NATO UNCLASSIFIED
SUPREME HEADQUARTERS ALLIED POWERS
EUROPE
GRAND QUARTIER GÉNÉRAL DES PUISSANCES ALLIÉES
EN EUROPE
B-7010 SHAPE, BELGIUM
Our ref:
SHAPE/JMED/
Date:
09 March 2015
TO:
Tel:
Tel:
NCN:
Fax:
+32-(0)65-44-7111 (Operator)
+32-(0)65-44-3930
254 + 3930
See Distribution
SUMMARY RECORD – MEETING OF THE MEDICAL ADVISOR BOARD HELD IN
NAPLES 10-11 FEBRUARY 2015
ATTENDEES:
ACO MEDAD
JFCBS MEDAD
JFCNP MEDAD
HQ AIRCOM Ramstein
HQ MARCOM Northwood
HQ LANDCOM IZMIR
HQ STRIKFORNATO Oeiras
HQ ARRC
HQ EUROCORPS
HQ 1 GE/NL CORPS
HQ NRDC IT
Mil Med COE
HQ USEUCOM
JFCNP MEDAD (Vice)
HQ 1 GE/NL CORPS (Vice)
JFCNP
HQ NRDC IT
SHAPE JMED
SHAPE JMED
BGen Istvan KOPCSO
Col Thierry LANTERI
Col Joerg FRERICHS
Capt Anas RAJA
Surg Capt Andrea TAMBURELLI
LTC Metin DEMIR
Lt Cdr Raul CARDENAL
Col David MORGAN-JONES
Maj An VERCAUTEREN
Col Ingo HARTENSTEIN
Col Michele TIRICO
BGen Stefan KOWITZ
Col John MITCHELL
Col Joerg HILLEBRANDT
Col Frans DIJKGRAAF
Surg Cdr Andrew NELSTROP
LTC Jurgen MUNTENAAR
LTC Andreas VALENTINER
Wg Cdr Helen STEWART
Chairman
Member
Member
Member
Member
Member
Member
Member
Member
Member
Member
Observer
Observer
Observer
Observer
Observer
Observer
Secretariat
Secretary
A summary of the Board’s discussions and decisions is recorded below with the
associated actions. If further background information is required, reference should
be made to the presentations.
ITEM 1 – OPENING REMARKS
1.
ACO MEDAD welcomed all participants to the newly renamed Medical
Advisory Board. Apologies had been received from NRDC SP and HQ MNC NE.
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ITEM 2 – UPDATE from ACO Medical Advisor
1.
Current situation is historical with many changes. Previously the NATO RUS
Council had been making good progress particularly with regards to medical. With
recent events the situation had changed. The development of hybrid warfare means
that ACO would need to be able to react in a timely manner. Wales was the most
significant summit with NATO being tasked with the RAP, Assurance measures and
the development of VJTF and NFIU.
2.
There would be more emphasis on exercises and in using TOPFAS. TRJE 15
and TRJE 16 would act as the certification exercises for the revitalised NRF.
Augmentation of the NRF, including medical, would be revisited and was due to be
completed within a year, which would be challenging as it needed to go through NAC
approval and submission to the MC. MARCOM certification would take place in Mar
15 and there would be an increase in exercises as part of the assurance measures.
The increased number of exercises per year would become the norm and the
enhanced tempo was set to continue. ISIL and other threats, including the RUS
situation meant that activities were ongoing in the UKR and other parts of the world.
At a recent high level Africa Conference some analysts stated that the future of
NATO was in Africa.
3.
The main priority still would be Resolute Support (RS) and the MMMSG,
whose scope had been extended to include all NATO operations, would take place in
Mar 15. This meeting provided the opportunity for some deconfliction of medical
force generation offers.
4.
There would be significant changes occurring within COMEDS with the
Chairman changing to CAN BGen Bernier. The incoming Liaison Officer would be
Col Gerard Rots (NL) and Col Edouard Albert, the outgoing Liaison Officer would be
moving to IMS.
5.
At a recent meeting of COMEDS in Interlaken the development of governance
of COMEDS was discussed; looking at how to coordinate more effectively the
working groups and expert panels. There would be changes to the COMEDS ToRs
and as COMEDS were the experts therefore the term expert would be removed with
regard to the specialist panels. The telemedicine panel would be disbanded, but a
temporary team in the Aeromedical Evacuation (AE) field would be set up as there
appeared to be some discrepancies from the non-medical Aeromedical board (not a
COMEDS Working Group) which required deconfliction by medical specialists.
There were currently 140 ongoing activities and COMEDS evaluated the majority as
being on track, with only the SOF medical body being behind timelines. The Medical
Training Expert Panel had been elevated to a Working Group and they should look
at proposing training priorities and coordinate activities. Training would become a
standing agenda item of the COMEDS. As there currently was no medical expert at
JWC there was an obligation on all to do MelMil scripting. The question raised by
the Board members was how medical was assessed? They also observed that
mentoring was missing. There was a need to evaluate medical to ensure that they
reached their goals during exercises, as this would provide evidence to the nations
that the training had been financially viable. There was a requirement to prioritise
exercises for the medical community.
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6.
One of the main topics throughout 2014 and ongoing was Ebola and at a
recent conference with NATO HQ SHAPE JFCs, and relevant IO and NGOs, it was
recognised that NATO specifically did not have a role regarding Ebola. As a
consequence IMS initiated SMART Defence Initiative on Biological responsiveness
and COMEDS issued a statement with the goal to have it as an MC statement. One
nation did not wish to support the statement, they thought that biological outbreaks
were not necessarily linked to military operations and terrorist actions, however it
was agreed by COMEDS that medical would need to be better prepared in this area.
7.
AJP4.10(b) was still in the ratification phase and it was due to be promulgated
in Feb 15, however it would be obsolete on issue and so work would be undertaken
to draft and ratify the AJP4.10(c) version which would cover how things currently
work, with the parallel drafting of the MC 326/4. Whilst medical manning across
ACO, NCFs and NFS appeared to be better, some current shortfalls remained with
additional future shortfalls predicted.
8.
There were 32 RAP workstrands with corresponding taskers at SHAPE and
the majority of them required a medical overview. Currently there were 4 medical
papers being prepared for MC approval. The Mil Med visions and strategic
objectives would be approved by COMEDS by May 15. ACT and IMS would be
producing a roadmap of how to mitigate shortfalls defined at the Wales Summit by
the end of Feb 15 and this would be submitted to the NAC by IMS. Following the
Armed Forces Declaration a paper had been drafted by the Mil Med COE. The
Medical Strategic Training Plan had not been approved by the MC and it had been
returned to COMEDS for review and amendment. MC 20/10 was being rewritten
(MC 20/11) explicitly stating that the Medical Standardisation Board was responsible
for reviewing anything that mentioned medical and was responsible for going through
LI/LL and propose any amendments to STANAGS. There had been a significant
delay in MEDICS and service acceptance for the first part was likely to be 2018 –
2020 (see further MEDIC update in AoB). The US was ready to release their
Medical Planning Tool Kit (MPTK) and NCIA were currently checking the software,
once implemented there would be an assessment undertaken with regard to the
training requirements for its use.
Action: SHAPE JMED would identify the MPTK training requirements as soon as
possible after NCIA approval.
ITEM 3 – UPDATE from JFCNP Medical Advisor
1.
TRJE 14 had been the certification exercise for JFCNP and it was felt that
there was a need to identify was expected at this command level, as at times they
thought they were being pulled into the tactical level, due to inexistent LOCON.
2.
There had been a proposal to remove the Medical Advisor from the Special
Advisory Group (SAG). However, as part of the ACO Optimisation it was stated that
the medical advisor’s direct access to the Commander should be sustained. If
medical was not part of the SAG they were likely to lose situational awareness and
end up playing catch up as decisions would have already been made. The role of
the medical advisor was not only to inform the Commander, but also needed to be
involved at the earliest stages to identify any potential hidden medical implications.
The wider experience of the medical advisors was considered an important aspect of
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being able to provide the commanders with advice. The organisational memory was
often weak, as when medical was successful it was taken for granted and it was
reiterated that medical could have impacts on both the strategic and tactical levels.
The MEDAB needed to articulate its concerns regarding the side-lining of medical in
some areas. The members were advised that questions had also been raised about
where JMED at ACO should sit and it had been suggested that JMED might be
moved under another Division, with some of the other divisions being merged;
discussions regarding this were ongoing. As the Optimisation study had been
started before the UKR activities, any changes might be delayed at MC level, but
due to the increased training requirements it was suggested that JMED should
amalgamate the FHP and Med Int posts and use the spare post for an additional
training position.
ITEM 3 – UPDATE from JFCBS Medical Advisor
1.
The MEDAD briefed on their manning issues advising that: FRA might
discontinue the MEDAD post; there was insufficient NCO admin support; the ESP
post remained gapped; currently the Dep MEDAD was detached to the US.
Regionally focused on N/NE part of NATO and developing contingency plans.
2.
Whilst RS has another 2 years to go, there might be a flexible end state. RS
Phase 1 Jan – Dec 15, medical support based on regional approach of 5 areas.
Current R3 at BAF and KAF, Dwyer was due for closure by the end of Jun 15. The
CJSOR issues related to Phase 1 had now been resolved. RS was their main
priority with TRJE15 second.
3.
A brief on TRJE 15 was provided with the following details: JTFHQ would be
deployed to ESP; during CPX personnel would be deployed to POR and to JWC
during ?ORT. The Crisis Response Phase had commenced and the CPX would
involve the NRF Component Commands. During CPX the following players would
be involved: ITA - JFAC, LCC - NRDC SP, Maritime - UK MARCOM, JLSG (provided
by JFCBS J4 with augmentees), JFCBS and SHAPE. The importance of getting the
CPX right was emphasised and it was envisaged that it would require 24 hour play, if
so JMED might require some additional staff to assist with the exercise (Ex). During
the MelMil scripting it would be important to adjust the military events to capture and
include possible medical inputs/ effects. There was a need to have assistance with
EXCON, at JWC, during the CPX and volunteers were requested.
Action: LTC Valentiner would request support by 23 Mar 15.
4.
During LIVEX RLS would be challenging for the exercise, although the HN
should provide. To better coordinate and increase SA of the Medical Task Force for
the LIVEX, RLS would be built upon the US and ESP Med Bdes, although there was
scope to integrate additional national assets. There was a requirement for TCNs to
sign TA /Financial agreements with HN. LIVEX would involve the following HN
would provide RLS (ESP, POR and ITA). Control of RLS would be exercised by a
staff element also named JLSG. SHAPE, JFCBS and single Service NCS. There
currently was no plan for any medical to be played during the LIVEX, although the
forthcoming planning conference in Ulm would provide better granularity about the
LIVEX. There were 28 NGOs attached to the Ex and the injects would also include
medical aspects. The GE/NL Corps advised that they had 2 medical specialists to
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provide inter-agency liaison. It was proposed that the TRJE15 Planning Conference
in Ulm should be the focal point for identifying how nations would provide real live
medical support and to define whether or not it would be possible to use some of the
medical assets on the ground as players. There was a need to understand what
medical capabilities were being brought. Linking medical players into different Ex
was difficult due to national financial constraints for these additional personnel. It
was important to separate RLS from players during the LIVEX. Whilst it was the
HN’s responsibility to provide RLS, JFCBS had also proposed the US for medical
RLS; however, if the US wished to use their personnel some agreement with the HN
might be required. The JFCBS MEDAD was due to leave and if not extended in post
might not act as the MEDAD for the Ex; currently FRA was trying to find a
replacement; a decision was expected by mid-March.
5.
The next MMMSG would be taking place in Brunssum 2-5 Mar; initially set up
for medical support in Afghanistan the scope of the meeting had been extended to
incorporate all NATO operations.
ITEM 4 – Brief from US EUCOM Medical Advisor
1.
Col Mitchell the USEUCOM provided a brief about EUCOM. EUCOM were
using TRJE15 as an opportunity for evaluating medical interoperability, and raised
the question of whether or not there were any interoperability training standards. In
response, there were 75 STANAGS available, all of which provided interoperability
agreements, however, there remained some national differences as well as some
internal inter-service differences. The members were advised that the US would be
practicing a 4-bedded R3 element and in all would have approximately 300 medical
personnel taking part during the LIVEX. As future operations might result in
disruption to healthcare facilities, the future might require medical support to be
provided out of modular capabilities.
ITEM 5 – Wales Summit Declaration, RAP and VJTF
1.
Following the Wales Summit some of the assurance and adaptive measures
had become blurred. The adaptive medical implications were to make the NRF more
nimble and deploy faster, to show that NATO could react quickly to a hybrid threat.
There had been 5 nations identified for PRC/IVJTF and a Battalion size would Ex
next year (financial costs lie where they fall). The Spearhead element of the future
NRF would have a shorter reaction time with 5-7 days NTM, medical manning would
be needed and it was assessed in order to guarantee one R2 at this readiness state
in fact 3 or 4 R2 of the TCN would be affected. For a Bde the medical support would
probably consist of R2-LM, plus 1-2 forward surgical teams, ground and RW
MEDEVAC elements and a PECC capability. It was suggested that as the conflict
moved towards Article V that the level of reliance experienced in ISAF on RW
MEDEVAC might have to be reduced. It was also suggested that the EU
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Battle Group Medical task Force structure, or the Danish model (two R2 per Bde),
might provide some guidance to the VJTF medical support model.
Action: LTC Valentiner would seek information from both EU BG and DNK
regarding their medical support models by 01 Apr 15.
2.
There would also be a new entity, yet to be stood up, the NATO Force
Integration Units (NFIU), currently 7 counties had been identified and this would
provide the Liaison Officer (LNO) / permanent OLRT function within the countries
preparing for the arriving forces. The use of a multinational medical staff officer
within each NFIU was suggested, as this would reduce any HN bias towards national
assets. The NFIUs were seen as part of the NATO Force Structure, if they became
part of this they would require MOUs. The NFIUs would not necessarily be identical
in each country. It was suggested that MN personnel of NFIUs could be used to
augment the JLSG manning. Discussion ensued regarding the differences between
the VJTF, which would be a rotating force, and the previous AMF (L), which was a
standing force. The short NTM of the VJTF would require many personnel to cover
the requirement and this might be difficult with the scarcity of medical personnel. It
was suggested that using either a standing multinational (might bring language and
standardisation issues), or a mono-national standing force might provide a better
medical solution. The overall manning of the NFIUs would be critical and would
show national support for the concept.
ITEM 6 – Update from GE/NL Corps Medical Advisor
1.
GE/NL Corps were involved, at short notice, with Ex NOBLE JUMP,
multinational forces from POL, CZE, NOR, NL and GER deployed to POL.
2.
If IVJTF was defined as a small Bde, there might be EU Working Time
Directive impacts on assigning personnel to a NTM of between 5-7 days, as there
might be some financial implications during peacetime. Once the NRF policy papers
had been re-written then MC551 would need to be reviewed, in light of the other
NRF changes.
Action: MC551 would be reviewed by SHAPE JMED once NRF policy papers had
been produced.
ITEM 7 – Update from LCC Medical Advisor
1.
Currently seeking new CE to meet new concept of LCC. There was some
discussion surrounding the forthcoming TRJE15 and attendance of interested parties
at the forthcoming Planning Conference in Ulm was advised. JFCBS would provide
some clarification with regard to LCC’s responsibilities.
2.
It was suggested that 2-monthly VTCs would enable all NCS/NFCs to have a
shared vision and to discuss any Ex related or other topics. The use of Lync rather
than VTC was proposed as a better and quicker way of discussing subjects. The
use of Reservists for Ex was suggested as they provide some enduring memory.
The increase in the number of Ex would require greater coordination and
prioritisation of medical efforts and the MEDAB should act as the coordinator,
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planning up to 2 years ahead. Ex would become a standing agenda item for the
MEDAB, with ACO MEDAD representing the Board’s decisions to COMEDS.
Actions:
a.
MEDAB Secretary would include exercises as a standing agenda item.
b.
ACO MEDAD would represent the MEDAB’s decisions on exercise
priorities to COMEDS.
ITEM 8 – Armed Forces Declaration – discussion by MilMed COE
1.
MilMed COE were responsible for identifying areas for improvement, these
might include training, policy, or amendments to other documents. The Medical
Training WG would synchronise and prioritise the list and identify any new training
requirements; these could be provided through national, NATO Oberammergau,
COE, or other resources. All areas should feed training requirements to ACO and
these could then be included in the annual Synchronisation Conference, which would
require medical representation. As the MEDADs were the owners of medical there
would be a need to have significant working relationships between MEDAB and
MilMed COE to ensure a cohesive approach. This requirement by the MEDAB
would be captured in the new Board’s ToRs. It was agreed that MilMed COE would
become a permanent attendee of the new MEDAB. As NATO (via ePrime) paid for
courses (personnel from UKR had recently attended) wider attendance should be
encouraged. MEDEX Clean Care VG15 might not occur due to a lack of
participants.
2.
The importance of medical observations leading to LI/LL was emphasised and
these should also include those from Ex. It was agreed that the MEDAB should be
extended in the future to capture experiences / observations and to review the LIs. It
was also important to recognise areas of success as well as areas for improvement,
so that best practice could be identified. The recent COE paper on their new LI/LL
process was discussed and all attendees were asked to review the attached
(attachment 1) and to send their comments to COE. Some comments during the
meeting included: possibly extending the process to capture non-clinical
observations, the role of COE in analysing the observations to recognise any trends,
patterns and risks from the observations, whilst avoiding any unnecessary focus on
isolated, singular observations, to identify the LIs. It was suggested, that following
the validation and analysis stage of the process that the urgent action body of
COMEDS Secretary, ACO, ACT and IMS representatives should be the deciding
body on which LIs should be sent for urgent or regular action. To ensure Ex
observations were also captured the ACO MEDAD issued direction that all post
evaluation Ex reports should to be sent to the MilMed COE. There was also a
requirement for increased input from nations to the MilMed COE.
Actions:
a.
All MEDAD Members would review and provide comments on the
attached Mil Med COE LI/LL process by 23 Mar 15.
b.
All MEDAD Members would forward any exercise reports to the Mil
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Med COE.
3.
The development of SOPs was discussed, the MMSOP had provided an SOP
for Medical Reporting and the GE/NL Corp MEDAD would send a copy of this to the
Board Members for their review. There was a need to analyse what information was
required, whilst identifying what it would be used for. The ARRC MEDAD was asked
to provide a PECC SOP.
Actions:
a.
GE/NL Corp MEDAD would send a copy of the Medical Reporting SOP
to the Board Members, who would review and comment by 17 May 15.
b.
The ARRC MEDAD would provide the PECC SOP by 17 May 15.
4.
There was a need for a common medical intelligence operational picture,
where any national differences e.g. in FHP were transparent, as this would enable
data to be analysed and to be linked to research. Additionally, data analysis had
already shown how longer transfer timelines had led to increased mortality/morbidity
and therefore there was a requirement to evaluate the skillset required for
MEDEVAC.
ITEM 7 – New MEDAB ToRs.
1.
A draft copy of the new Board’s ToRs were presented, it was important for the
MEDAB to be properly defined as a decision making body. MARCOM MEDAD
would send a copy of the draft ToRs to all MEDAB Members for review and
comment. To assist with the short time line for submission the Board Members were
to review and provide comments on the draft ToRs within 4 weeks, the final version
would be signed by the Chairman (ACO MEDAD), or COS SHAPE (TBD), with a
copy to ACO DCOS Res. The importance of not infringing on the scope of the
MMSOP was articulated and LTC Valentiner would send a copy of the draft MEDAB
ToRs to the MMSOP for comment.
Actions:
a.
MARCOM MEDAD would send a copy of the draft ToRs to all MEDAB
Members who would review and provide comments by 31 Mar 15 (attachment
2).
b.
LTC Valentiner would send a copy of the draft MEDAB ToRs to the
MMSOP for comment by 27 Feb 15.
c.
The finalised MEDAB ToRs would be signed and a copy would be sent
to DCOS Res.
ITEM 8 – Update from MARCOM Medical Advisor
1.
MARCOM was the only advocate for maritime issues in NATO and the
provision of a mentor during the preparation phase of Ex was suggested. It was
proposed that the new emphasis on Ex should be utilised to address the gapping of
the medical post at JWC. The idea of triggering nations to consider a NATO
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sponsored R2 B/E afloat was suggested and MARCOM MEDAD was advised to
discuss this suggestion at the Maritime Medical Conference.
Action: MARCOM MEDAD would discuss this suggestion of a NATO sponsored R2
B/E afloat at the Maritime Medical Conference.
ITEM 9 – Any other business
1.
MEDICS Update by HQ ARRC MEDAD. A number of the MEDADs had
attended the MEDICS SOR review in the US during the week prior to the MEDAB
meeting. Key points to note were: it does have considerable operational potential to
support planning at the 3* level. TOPFAS already had components built into it for
medical and the NCIA would be opening a portal into their website to enable medical
planners to access their user instructions. MEDICS needed to be fully embraced by
the ACO MEDAD’s Panel for its potential to be fully realised and it was suggested
that MEDICS should become a standing agenda item, so that progress could be
tracked and supported.
2.
Next MEDAB. The next meeting would take place at AIRCOM with Capt
Anas RAJA as POC, it would be over 2 full days in the middle of November 15
(Sec’s note: due to Ex events next meeting would take place 19-21 Jan 16, pending
availability).
Helen Stewart
OF-4 GBR AF
Secretary
DISTRIBUTION
External:
Internal:
Action:
Action:
JFCBS MEDAD
JFCNP MEDAD
HQ AIRCOM MEDAD
HQ MARCOM MEDAD
HQ LANDCOM MEDAD
HA STRIKFORNATO MEDAD
HQ ARRC MEDAD
HQ EUROCORPS MEDAD
HQ 1 GE/NL CORPS MEDAD
HQ NRDC IT MEDAD
HQ NRDC SP MEDAD
HQ NRDC TU MEDAD
HQ RRC FRA MEDAD
HQ GRC CORPS MEDAD
HQ MNC NE MEDAD
Mil Med COE
ACO MEDAD
HS HQ SHAPE
SHAPE JMED
Information:
DCOS Res
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Information:
HQ USEUCOM MEDAD
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