IL FUTURO NORMATIVO E PROCEDURALE IN AMBITO EUROPEO E NATO

1

T.Col. Francesco TORCHIA

CORPO SANITARIO AERONAUTICO CHAIRMAN EAG AvMed CB

• Overview of International regulations/procedures related to the Aeromedical Evacuation

• NATO Standards

• European Air Group

– Aviation Medicine project

– Strategic AE projects

• European Defence Agency

• From standardization to INTEROPERABILITY

Agenda

30-Oct-14 2

NSA

Military Committee

MCMedSB

COMEDS

MCLSB

MCMSB

MCASB

Working Groups

EXPERT Panels Expert Panels

NATO ORGANIZATION

: MEDICAL Policy

: MEDICAL Standardization

MedStdWG MedCBRN MilHC MMSOP

MCJSB

MM Steering Group

AMD WG

NATO AE Documents

30-Oct-14 4

• 3204 (ed. 7) Aeromedical Evacuation

• AJP 4.10 (A) • Related documents (between others)

- 2040: Stretchers, bearing brackets and attachement support

- 2132: Documentation relative to medical evacuation treatment and cause of death of patients

- 3345: Data/Forms for planning air movements

- 2087: Medical employment of air transport in the forward area

NATO AE 3204 (ed. 7)

30-Oct-14 5

• General statements

- Ann. A: Terminology

- Ann. B: Selection of patients

- Ann. C: Classification - Priority

- Dependency

- Classification

- Ann. D: Procedures

- Ann. E: Equipment

- Ann. F: Training

- Ann. G: Chemical and infectious patients management

STANAG 3204 ed. 8 in Ratification Draft 2

9 liner message

COMANDANTE DELL’UNITA’ / GDO

POC PHONE

FORZE ARMATE ITALIANE

SCHEDA PER RICHIESTA EVACUAZIONE PAZIENTE

A: COI JMCC - COI JMED – COI OPS.ROOM

COGNOME / NOME N° MATRICOLA

GRADO NAZIONALITA'

FORZA ARMATA

STRUTTURA SANITARIA DA CUI VIENE SGOMBERATO

POC PHONE:

M DATA DI NASCITA

F

1

URGENTE (IPV) SALVA VITA

SALVA ARTI

SALVA

FUNZIONI

2 PRIORITY ( MAX 48 HRS) P

RIO

RIT

À

PR

IOR

ITY

3 ROUTINE

1 ALTA

2 MEDIA

3 BASSA

AS

SIS

TE

NZ

A I

N

VO

LO

DE

PE

ND

EN

CY

4 MINIMA

1A PSYCHIATRIC

SEVERE

1B PSYCHIATRIC

INTERMEDIATE

1C PSYCHIATRIC

MILD

2A STRETCHER IMMOBILE

2B STRETCHER

MOBILE

3A

SITTING Not psychiatric NEEDS HELP TO ESCAPE

DIAGNOSI E PROCEDURE CHIRURGICHE EFFETTUATE:

1. IL PAZIENTE E’ IN IMMINENTE PERICOLO DI VITA (IPV)

2. IL PAZIENTE E’ TRASPORTABILE PER VIA AEREA E

SUCCESSIVO TRASFERIMENTO INTERMODALE

3. PAZIENTE E’ AFFETTO DA MALATTIE INFETTIVE

CONTAGIOSE

4. ESISTONO INDICAZIONI SANITARIE CHE IMPONGONO IL

TRASFERIMENTO A BORDO DI VETTORE PRESSURIZZATO

5. IL PAZIENTE E’ BARELLATO

6. E’ NECESSARIA ASSISTENZA SANITARIA A BORDO CON

a) MEDICO NON SPECIALISTA b) MEDICO SPECIALISTA ANESTESISTA/RIANIMATORE c) MEDICO SPECIALSTA CARDIOLOGO d) INFERMIERE

e) ACCOMPAGNATORE NON SANITARIO

7. E’ NECESSARIO IMBARCARE EQUIPAGGIAMENTO

SANITARIO SPECIALE

a. MONITOR MULTIPARAMETRICO

b. DEFIBRILLATORE c. PACING EST. d. POMPA INFUSIONALE e. VENTILATORE AUTOMATICO f. OSSIGENO g. TAVOLA SPINALE h. KIT PER RIANIMAZIONE

SI

1

2

3

4

5

6

a

b

c

d

e

7

a

b

c

d

e

f

g

h

NO

1

2

3

4

5

6

a

b

c

d

e

7

a

b

c

d

e

f

g

h

TIPOLOGIA PAZIENTE (SONO POSSIBILI PIÙ SCELTE)

3B

SITTING Not psychiatric NO HELP TO

ESCAPE

TRAUMA DA COMBATTIMENTO BATTLE INJURY (BI)

MALATO DISEASE (D)

TRAUMA NON DA COMBATTIMENTO NON BATTLE INJURY (NBI)

CONTAGIOSO (DA ISOLARE) CONTAGIOUS (ISOLATE)

4 WALKING

STRESS DA COMBATTIMENTO BATTLE STRESS (BS)

CONTAMINAZIONE CONTAMINATION

MEDICO CHE CHIEDE L’EVACUAZIONE / GDO

CL

AS

SIF

ICA

ZIO

NE

N

AT

O

CL

AS

SIF

ICA

TIO

N

POC PHONE

RICHIESTA EVACUAZIONE SANITARIA (FAC SIMILE)

FM (XXXXXXXX) inserire indirizzo Ente Responsabile che scrive

TO COI JMCC

COI JMED

INFO POLICLIMILES

inserire tutti gli altri INDIRIZZI IDONEI

UNCLASS

SIC WAI

OGGETTO/:/ OPERAZIONE (inserire nominativo operazione militare) - RICHIESTA

TRASPORTO EVACUAZIONE SANITARIA (inserire se PER I.P.V., oppure

IN PRIORITA’ UNO1 oppure IN PRIORITA’ DUE

2).

TESTO: SI RICHIEDE EVACUAZIONE SANITARIA (se PER I.P.V., o IN PRIORITA’

UNO o IN PRIORITA’ DUE) SU POLICLIMILES CELIO DEL SEGUENTE

PERSONALE:

- GRADO COGNOME NOME;

- NUMERO TESSERA MILITARE;

- REPARTO DI APPARTENENZA.

IL PAZIENTE:

- EST AFFETTO DA (inserire sintetica DIAGNOSI)

- NON EST AFFETTO DA ALCUNA PATOLOGIA CONTAGIOSA;

- PUO’ ESSERE TRASPORTATO PER VIA AEREA ET AUTOAMBULANZA (specificare

eventuali limitazioni);

- (se I.P.V. specificare EST RICHIESTO VETTORE AEREO URGENTE PER RISCHIO

IMMINENTE PERICOLO DI VITA);

- (se utilizza vettori strategici prepianificati specificare POTEST UTILIZZARE VETTORE

PREPIANIFICATO SAFOPS et specificare numero del volo) DEL GIORNO (specificare la

data del volo);

- (se ci sono motivi medici gravi, inserire) VETTORE PREPIANIFICATO DEBET FARE

SCALO AGGIUNTIVO A CIAMPINO PERCHE’ (specificare motivo medico);

- (inserire EST o NON EST) BARELLATO;

- (se non è barellato inserire DEAMBULA NORMALMENTE oppure DEAMBULA CON

STAMPELLE oppure DEAMBULA CON ACCOMPAGNATORE);

- (inserire NECESSITA oppure NON NECESSITA) DI ASSISTENZA SANITARIA (inserire se

MEDICA oppure INFERMIERISTICA) A BORDO (se procurata dal teatro aggiungere

nominativo dell’accompagnatore e/o medico e/o infermiere);

- (inserire NECESSITA o NON NECESSITA) DI SUPPORTI/ATTREZZATURE MEDICHE A

BORDO TIPO (inserire il tipo di attrezzature necessarie) (se procurate dal teatro

aggiungere PROCURATE AT CURA SCRIVENTE, se sono invece fornite da altro Ente

aggiungere DI CUI EST STATA COORDINATA FORNITURA DA PARTE DI et specificare

con quale Ente è stata coordinata la fornitura dell’attrezzatura);

CERTIFICATI MEDICI IN ORIGINALE DI TRASPORTABILITA’ AEREA E NON

CONTAGIOSITA’ VERRANNO CONSEGNATI AT CAPO-EQUIPAGGIO ALL’ATTO

DELL’IMBARCO.

FIRMATO IL RESPONSABILE GRADO NOME COGNOME TELEFONO.

1 PRIORITA’ UNO indica la obbligatorietà di imbarco su primo vettore prepianificato possibile creando eventualmente

il posto, qualora non disponibile. 2 PRIORITA’ DUE indica la necessità di imbarco su primo vettore prepianificato utile.

STRATEVAC

European Air Group

30-Oct-14 8

Multinational, Single Service organisation

Based on an Inter Governmental Agreement (IGA)

9

To improve the operational capabilities of the

Parties’ Air Forces to carry out operations in pursuit

of shared interests, primarily through mechanisms

which enhance interoperability.

THE EAG MISSION

Av Med Project

The objective of this Technical Arrangement is to provide a multi national framework to promote and facilitate

collaboration and cooperation between the Participant´s Air Forces in the field of

Aviation Medicine

Aviation Medicine TA Signed 2005; 5th Amendment 01 January 2012

- To improve interoperability

- To reduce costs

- To create a forum for discussion and mutual knowledge

- Cooperation with EDA, NATO AMDWG, ASIC

• Aviation Medicine TA • Advanced Aviation Medicine Course • EAG Common Medical Record • Agreed Flight Surgeon Course Syllabus • AE Catalogue • Specialty Matter Expert List • EAG AVMED WISE site • Common Medical Standards • High Cost Equipment TA • EAG’s UAV Med Standards • Strategic AE TA

EAG AvMed Products

Short &

Medium Term

• Aim: To share information and to make planners aware of the

AE capabilities and to optimize EAG Nations’ resources.

• AE Equipment Make & Model

• AE Assets Aircrafts & Configurations

• AE Related Documents

• AE Units & Coordination Cells

• AE Activities & Statistics

EAG AE Catalogue

EAG AE Catalogue Examples Out of Date

Air Bio medevac - Equipment

(ATI)

• Aim: To share strategic transport between

Member States - located in Eindhoven (NLD)

• Germany, France, Belgium, The Netherlands,

Luxembourg, Spain (ITA will join in 2015).

»EATC - AECC (European Air Transport

Command – Aeromedical Evacuation

Control Centre) uses EAG AE

Catalogue to plan and conduct real AE

missions

EATC European Air Transport Command

EATC 2013

Ex. VOLCANEX

Ex. EATT

30-Oct-14 18

Standardizzare e testare procedure, training e

equipaggiamenti vitali per una efficace interoperabilita’

PROTECT – MEDICAL / CONFIDENTIEL MEDICAL

EAG In – Flight Patient Transfer Form / fiche de suivi du patient durant le vol

Surname / Nom

Forenames / Prénoms Gender/Sex DOB DDN

Service No. / Matricule

Rank / Grade

Service / Armée

Unit / Unité

Pre-Flight Administration Checklist / checklist avant départ

Passport: ID: Doctor/Hospital Letter: Medical Notes Own M edications: CI courrier médical dos sier médical médicaments

X-Rays or scans Radios

Type: Medication Current: Ttt actuel

Priority: Priorité

Classification: Dependency:

Dependency: Dépendance

Pre-Flight Brief by: transmissions avant le vol réalisées par

Rank Date

Presenting Complaint: Affections en cours

History of Presenting Complaint: Or Mechanism of Injury: Histoire de la maladie

Past Medical History / Antécédents

Allergies:

Medical / médicaux

Surgical / chirurgicaux

On Examination: Examen clinique

Physical Appearance, General Behaviour / apparence physique, comportement

Mood / Humeur

Speech & Thought / Elocution & pensées

Abnormal Perception / sensations anormales

Cognitive State / état cognitif

Insight & Judgement / perspicacité & jugement

Baseline Observations

Temp oC Weight/Poids Haemoglobin/

Haemoglobin/ BP / PA HR / FC SpO2 %

DTG (Zulu) / Date, h (Zulu)

Fit to Fly: Apte au vol

Yes No Authority By: Délivré par

Comments: Commentaires

Date:

Signature: Name: Rank:

Statistics (indicate with YES if required/delivered or NO if not needed) / cocher les cases si besoin

Treatment Pre-Flight / traitement avant le vol Treatment During Flight / traitement pendant le vol

1. Haemodynamic Obs Surveillance hémodyn

4. DVT Prophylaxis prévention thromboses

1. Haemodynamic Obs Surveillance hémodyn.

4. DVT Prophylaxis prévention thromboses

2. Oximetry oxymétrie

5. Pressure Area Care / Soins aux zones d’appui

2. Oximetry oxymétrie

5. Pressure Area Care Soins aux zones d’appui

3. Extremity Checks contrôle des extrémités

6. Other autres

3. Extremity Checks contrôle des extrémités

6. Other autres

19 30-Oct-14

20 Thursday, 30 October 2014

EAG/EATC AE DOCUMENTS

1. 9-Line Request (NATO Standard)

2. PMR* High Care

3. PMR Low Care

4. Patient Report Form

5. PMR Lite – Tactical AE PMR

6. AE Catalogue

7. AE Crews Training Syllabus

8. Draft AE Technical Arrangement (TA) *Patient Movement Request

21

EAG AE Project background:

IMPROVEMENTS can be made in terms of costs,

efficiency and effectiveness when operating together.

AE TA

EAG STRATEGIC AE PROJECT

30-Oct-14 22

AIM: reduce costs and delays by establishing a

framework allowing Nations to perform MN AE

missions and to use ATARES as the reciprocal

compensating mechanism.

Many Strategic MN AE mission standards apply

also to Tactical MN AE missions

Air Transport and Air-to-Air Refuelling Exchange of Services (ATARES) TA.

EXCHANGE OF SERVICES

NO use of CASH: currency is the

C130 flying hour and equivalent

ATARES

ALL THIS IMPLIES DEFINING:

• The legal framework.

• The EAG National AE services reciprocally

acceptable.

• The Multinational AE Cross-training Program.

• The common and minimum onboard AE equipment.

• The common AE forms & SOPs.

• The specific costs within the ATARES framework.

STRATEGIC AE TA PROJECT

30-Oct-14

MAIN ISSUES:

REDUCE costs – REDUCE delays – ESTABLISH

framework – ALLOW MN AE missions – USE ATARES

24

MEDICAL SUPPORT – Project Team Medical

EUROPEAN DEFENCE AGENCY

2

6

The European Defence Agency

European Defence Agency: agency of the European Union, under

authority of the EU Council, which issues guidelines to and receives

reports from High Representative as Head of the Agency.

High Representative chairs the Steering Board, the principal decision-

making body of the Agency, made up of Defence Ministers from 26

participating Member States (all EU members except Denmark) and a

member of the European Commission.

AIM: to offer a forum for identifying and satisfying operational

requirements and supporting the European Defence technological and

industrial base.

“Pooling & Sharing” is a concept aimed to preserve and enhance national

opertional capabilities – with improved effect, sustainability,

interoperability and cost efficiency as a result.

2

7

EDA Organisation Chart

MANOEUVRE

IDT DEPLOY IDT SUSTAIN

PT

MEDICAL PT

SEABORNE

LOGISTICS

SUPPORT

PT

FUEL

AND ENERGY

TPLS

PLATFORM PO (2)

HELICOPTER

PO

MEDICAL

PT

EATF

CAPABILITY

DIRECTORATE

STEERING

GROUP

2

8

Goal of the PT MED

Project Team Medical goal: to find out solutions

to the capability gaps identified by the EU in the

field of medical support

PT Med needs to promote effective and economic

medical support of deployed forces, offered by

pMS for operations, by seeking multinational

integrated or cooperative solutions (Pooling &

Sharing)

29

IDT Sustain – Pooling & Sharing

Current PT

Medical

•

Deliverable

• Ad Hoc Working Group MEDEVAC

1. Medical Field Hospital

- 3MU “Multinational Military Medical Units”

2. Medical Evacuation

3. Medical Supply – Blood, Oxygen, Drugs

4. Force health protection – examination, vaccination,

epidemic

5. Medical C3 - Casualty Tracking and Tracing

- Telemedicine

- diseases surveillance

10/30/2014 30

HOSPITALI-

SATION

RESUSCITATION

AND STABILI-

SATION

ADDITIONAL

EMERGENCY

SURGERY AND

SURGERY TO

MINIMISE RESIDUAL

PHYSICAL AND MEN-

TAL DISABILITIES

IMMEDIATE

LIFE SAVING

SURGICAL

INTERVENTIONS

PREVEN-

TIVE

MEDICINE (BEFORE

DEPLOY-

MENT)

PREVEN-

TIVE

MEDICAL

MONITO-

RING

DEFINI-

TIVE

TREAT-

MENT

&

REHA-

BILITA-

TION

OUT OF

THEATRE OUT OF

THEATRE IN THEATRE

ROUTINE

CARE

MEDICAL EVACUATION

MEDICAL

LOGISTICS

NATO DOCTRINE - MEDICAL SUPPORT FUNCTIONS

AJP 4.10 “Allied Joint Medical Support Doctrine”

Revisione della AJP 4.10 e

iniziativa Smart Defence NATO

NATO UNCLASSIFIED-RELEASABLE TO PfP

Tier 1 – Progetti

•Campo di applicazione

concordato

• Lead nation &

nazioni partecipanti

• Coordinati con la UE

Totale = 29

Tier 2 – Proposte

• Campo di

applicazione ipotetico

• Interesse espresso

dalle Nazioni (ma non

LN)

• discusse con la UE

Totale = 54

Tier 3 – Idee

• Idee interessanti

• Possibili opzioni per il

futuro

• Necessità di accrescere

l’interesse

Totale = 66

Tier 1.15:

Pooling and sharing of multinational medical

treatment facilities (Role 2) -

Aperto a tutte le Nazioni NATO e Partner

Principi

• 2 tipi di moduli

• Ogni modulo rappresenta una

funzione

• I moduli non possono essere

divisi

• I Moduli Core and Enhancing

sono stati definiti in dettaglio

• I Moduli e i Contributi

Complementari sono stati

concordati in ambito NATO e UE

Costituire e condividere Strutture Sanitarie Campali

Multinazionali, che comprendono personale e materiali.

Enhancing

CORE

Complementary

Contributions

Principi

Core Modules

CORE

Modules

1. Emergency Area

2. Initial Surgery Response Capability

3. Specified Diagnostic Capabilities

4. Patient Holding Area

5. Post OP (high/medium dependency)

6. C4I (including telemedicine support)

7. Med Supply

The core modules constitute together a Basic Role 2 MTF!

YOU NEED THEM ALL!

Enhancing Modules

Zahnarz

t CORE

Primary

Surgery

Imagery

CT-

Scan ICU (long-

term

ventilation)

Labor

atory

Dental

Internal

Medicine

Isolation

Ward

Sterili-

zation

Hospital

Manage

ment

Ward (general)

YOU DON’T

NEED

THEM ALL!

Pharmacy

To be selected from the

NATO medical toolbox!

Mental

Health

Primary

Health

care

Enhancing

3

5

Interactive connections

EDA Ad Hoc Working Group Aero Medical Evacuation: 3rd Meeting 5-6 november at EAG premises, High Wycombe (UK)

Exercises: - European Air Transport Training (EATT): EATC + EDA (tactic upload of patients with running engines) - Vigorous Warrior: NATO Mil Med CoE - Volcanex: EAG + EATC Military - Civilian Partnership - EUTM Mali: civilian contractor for AE services - SOS International , Phoenix : AE of high infectious disease

patients

The only thing worse

than working with allies

is working without them.

Inspired by the words of Winston Churchill

Conclusion

GRAZIE PER L’ATTENZIONE