibilities therefore; other than minor injuries, all casualties will be evacuated to the nearest Coalition Forces BAS provided by the area MSC. 2. MISSION. Provide medical support, basic first aid, preventive medicine support, and limited BAS functions for unit personnel. Provide emergent and non-emergent health care in a forward operational setting. 3. EXECUTION. a. Concept of Operations. Upon arrival in the theater of operations, the Medical Department will establish a temporary aid station utilizing the field ambulance. Once the BAS is functional, all medical operations will be transferred to the BAS. The following procedures for processing injuries/illnesses will be used. b. Tasks. (1) Each Company will determine the most direct transport route for movement of casualties from their Area of Responsibility (AOR) and Command Post (CP) to the BAS. Patrol Leaders, Convoy Commanders and Company Commanders will coordinate casualty transport by contacting the Combat Operations Center (COC) for movement instruction . (2) The BAS will be manned at all times by a duty corpsman. Sick call will be available from 0600-0700. Emergencies will be seen at any time. A duty Ambulance Driver will be assigned to the BAS on standby in the event of organic/ground MEDEVAC. This driver will be familiar with ground MEDEVAC routes to the Landing Zone (LZ) and to the nearest available medical facilities. (a) If evacuation is conducted via ambulance, the COC will notify higher Headquarters and request that notification be passed to the definitive care Medical Treatment Facility (MTF). (b) If evacuation is conducted by helicopter MEDEVAC, the COC will use the organic radio or cell phone and request the MEDEVAC helicopter. The COC will coordinate the on scene MEDEVAC movements. The COC will notify the definitive care MTF via higher Headquarters and send appropriate Casualty Reports (CASREPS) to higher Headquarters. The COC will notify the Quick Reaction Force (QRF) Team Commander. Battalion MEDEVAC drills will occur throughout operations to further develop and train personnel on MEDEVAC procedures. During MEDEVAC drills, injuries will be simulated and handled as if the injury was actual with one exception: All verbal/written reports will stress “SIMULATED CASUALTY”. Injuries will be tracked, and medical personnel will recommend and simulate appropriate treatment and patient care for each patient. c. Mass Casualty Situation: (1) Initial care will be provided by personnel who are at the scene. First respondent personnel will notify the COC that a casualty exists and the extent of injury. (2) The COC will notify the BAS providing any available information as to the number and nature of casualties. The COC will notify the Commanding Officer, QRF Team, higher Headquarters and the Office of Security Cooperation’s Office of Health Affairs of the situation. (3) The COC will notify Company CPs that a mass casualty situation exists and direct the CPs to dispatch Company stretcher-bearers and stretchers to the casualty area. Once stretcher-bearers reach the casualty site, they will report to the QRF Team Commander (these individuals will not be released until the situation is secured). (4) The BAS will conduct Triage and initiate all required life saving medical care to stabilize the casualties. Once patients are stabilized, the BAS will determine the method and requirements needed to move the patients to the MTF for definitive care. Once route of evacuation is determined, the COC will be notified. 4. ADMINISTRATION AND LOGISTICS. a. Each Company will ensure personnel are trained to perform as stretcher-bearers. b. A minimum of two stretchers (army field litters) will be maintained by each Company CP. Stretchers will be drawn from the BAS upon arrival. In event of mass casualties, additional stretchers will be improvised utilizing cots, ponchos, etc. 5. COMMAND AND SIGNAL. a. CASREPs will be submitted by Company Commanders, Platoon Leaders, Patrol Leaders and Convoy Commanders to the COC for all "ACTUAL" and "SIMULATED" casualties. b. For "ACTUAL" or "SIMULATED" casualties occurring within the confines of camp, the Battalion Surgeon and Duty Medic will request a MEDEVAC from the COC. In cases, where the Battalion Surgeon/Duty Medic are not available, (jobsites, Patrols, Convoys), authority to request MEDEVAC from the COC lies with the senior person present. c. All requests for MEDEVAC will be routed through the Battalion COC. TABS: A – Helicopter Landing Zone SOP Encl 1: Landing Zone Brief Encl 2: Helicopter LZ Control Hand and Arm Signals TAB A (Helicopter Landing Zone SOP) to INTF MEDICAL SERVICES TACTICAL FORWARD OPERATIONS STANDARD OPERATING PROCEDURES 1. SITUATION. A helicopter Landing Zone (LZ) will be established to receive aerial resupply and for MEDEVACs. 2. MISSION. To select an appropriate Landing Zone and provide adequate security to safely and effectively land a helicopter during aerial resupply and MEDEVAC Operations. 3. EXECUTION. a. Concept of Operations: (1) Upon arrival at the Battalion Area of Operations (AO), the Operations Officer (S-3) or the Quick Reaction Force (QRF) Team Commander will select the optimum site for a helicopter LZ and provide the COC with the 6-digit grid and Global Positioning System (GPS) location. Once approved, the COC will pass the 6-digit grid coordinate and GPS location to higher Headquarters. An alternate LZ will also be selected with the information passed to the COC. (2) The following considerations will be taken into account: (a) Tactical Suitability - Able to be secured; free from enemy observation and direct fire; proximity to camp. (b) Size of Landing Site - The number and type of helicopters will determine the size of the clearance area required and will have a bearing on the size of the LZ itself as well as the landing formations allowable. LZ will be 150 feet larger than the diameter of the rotor blades. In general, allowable distances between the utility helicopters are 50 meters on line or in echelon and 70 meters in trail. The allowable distance for cargo helicopters is 75 and 100 meters respectively. (c) Surface Conditions - The landing site will be free of rocks, logs, and heavy dust or loose snow. (d) Ground Slope - The maximum permissible ground slope to land helicopters is 14%, or 8 degrees. If the ground slope is between 7% and 14%, the helicopters will be landed side-slope. (e) Routes in and out of the LZ - The LZ will have routes in and out for both ground forces and the helicopters. Most helicopters require a 10 to 1 ratio of take-off runway to obstacle height to clear the LZ on take off. (f) Winds - Helicopters will land and take off into the wind if at all possible. Maximum allowable crosswinds are 10 knots and maximum allowable tailwinds are 5 knots. (g) Obstacles - Remove all obstacles greater than 10 inches in height or depth, and mark those, which would not be apparent to the aircraft. (3) In case of a medical emergency, the BAS will request a MEDEVAC through the COC using a standard NATO 9-line MEDEVAC Format request b. Tasks: (1) COC: (a) S2: Be prepared to provide updated weather reports. (b) Fire Support Commander (FSC)/S2: Verify the proximity of all pending fire missions or known enemy positions to the landing zone (LZ). (c) S3: Update the QRF Team Commander. (d) COC: Maintain communications with the helicopter until QRF Team Commander has the helicopter in sight. Then pass Command and Control to the QRF Team Commander. (2) Quick Reaction Force (QRF) Team: (a) The QRF Team Commander will ensure that the LZ is appropriately marked and of the proper size for the inbound helicopter. (b) QRF Team Commander will post one guard at each corner of the LZ facing outward. (c) Establish one entry and exit to the LZ. (d) Once in sight, the QRF Team Commander will take control of the incoming helicopter and discuss the direction of approach with the pilot. (e) The QRF Team Commander will provide the COC with updates as the situation develops. (3) Litter Bearers: (a) Know the avenues of approach and distances from the BAS to the LZ. (b) The Medic-in-Charge or Triage Officer will direct the staging of casualties, working parties, and litter-bearers. 4. ADMINISTRATION AND LOGISTICS a. Medical Officer will provide medical supplies as required. b. If the incoming helicopter is on a resupply mission, S4 will provide adequate number of personnel to assist in unloading the helicopter. The Company will provide the necessary equipment to assist in the aircraft offloading. c. QRF Team will provide adequate arms/ammunition to provide security to the LZ. 5. COMMAND AND SIGNAL a. Visual signals at the helicopter landing site shall be used. b. Establish positive voice communications. The MEDEVAC frequency is_____________________. c. Landing Zone Brief: This brief (enclosure (1)) will be given to the pilot immediately after the first voice communications. d. Use smoke on call from the pilot. e. Use clock code method if pilot does not see landing zone. f. Be prepared to guide the helo into the zone using hand and arm signals. g. Use of visual signals at the helicopter landing site: (1) Day: The only signals required are smoke and panels to mark obstacles not apparent to the aircraft (do not use panels any closer than 50 feet to touchdown point). A signalman shall be positioned to guide the lead helicopter to its touchdown point. (a) Marker panels: The top of the "T" should be into the wind. The color of the panels shall correspond to the landing site. Landing points shall be indicated with panels placed in a cross. (b) Smoke: Fired after pilot requests it. Pilot will identify the color and relay it to the LZ personnel prior to landing in the zone. (c) Mirror: Use as directed on the back of the signal mirror. Caution will be used as the reflection can temporarily blind the pilot if they are transitioning to land and you continue to signal. Discontinue signal when the pilot reports that he has the landing zone in sight. ENCLOSURE 1 (Landing Zone Brief) to TAB A (Helicopter Landing Zone SOP) to MEDICAL SERVICES TACTICAL OPERATIONS STANDARD OPERATING PROCEDURES PRIVATE LANDING ZONE BRIEF Transmission Item You Say 1. Mission Number (Provided by higher authority) 2. Location: Coord / Rad / DME 3. Unit Call Sign 4. Frequency Primary: Secondary: 5. Landing Zone Markings (If you use smoke, ask the pilot the color, do not tell the smoke color.) 6. Wind Direction & Velocity Smoke straight up No wind Smoke at 30° Wind at 3-5 knots Smoke at 60° Wind at 5-7 knot Smoke along ground Wind in excess of 8 knots 7. Elevation / Size 8. Obstacles 9. Friendly Positions (Direction / Distance) 10. Enemy Position (Direction / Distance) 11. Last Fire Received 12. Direction of Fire / Distance 13. Clearance to Fire (Direction / Distance) 14. Approach / Retirement (Recommended) 15. Personnel / Equipment 16. Other DESCRIPTION OF MEDICAL EVACUATION REQUEST PREPARATION LINE ITEM EXPLANATION SOURCE NORMAL SOURCE REASON FOR INFORMATION 1 Location of Pick-up Site Encrypt the grid coordinates of the pick up site. When using DRYAD Numeral Cipher, the same “SET” line will be used to encrypt the grid zone letters and the coordinates From Map Unit Leaders Required so evacuation vehicle knows where to pick up patient. 2 Radio Frequency Call Sign And Suffix Encrypt the frequency of the radio at the pick up site, not a relay frequency. The call sign of a person to be contacted at the pick up site may be transmitted in the clear. From SOI Radio Operator Required so that the evacuation vehicle can contact requesting unit while en-route for additional information as needed. 3 Number of Patients by Precedence Report only applicable information and encrypt the brevity codes: “A” – Urgent “B” - Urgent Surgical “C” – Priority “D” – Routine “E” – Convenience If two or more categories must be reported, insert the word “Break” between each category From Evaluation of Patient(s) Medic or Senior Person Present Required by unit controlling the evacuation vehicles to assist in priority of missions. 4 Special Equipment Required Encrypt the applicable brevity codes. A – None B - Hoist C - Extraction equipment D - Ventilator From evaluation of patient or situation Medic or Senior Person Present Required so that the equipment can be placed on board the evacuation vehicle prior to the start of the mission. 5 Number of Patients by TYPE Report only applicable information and encrypt the brevity code. If requesting MEDEVAC for both types, insert the word “Break” between the litter entry and the ambulatory entry. “L” - and Number of Litter Patients “A” - and Number of Ambulatory Patients From evaluation of patient(s) Medic or Senior Person Present Required so that the appropriate number of evacuation vehicles may be dispatched to the pick-up site. 6 (Wartime) Security of Pick up Site Encrypt the applicable brevity code only: “N” - No Enemy troops in area “P” - Possible Enemy Troops in Area “E” - Enemy Troops in Area, Use caution “X” - Enemy Troops in Area, Armed Escort Required From Evaluation of the Situation Unit Leader Required to assist the evacuation crew in assessing the situation and determining if assistance is required. More definitive guidance can be furnished to the evacuation vehicle while it is en route. LINE ITEM EXPLANATION SOURCE NORMAL SOURCE REASON FOR INFORMATION 6 (Peacetime) Number and Type of Wound, Injury Specific information regarding patient wounds by type (gunshot or shrapnel). Report serious bleeding, along with patient blood type, if known. From Evaluation of Patient Medic or Senior Person Present Required to assist evacuation personnel in determining treatment and special equipment needed. 7 Method of Marking Pickup Site Encrypt the brevity codes: A - Panels B - Pyrotechnic signal C - Smoke signal D - None E - Other Based on situation and availability of material Medic or Senior Person Present Required to assist crew in identifying the specific location of the pickup site. The color of panels or smoke should not be transmitted until the vehicle contacts the unit. 8 Patient Nationality and Status The number of patients in each category need not be transmitted. Encrypt only the applicable brevity codes: A - US Military B - US Civilian C - Non-US Military D - Non-US Civilian E - EPW From Evaluation of Patient Medic or Senior Person Present Required to assist in planning for destination facilities and need for guards. Unit requesting support should ensure that there is Englishspeaking representative at the pickup site. 9 (Wartime) NBC Contamination Include this line only when applicable. Encrypt the applicable brevity codes: N - Nuclear B - Biological C - Chemical From Situation Medic or Senior Person Presen Required to assist in planning for the mission. Determine which evacuation vehicle will accomplish the mission and when it will be accomplishe 9 (Peacetime) Terrain Description Include details of terrain features in and around proposed landing site. If possible, describe relationship of site to prominent terrain feature (lake, mountain, tower). From Area Survey Person at Site Required to allow evacuation personnel to assess route/avenue of approach into area. Of particular importance if hoist operation is required EVACUATION CATAGORIES URGENT - PRIORITY 1 This precedence is assigned to emergency cases that should be evacuated as soon as possible and within a maximum of 2 hours to save life, limb, or eyesight. URGENT SURGICAL - PRIORITY 1A This precedence is assigned to patients who must have far forward surgical intervention to save life and to be stabilized for further evacuation. PRIORITY - PRIORITY II This precedence is assigned to sick, injured, and wounded personnel requiring prompt medical care. It is used when the individual should be evacuated within 4 hours or his/her medical condition will deteriorate to such a degree that he/she becomes an URGENT precedence. ROUTINE - PRIORITY III This precedence is assigned to personnel requiring evacuation, but whose medical condition is not expected to deteriorate significantly. The sick, injured, or wounded in this category should be evacuated within 24 hours. CONVENIENCE - PRIORITY IV This precedence is assigned to patients for whom air evacuation is a matter of medical convenience rather than necessity. TRIAGE CATAGORIES QUICK REFERENCE CHART BREATHING NO reposition airway NO EXPECTANT YES  = > 30/min--------------------IMMEDIATE = < 30/min CIRCULATIONCapillary Refill >2sec or weak/irregular pulse -->IMMEDIATE <2sec or strong pulse MENTAL STATUS Follows simple commands--------------DELAYED Fails to follow commands-------------IMMEDIATE TRIAGE CATEGORIES IMMEDIATE: Life threatening problems, which should be correctable with immediate medical intervention. Prediction is 20% of the casualties. EXAMPLES:(A) Sucking chest wounds, tension pneumothorax, respiratory obstruction, asphyxia, maxillofacial wounds with asphyxia or where asphyxia is likely to develop, (B) exsanguinating internal hemorrhage unresponsive to vigorous volume infusion, (C) most cardiac injuries, (D) central nervous system wounds with deteriorating neurological status, (E) unstable chest and abdominal wounds, (F) inaccessible vascular wounds with limb ischemia, (G) incomplete amputations, (H) open fractures of long bones, (I) white phosphorous burns, and second or third degree burns of 15 – 40% total body surface area. DELAYED: Significant injuries requiring medical care, but in which a delay in giving care will not lead to loss of life or limb. Prediction is 20% of the casualties. EXAMPLES: Stable abdominal wounds, soft tissue injuries requiring debridement, maxillofacial wounds without airway compromise, vascular injuries with adequate collateral circulation, genitourinary tract disruption, fractures requiring operative manipulation, debridement and external fixation, most eye and CNS injuries. EXPECTANT: Life threatening injuries unlikely to respond to medical intervention. Prediction is 20% of the casualties. EXAMPLES: Unresponsive patients with penetrating head wounds, high spinal cord injuries, mutilation explosive wounds involving multiple anatomical sites and organs, second and third degree burns in excess of 60% of body surface area, convulsions or vomiting within 24 hrs of radiation exposure, profound shock with multiple injuries, agonal respirations. MINIMAL: The “walking wounded.” Prediction is 40% of the casualties. EXAMPLES: Burns less than 15% body surface area (except for hands, face, genitalia), upper extremity fractures, sprains, abrasions, behavioral disorders or psychological disturbances.