伤员转运后送
01-从角色2向角色3医疗设施航空医疗后送期间的战斗伤亡管理
03-Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane- a retrospective descriptive study
04-乌克兰火车医疗后送的特点，2022
02-Decision Support System Proposal for Medical Evacuations in Military Operations
02-军事行动中医疗后送的决策支持系统建议
05-无人驾驶飞机系统的伤员疏散需要做什么
04-Characteristics of Medical Evacuation by Train in Ukraine, 2022.
05-Unmanned Aircraft Systems for Casualty Evacuation What Needs to be Done
07-一个德语语料库，用于搜索和救援领域的语音识别
08-雷达人类呼吸数据集的应用环境辅助生活和搜索和救援行动
08-Radar human breathing dataset for applications of ambient assisted living and search and rescue operations
06-基于信息融合的海上搜索救援目标定位
07-RESCUESPEECH- A GERMAN CORPUS FOR SPEECH RECOGNITION IN SEARCH AND RESCUE DOMAIN
12-欧盟和世卫组织联手进一步加强乌克兰的医疗后送行动
09-战场伏击场景下无人潜航器最优搜索路径规划
11-麦斯卡尔医疗后送-康涅狄格州陆军警卫医务人员在大规模伤亡训练中证明了他们的能力
06-Target localization using information fusion in WSNs-based Marine search and rescue
13- 年乌克兰火车医疗后送的特点
09-Optimal search path planning of UUV in battlefeld ambush scene
10-志愿医护人员从乌克兰前线疏散受伤士兵
14-海上搜救资源配置的多目标优化方法——在南海的应用
14-A Multi-Objective Optimization Method for Maritime Search and Rescue Resource Allocation An Application to the South China Sea
15-基于YOLOv5和分层人权优先的高效无人机搜索路径规划方法
17-乌克兰医疗保健专业人员在火药行动期间的经验对增加和加强培训伙伴关系的影响
17-Ukrainian Healthcare Professionals Experiences During Operation Gunpowder Implications for Increasing and Enhancing Training Partnerships
15-An Integrated YOLOv5 and Hierarchical Human Weight-First Path Planning Approach for Efficient UAV Searching Systems
16-基于旋转变压器的YOLOv5s海上遇险目标检测方法
16-YOLOv5s maritime distress target detection method based on swin transformer
19-人工智能的使用在伤员撤离、诊断和治疗阶段在乌克兰战争中
19-THE USE OF ARTIFICIAL INTELLIGENCE AT THE STAGES OF EVACUATION, DIAGNOSIS AND TREATMENT OF WOUNDED SOLDIERS IN THE WAR IN UKRAINE
18-军事行动中医疗后送的决策支持系统建议
20-乌克兰医疗保健专业人员在火药行动中的经验对增加和加强培训伙伴关系的影响
20-Ukrainian Healthcare Professionals Experiences During Operation Gunpowder Implications for Increasing and Enhancing Training Partnerships
21-大国冲突中医疗后送的人工智能
18-Decision Support System Proposal for Medical Evacuations in Military Operations
23-伤亡运输和 疏散
24-某军用伤员疏散系统仿真分析
23-CASUALTY TRANSPORT AND EVACUATION
24-Simulation Analysis of a Military Casualty Evacuation System
25-无人驾驶飞机系统的伤员疏散需要做什么
26-Aeromedical Evacuation, the Expeditionary Medicine Learning Curve, and the Peacetime Effect.
26-航空医疗后送，远征医学学习曲线，和平时期的影响
25-Unmanned Aircraft Systems for Casualty Evacuation What Needs to be Done
28-军用战术飞机上sars - cov -2相关ARDS患者的集体航空医疗后送——一项回顾性描述性研究
27-乌克兰火车医疗后送的特点，2022
27-Characteristics of Medical Evacuation by Train in Ukraine, 2022.
28-Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane- a retrospective descriptive study
03-军用战术飞机上sars - cov -2相关ARDS患者的集体航空医疗后送——一项回顾性描述性研究
30-评估局部现成疗法以减少撤离战场受伤战士的需要
31-紧急情况下重伤人员的医疗后送——俄罗斯EMERCOM的经验和发展方向
31-Medical Evacuation of Seriously Injured in Emergency Situations- Experience of EMERCOM of Russia and Directions of Development
30-Evaluation of Topical Off-the-Shelf Therapies to Reduce the Need to Evacuate Battlefield-Injured Warfighters
29-军事行动中医疗后送的决策支持系统建议
29-Decision Support System Proposal for Medical Evacuations in Military Operations
32-决策支持在搜救中的应用——系统文献综述
32-The Syrian civil war- Timeline and statistics
35-印尼国民军准备派飞机接运 1
33-eAppendix 1. Information leaflet basic medical evacuation train MSF – Version April 2022
36-战场上的医疗兵
34-Characteristics of Medical Evacuation by Train in Ukraine
22-空军加速变革以挽救生命：20年来航空医疗后送任务如何取得进展
34-2022年乌克兰火车医疗疏散的特点
33-信息传单基本医疗后送车
40-航空医疗后送
43-美军的黄金一小时能持续多久
42-陆军联手直升机、船只和人工智能进行伤员后送
47-受伤的士兵撤离
46-伤员后送的历史从马车到直升机
37-从死亡到生命之路
41-后送医院
52-印度军队伤员航空医疗后送经验
53-“地狱之旅”：受伤的乌克兰士兵撤离
45-伤病士兵的撤离链
54-热情的和资源匮乏的士兵只能靠自己
57-2022 年乌克兰火车医疗后送
51-医务人员在激烈的战斗中撤离受伤的乌克兰士兵
59-乌克兰展示医疗后送列车
61-俄罗斯士兵在乌克兰部署自制UGV进行医疗后送
60-“流动重症监护室”：与乌克兰顿巴斯战斗医务人员共24小时
50-医疗后送——保证伤员生命安全
阿拉斯加空军国民警卫队医疗后送受伤陆军伞兵
航空撤离，印度经验 抽象的
通过随机森林模拟规划方法解决军事医疗后送问题
2022 年乌克兰火车医疗后送的特点
战术战地救护教员指南 3E 伤员后送准备和要点 INSTRUCTOR GUIDE FOR TACTICAL FIELD CARE 3E PREAPRING FOR CASUALTY EVACUTION AND KEY POINTS
军事医疗疏散
北极和极端寒冷环境中的伤亡疏散：战术战斗伤亡护理中创伤性低温管理的范式转变
-外地伤员后送现场伤亡疏散
伤员后送图片
从角色2到角色3医疗设施期间战斗人员伤亡管理
关于军事行动中医疗疏散的决策支持系统建议书
在军事战术平面上对sars-cov-2相关 ARDS患者进行的集体空中医疗后送： 回顾性描述性研究
2022年乌克兰火车医疗疏散的特点
透过战争形势演变看外军营救后送阶梯 及医疗救护保障措施
东部伤兵营 英文 _Wounded_Warrior_Battalion_East
组织紧急医疗咨询和医疗后送 2015 俄文
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-外地伤员后送现场伤亡疏散
***未分类的*** **联合国** **业务支援部** **和平行动部** **建设和平和政治事务部** **安全与保障部** **裁判员日期/2020.7** **政策** **现场伤亡疏散** 批准人：USG DOS；USG DPO；USG DPPA；USG DSS 生效日期：2020年3月1日 联系人：医疗支持部，SSS/LD/OSCM/DOS 审核日期：2023年3月1日 **在此提供反馈：**  目录 [A. 目的.3](#bookmark1) [B. 范围 3](#bookmark2) [C. 基本原理 3](#bookmark3) [D. 政策 3](#bookmark4) [D.1. 的定义 卡塞瓦克和 导引 原则 3](#bookmark5) [D.2. 的含义 10-1-2 内 联合国 任务 上下文 4](#bookmark6) D.3. 过程 （见附录A中的示意图） [6](#bookmark7) D.4. 病人类别和 疏散 优先事项 [8](#bookmark8) D.4.1 病人 种类 [8](#bookmark9) [D.4.2 疏散 先 9](#bookmark10) D.5. 卡塞瓦克服务 用于 非任务的 个人和 实体 [9](#bookmark11) D.5.1 非任务的卡塞瓦克 联合 国家 人员 [9](#bookmark12) [D.5.2 非联合的卡塞瓦克 国家 患者 10](#bookmark13) [D.5.3 非联合 国家 医疗设施 10](#bookmark14) E.当局， 角色和 责任 [10](#bookmark15) E.1. 联合 国家 总部 [10](#bookmark16) E.1.1 负责业务支助的副秘书长 [10](#bookmark17) [E.1.2 副秘书长 和平行动 11](#bookmark18) [E.1.3 副秘书长 建设和平与 政治事务 11](#bookmark19) [E.1.4 主管安全事务的副秘书长 和 保护措施 11](#bookmark20) [E.2. 在 场地 11](#bookmark21) [E.2.1 的负责人 代表团 11](#bookmark22) [E.2.2 的负责人 军事的 和 警察部门 组件 12](#bookmark23) E.2.3 主任/主任 代表团 支持 [12](#bookmark24) E.2.4 参谋长（硫化羰） [13](#bookmark25) E.2.5 负责人 医疗的 军官 （CMO） [13](#bookmark26) E.2.6 强迫 医务人员 [13](#bookmark27) [E.2.7 首席航空 军官 14](#bookmark28) E.2.8 首席执行官/首席安全顾问/首席安全官 [14](#bookmark29) [E.2.9 指挥官 经理 接收 医疗治疗 设施。14](#bookmark30) F. 参考文献 [14](#bookmark31) [G.监控和合规性 15](#bookmark32) [H. 接触 15](#bookmark33) [I. 历史 15](#bookmark34) [附件A.卡塞瓦克 启动 过程 流程图 16](#bookmark35) 附件 B. 示例 任务伤亡 疏散SOP [17](#bookmark36) ***未分类的*** **政策上** **现场伤员疏散** **A.目的** 1.本文件的目的是为整个联合国（UN）外地特派团的伤员疏散（个案）管理提供政策指导。该政策采取以病人为中心的方法，疏散的及时性和速度至关重要。 **B.范围** 2.本政策适用于由和平行动部、建设和平和政治事务部和业务支助部管理的所有联合国实地特派团。它没有解决资源的影响，并尊重特派团领导优先考虑资源以满足个案任务。医疗后送（医疗）¹operations和遗体运输不在本政策的范围内。 **C. 基本原理** 3.联合国实地和特别政治任务通常是在高威胁和严峻的运作环境下进行的。这促使联合国要求为疏散和治疗提供能力，并认识到创伤和急性危及生命的疾病患者的及时疏散和生存之间存在直接关系。有效的疏散需要精心安排一系列的组织和资产。该政策明确说明了将联合国人员及时从有害疾病点（POl）撤到适当的医疗设施（MTF）²所需采取的切实行动。 D.**政策** **案例分析中的D.1.DEFINITION及指导原则** 4.案件的定义是利用最有效的运输工具将伤员从POI疏散到最近的适当MTF。这是一个连续的护理，支持从POI到疏散，到手术，再到需要的重症监护。 5.特派团伤亡疏散系统的责任由特派团团长（HoM）负责，但通常由特派团支助主任或主任（DMS/CMS）和首席医疗官（CMO）或委派完成这项任务的其他官员管理。案例计算系统必须结构简单，管理精益，易于使用者理解。 1医疗后送（医疗疏散）是从一个医疗设施后送到另一个医疗设施的过程。一次a 伤员已被送入医疗设施，所有为医疗目的而进行的后续行动都被认为是 2个MTFs是联合国1级、1级+、2级和3级医疗设施。二级开始可有手术干预 麦德瓦克。 并可能在一些一级+设施中使用 这里的伤亡是指那些遭受创伤和突然发作，急性生命的人 需要立即进行专家医疗干预的威胁性条件。 4.在极端情况下，这可能意味着利用任何可用的运输工具。 野外伤亡疏散政策 可以移交，包括根据需要移交到部门一级。 更好地理解被接受的风险，并为未来的知情决策提供基础。 8收集流行病学数据，使联合国能够 最低的级别是指定的运营中心或负责责任的中心 ***未分类的*** 6.除了应对对联合国人员的直接威胁的行动外，个案会议优先于所有其他任务活动。考虑到患者的类别和数量，将进一步优先考虑病例治疗手术。 7.在穿透性创伤的情况下，受伤后没有死亡或剩余致残率急剧上升的拐点，而是渐进的，基本上呈线性增长。因此，延误治疗时间导致了死亡率和残疾率的增加。为了业务卫生规划的目的，出现了试图权衡临床需要与业务风险的准则。联合国系统中采用的指标是“10-1-2”guideline⁵；这要求： 由受过急救培训的人员可立即采取救生措施。对最严重的伤亡人员进行出血和气道控制，将在10分钟内完成，并发送伤亡警报信息。 高级复苏/治疗由紧急医疗机构开始进行 受伤/生病发生后1小时内的工作人员。 如果需要，应尽快开始损伤控制手术（DCS） *切实可行，但不迟于受伤/疾病发病后2小时6。* **10** 1 2 8.为了满足这一苛刻的时间框架，将采用“最高层次的所有权和最低层次执行”的理念（见第17段）。虽然案例系统的所有权投资于高级任务领导，但启动案例操作的权力被移交给最低的实际level⁷without，需要寻求所有权级别的许可。 **在联合国特派团范围内的D.2.IMPLICATIONS为10-1-2** 9.资源。在建立特派团医疗系统结构时，对10-1-2准则的遵守应与其他特派团基本规划因素给予同等的重视。它要求提供一个地面和空中疏散平台的矩阵，并有足够的mtf能够提供复苏手术。这可能是特遣队、联合国拥有、合同和东道国能力的混合。在维持和平特派团中，将参考特派团保健支助计划（HSP），以及支助个案行动所需的相关资产，如攻击直升机。特派团卫生系统的责任最终由特派团团长（HoM）承担，但由特派团支助主任或主任（DMS/CMS）和首席医疗官（CMO）或委派完成这项任务的其他官员管理。 10.风险管理。如果不能遵守10-1-2指南，则HoM必须遵守 决定任务任务规定的风险是否可接受。 这一决定应基于全面的风险评估，包括来自于 首席营销官和阐明在任务HSP。还应通知正式的风险验收情况 向UNHQ的医疗主任提供信息。8 11.首席营销官必须确保任务领导层清楚地了解他们所负责的医疗风险。如果卫生部决定接受与可预见的无法实施10-1-1-2准则的要素有关的风险，这应在任务计划、风险登记册或卫生支助计划(或其他适当的计划中正式详细说明 1012指南是根据典型的穿透性创伤类型制定的 战场。由于联合国人员接触到这种类型的伤害，本指南告知联合国的结构 卡塞瓦克系统。参见参考A。 610月12日指南累积；受伤/受伤和手术之间的总时间间隔应该在2以下 小时(120分钟）。 现场伤亡疏散政策 4  此外，在安全风险管理流程已经确定了 *未分类的* 文件)，并应尽一切合理的努力来降低风险。接受不执行风险的决定应接受任务领导的定期审查；如果情况允许，或风险概况变化到管理员无法接受的水平，应纠正偏离时间表的情况，或修改操作，使风险暴露降低到可接受的水平。 **12.急救。**受伤后最初几分钟采取的行动是最重要的 确定生存。因此，所有部署在任何联合国的所有军事和警察人员 特派团应接受符合联合国指导标准的基本创伤急救方面的培训和认证 并提供创伤聚焦设备，以促进“自我和“伙伴急救”9。 需要一个第一反应者方案，即特派团团长，在其职能上作为一个人 指定官员（DO），将任命联合国安全管理机构（UNSMS） 来自文职人员中的急救人员(请参阅安全政策手册 第四章A节关于安全风险管理与安全管理操作 手册第一章关于第一反应Programme).10设备指南 训练必须强调控制灾难性出血和确保气道通畅。 13.急救人员和扩展的现场护理。第一反应者是非医疗机构的个体 受过高级急救训练的人员，能够在POI治疗伤员 在急救医学培训人员到达之前。在联合国内部，首先 响应者被称为现场医疗助理（FMA）。他们必须接受训练 长期管理伤员，直到急救人员到达。 因此，他们的技能超出了最初10分钟的最初护理和 有时超过10小时12小时的第一个小时。必须配备急救人员 适当地履行这一角色12。 14.急救人员。紧急护理人员通常是部队/警察贡献国（TCC/PCC）的保健服务/医疗部门的成员，或联合国文职人员或被雇用来履行这一职责的合同工作人员。这包括救护人员、野战/战斗医疗技术人员、护理人员、护士和接受过院前创伤护理培训的医生。 15.途中护理。疏散必须由一个能够在途中提供先进紧急医疗服务的团队进行，无论使用哪个平台。对于航空医疗后送队（AMET），该小组将由一名接受过院前急救护理培训的医生领导。13 16.**最初的手术。**最初的手术干预是在损伤控制手术（DCS）的理念下进行的，如果需要，可采用快速继续医疗后送（medevac）进行最终护理。 17.指挥和控制的哲学。虽然个案系统的所有权投资于一名高级特派团领导——通常是DMS/CMS——启动个案行动的权力将被移交到最低的实际水平，而不需要寻求 9这必须至少达到联合国伙伴急救课程（UNBFAC）的标准 10.这些急救人员包括那些成功完成紧急创伤的文职人员 包急救人员课程（ETBFRC）和/或个人急救箱（IFAK）课程。 第一反应者必须能够处理那些导致大多数创伤死亡的因素，即所谓的致命三联征”。 12最低急救设备要求已包含在参考文献b中。所提供的设备比IFAK的设备更全面，并设计供团队使用。 13.联合国对AMET的标准人员配备要求规定了两个分小组，每个分小组由一名医生和两名护士或护理人员组成，总共有6名接受过紧急护理和航空医疗后送培训的人员。特别是在缺乏国际商定的某些医学专业培训标准的情况下 急诊医学-所需的临床技能集，和必要的资格证明文件，要求 d ntiniint fenretilajt到a 参考文献B，第3章，附录C，附录8。 野外伤亡疏散政策 来自“所有权级别”的权限。及时撤离需要高级领导和那些被授权执行案件行动的下属之间的高度信任。在大多数任务中，发射权将委托给对整个任务区域的安全、空中和医疗资产情况有态势感知的总部工作人员。在较大的特派团中，设立外地办事处（办公室首长、警察、军事部门），可将个案行动的权力酌情下放并下放给这些总部。这将要求这些总部的工作人员承担下文过程部分所述的值班干事职能。特派团业务和卫生支助计划必须明确说明案件审查系统内的授权范围。 **临时资源分配和操作控制（OPCON）。**保健支助是业务规划的一个关键组成部分。在各级的行动规划中，都必须考虑到个案评估能力的可用性。及时撤离的风险，如不利的天气条件或技术障碍，必须反映在任务规划和执行中，并可能限制行动活动。风险缓解可能涉及处理和疏散资产的临时搬迁。在进行高风险行动期间，可能需要在一段特定时间内--通常是在高风险行动期间--分配资源，特别是配备航空医疗疏散小组（AMET）的直升机，专门支持这些行动。这将包括对这些资产的临时业务控制。该分配已由HoM批准。命令和控制（C2）安排必须符合DPO-DOS权限、命令和控制政策（参考C）。 **特别政治任务（SPM）。**在没有可协调个案支助的指定行动中心的特别行动中心，卫生部将需要建立一个根据特派团的需要制定的管理受伤、受伤或生病个人的系统。该系统应寻求遵守10-1-2的指导方针，并使用联合国和任务地区现有的其他资产的组合，与本政策中所阐明的过程保持一致。该系统一旦建立，应对其他任务进行定期测试。该工作组将任命一名负责个案评估系统的个人，这应在特派团业务和卫生支助计划中阐明。 **D.3.工艺（见附录A中的示意图）** 警报信息：受伤后，必须尽快将警报信息传送至任务指定行动中心（DOC）14发起一个案例响应。警报消息格式将在任务案例标准操作规程中定义，但强制包括至少四个独立的信息： 事件的位置，包括网格引用和呼号。 事故性质（简易爆炸装置罢工、机动车事故等）。 目前正在现场采取的行动（治疗和安保）。 因病人病情原因所需的伤亡人数和特殊资源。15 该信息的口头传输应直接从事件现场到国防部，任务通信架构促进此。在无法实现这一点的情况下，在传递此信息时可能需要包含尽可能少的中间节点。事故地点和DOC之间的中间总部——如营、部门和UNPOL总部——将在初始警报信息中被绕过 14任务健康支助计划和案例SOP应明确说明一个指定的负责案例行动的行动中心（可能是JOC、MOC、TOC、MAOC、POC、MSC等），这可能是“任务”级别，或在适当的情况下根据第16段委派给部门级别。任务负责人将指定哪个总部将负责指定的行动中心。 15一个示例警报消息格式“9班轮”出现在附件B的SOP模板中。  *未分类的* 通信架构允许的，尽管这些总部必须在合理可行的情况下尽快得到通知。医生收到警报消息必须触发快速的案例响应。 21.**警告顺序（WngO）。**收到警报信息后，国防部值班作战官（D/OpsO）立即向那些最有可能用于疏散的资产发出WngO，通常是直升机单位、航空医疗疏散小组（AMET）和接收MTF；通常是二级设施。如果可能有若干替代资产可用于完成一项任务，则应向所有尚未最终确定所需确切资产的通报。WngO应包括来自警报消息的所有信息。在没有共同地点的地方，收到WngO的amet必须立即移动到其指定的疏散平台的位置。 22.启动咨询。在WngO发布后或同时，D/OpsO将立即咨询值班空中作战官（D/空中OpsO)16和值班疏散医疗官（D/EvacMO）以确认案例发射要求，澄清航空和一般安全情况（一些高风险任务中可能需要正式的紧急地面风险评估-EGRA 17）并确认接收MTF。18一旦这三个当局确认需要发射案例飞机，D/OpsO将把发射权限传送给航空或地面疏散资产和相关的AMET/疏散小组。19.他们还将通知接收方的多国部队，并提供估计到达时间（ETA）和估计伤亡人数。如果D/OpsO和D/Air OpsO不能迅速获得医疗建议，他们有权在不参考D/EvacMO的情况下启动aCASEVAC。当不需要空气疏散时，D/OpsO也可授权使用地面疏散资产，而不参考D/Air OpsO。在使用空疏散时，D/Air OpsO必须确认发射，以符合航空安全要求。D/OpsO负责协调从收到警报信息到收到最后一名患者到达MTF的病例评估过程的所有方面。 23.**协调信息。**D/OpsO是为了确保协调的信息是 事故现场、空中行动和疏散资产/AMET（空中或地面）， 在他们发布发射权限之前，需要这些信息。这包括： ·有关突发事件的网格参考资料。 ·直升机着陆地点（HLS）/接收点的网格参考。 ●是疏散资产和事故现场指挥官的呼叫标志。 ·主无线电频率和任何其他无线电频率。 ·预计将被转移的伤亡人数。 ·接受医疗机构名称（MTF）的地点。·EGRA信息（如有需要）。 **24.伤亡情况报告（参考）。一个伤亡情况报告的目的是为了** 通知D/EvacMO人员伤亡状态。这通常是由首先编译的 必须接受培训和装备以提供所需信息的应急人员。这个 报告应定期更新并发送至商务部的D/EvacMO 在通信架构允许的地方。D/EvacMO将传输所有相关的信息 如果可能的话，提供给接收MTF(s)和AMET团队的临床信息 16.通常位于任务空中作战中心（MAOC）。请参见参考文献D。 17在附录B的SOP模板中有一个示例EGRA格式。 18.可能有多个MTF，其中有多人伤亡。 19D/OpsO可以将将发射权传递给相关航空单位和MTF的任务分别委托给D/AirOpsO和D/EvacMO，这样做将加快发射过程。 如果有，任务委员会必须说明（预约）联系谁 对于D/OpsO和D/AirOpsO对最终发射决定的发射决定存在分歧。 现场伤亡疏散政策  *未分类的* 包括他们可能会收到的伤亡人数和估计的到达时间。不需要做出发射决定，收到此信息不得延迟该决定。21 25.第一次医疗报告（FMR）：FMR由接收伤员的MTF)提供，并在伤员到达后一小时内直接传送给D/EvacMO。该报告向特派团领导通报了伤亡情况，并构成决定可能进一步医疗后送的基础（MEDEVAC）.22 26.“需要知道”。在发射批准过程中，不需要定期咨询或通知DOC以外的个人，但必须在D/运营办公室或其工作人员在所有其他优先级协调行动完成后合理可行的情况下尽快完成。在大多数情况下，这些信息可以在正常工作日通过电子邮件传输，尽管可能需要在日常工作时间之外进行电话通信。那些不直接参与案件决策和协调的人员必须避免向医生的工作人员寻求信息，但是，在医生和事件管理的能力范围内，D/OpsO应告知关键的外部利益相关者。 27.行动审查后（AAR）。在案例事件发生后的72小时内，CMO将进行正式的AAR，以确认案例事件过程，并确定经验教训，并对系统提出改进建议。这将提交给CMS/DMS或由HOM指定的负责案例分析系统的整体质量管理的个人。 **D.4.PATIENT类别和疏散优先级** **D.4.1患者类别** 28.为了本政策，对病人进行分类，并根据医疗护理和疏散的优先事项进行分类如下：23 ·Alpha类（关键类）。生命立即受到威胁。需要快速疏散、紧急复苏和/或手术，以挽救生命、肢体或视力。在缺乏立即和适当的医疗和/或外科手术的情况下，将有显著的死亡率或发病率显著增加。 ·Bravo类别（处于紧急状态）。生命、肢体或眼睛都处于严重的危险之中。应尽快进行疏散。这一类别仍然是稳定、受伤点治疗和疏散的优先事项，除了预测的病情恶化或不太可能在6小时内出现负面结果。 ●**类别查理（延迟或保留）。生命、肢体或眼睛都没有严重的危险。** 一旦有合适的运输方式，疏散应受到影响。 这一类别仍然是医疗护理的优先事项。机制和 损伤性疾病的定位并不能预测未来24小时内的负面结果。 **·类别Delta（预期）。**受伤情况与生存情况不一致的伤亡人数。他们将在其他Bravo类患者出现后被疏散。 29.将患者分为这些类别是动态的，当他们在等待疏散时重新评估或在疏散的任何阶段由更高级的临床医生评估时，可能会发生改变。例如，AMET医生到达没有医生的大规模伤亡事件现场，如果伤亡人数超过飞机的容量，可能会重新分类伤亡，以确保最严重/受伤者首先移动。 21附件B的SOP模板中出现了一种参考消息格式。 22在附录B的SOP模板中有一个示例FMR格式。 23.伤亡人员的分类由临床培训水平最高的个人在现场进行。 野外伤亡疏散政策  *未分类的* **D.4.2疏散优先级** 30.一般原则。除了应对对联合国人员的直接威胁的行动外，个案会议优先于所有其他任务活动。病例治疗手术将优先考虑患者的类别和数量。 **31.大规模的伤亡事件。大规模伤亡事故（MCl）发生时的生活人数** 病人超过了可及时疏散或及时治疗的资源 而延误很可能会导致其他可预防的死亡。通常声明一个MCl “自下而上”，来自各级指挥或医疗设施。轻度认知障碍可能有显著的 对当前运营的影响，因此需要“自上而下”进行管理。其中 MCl已被宣布为CMO或其提名的代表必须在博士中提供 以便就适当的mtf的伤亡管理和临床的使用提供建议 和疏散资源。治疗的原则可能需要改变 关注个别患者需要达到最好的结果 伤亡人数。AMCi也可能被D/OpsO根据建议声明为“自上而下” D/EvacMO或CMO的成员。现已宣布发生大规模伤亡事件，具体情况如下 原则适用： ·阿尔法类患者的优先级最高。这些病人应直接被疏散到最适当的医疗设施； ·Allha类患者在Alpha和Bravo类伤亡后撤离； ·查理类患者应留在受伤/疾病点，直到所有Alpha、Bravo和Delta类患者都被撤离。 ·Bravo和查理类患者可能首先被疏散到I级MTF进行初始护理，以缓解1级+（手术）、2级和3级设施的压力。 ·如果到达MCl的病例评估资产有剩余容量，但不需要额外的Alpha类患者，则不应推迟Bravo和查理类患者的撤离。 ·在MCI现场被宣布死亡的人员将使用适当的运输方式最后转移。 **为执行非任务的个人和实体提供的D.5.CASEVAC服务** **D.5.1联合国非特派团人员的案件审查委员会** 32.在有联合国国家小组（UNCT）的任务区域，联合国安全管理系统（UNSMS）与安全管理小组协商，并根据UNSMS的相关政策和指导方针，制定由指定官员批准的安全计划。安全计划包括一个案例计划作为医疗计划的一部分。在任务设置中，首席/首席安全顾问或首席安全官支持任务，包括安全计划、案例计划，并协调负责总体所有权/管理案例系统的高级负责人和UNSMS组织。在这方面，他们应该共同努力，以确保一个有凝聚力的反应，包括在影响任务和其他UNSMS人员的事件实例中。24 24 UNSMS人员是由联合国系统范围的“联合国安全管理系统适用性”政策（安全政策Manuel第Ⅲ章，A节）定义的人员。 野外伤亡疏散政策  *未分类的* **D.5.2针对非联合国患者的案例分析** 33.在联合国行动中被联合国部队伤害的敌对战斗人员和平民必须与联合国人员一起接受治疗和撤离。25.非联合国平民的撤离通常将到非联合国设施，并可在可能的情况下与当地卫生服务部门合作实现。被认为是敌对战斗人员的个人将被疏散到联合国设施或在HSP 26中由HoM指挥的其他设施 34.在非联合国行动导致的情况下受伤或生病的非联合国患者也可以获得个案援助。这可根据第三方（非联合国）的要求，通过任务团长办公室或任务团长指示的其他办公室发起，并由卫生部或其授权作出此决定的个人授权。当任务任务资产用于非联合国实体时，管理员或代表必须确保联合国人员和其他任务人员的任务具有储备能力。 **D.5.3非联合国的医疗设施** 35.如果更可行或情况需要，患者可以被疏散到当地或邻国的MTF，以获得适当和及时的治疗。特派团负责在必要时安排获得进入非联合国医疗设施的机会。这可能包括跨境案例分析的检查、认证、承包和批准（包括飞行批准）。当地和邻国医疗设施的地点和联系信息应列入任务个案计划。 **E. 权限、角色和职责** **E.1.United国家总部** **E.1.1负责业务支助的副秘书长** 36.主管业务支助的副秘书长向秘书长负责： ·确认在整个特派团生命周期中建立了专门针对每个联合国外地特派团的个案评估系统、提供适当的资源、支持和监测 ·为预算、人员配备和后勤资源提供战略指导，以支持任务案例系统。 ·确保为个案管理系统制定联合国卫生治理标准，并得到监测和执行。 **E.1.2主管和平行动的副秘书长** 37.主管和平行动的副秘书长应向秘书长负责 这是武装冲突法的要求。See:https://ihl- databases.icrc.org/applic/ih/ihl.nsf/Comment.xsp?action=openDocument&documentld=CECD58D1E2A2AF30C1 257F15 26.在疏散期间和在照顾敌对战斗人员的设施中，可能需要提供安全保障。当任务开发正式的EGRA过程时，必须包括这个问题。必须尽一切努力确保这一决定不会造成任何不必要的延迟撤离。 野外伤亡疏散政策 确保在任务启动阶段，案例分析被包含在任务概念中27. 确保所有维和人员遵守这一政策和相关的联合国政策。 确保产生相关的应急资源，用于案例分析。 **E.1.3主管建设和平和政治事务的副秘书长** 主管建设和平和政治事务的副秘书长应向秘书长负责： 与总部有关部门协调，支持各领域的特别政治特派团建立个案安排。 确保在任务启动阶段，案例分析被包含在任务概念中。 **E.1.4主管安全和安全副秘书长** 负责安全和安全的副秘书长向秘书长负责，以确保执行、遵守和对UNSMS活动的安全方面的支持，这些联合国人员被联合国安全管理系统的适用性所覆盖。 **E.2.在现场** **E.2.1任务负责人** 卫生部应向秘书长负责： 确保在建立任务区域后，建立综合个案系统并尽快进行测试。 确保特派团提供行政和后勤支助，并确保所有特派团人员通过定期执行系统，了解其在系统内的权力、作用和责任。 指定一名高级领导，负责案件管理系统的整体所有权/管理。 指导一个指定的行动中心，领导协调特派团一级和适当的地方/部门一级的个案行动。 定期进行训练，间隔不超过四个月测试案例系统。28 与其他联合国、地方、非政府组织和其他公认的国际实体一起，寻求机会使任务地区的个案资源合理化。 与东道国政府合作，创造一个环境，使案例系统成为可能，并在可能的情况下进行联合案例演习。 确保在要将特派团案件系统扩展到各联合国其他实体、其他政府和非政府组织、外交使团成员或基于人道主义理由的国民和其他无资格人员的地方，提供支助的条件和条件是 27它也应列入特派团支助概念和特派团计划。 28四个月的演习必须被视为进行这种练习的绝对最低限度，理想 间隔为两个月，应尽可能配合主要部队轮调，以确保新到达的部队熟悉所涉及的过程。 在一份单独的协议中明确规定了包括行政、财务和物流参数。29 为保护联合国组织“联合国安全管理系统适用性”政策所定义的联合国人员，HoM作为指定官员（DO）通过安全保障部（DSS）USG向秘书长负责执行UNSMS政策和指导方针，包括与安全风险管理有关的政策和指导方针。 执行本政策的责任和权力由主管承担，他可以书面授权任何高级任务案例系统的所有权和管理（指挥和控制）责任，尽管这通常是DMS/CMS。30 **E.2.2军事和警察部门的负责人** 军事和警察部门的负责人对HoM负责： 发布和执行指示，以确保军事和警察部门遵守本政策和相关的任务框架。 确保业务规划包括风险评估/伤亡评估。 提供信息，控制地面疏散路线，确保着陆区，并根据需要为地面和空中疏散队提供保护。 确保描述或引用了伤亡人员疏散的行为31在其职责范围内进行的所有军事和警察活动的所有行动命令中。 确保所有军事和警察人员收到关于任务任务标准操作程序的强制性简报，并了解他们在任务标准操作程序系统中的角色职责。 确保军事和警察人员的分配和纳入负责协调/执行案件的任务结构。 确保部队医务人员意识到他们在案件调查系统中的责任。 在所有业务中提供培训、排练和纳入医疗资产。 **E.2.3任务支持主任/主任32** 特派团支助主任/主任应执行所有授权，以确保在特派团中及时和无缝地执行个案，并负责： 确保建立一个连贯和综合的案件系统，以满足整个任务业务区域的这一政策的要求，并建立和执行支持和确保任务中有效和透明的治理协议的程序。 29此安排的细节不应在任务案例标准操作程序中详细说明，而应在其他地方详细说明。 30请注意，在这些情况下，案件计算系统的管理归因于除 DMS/CMS，如果该政策中的下属，如CMO，在案例分析系统的某些方面要向DMS/CMS负责，这种责任将由提名的官员而不是 DMS/CMS。 31参考资料通常是任务案例SOP。 32这只适用于HOM授权案件系统“所有权”的情况。如果另一名官员获得永久授权，则该个人承担这些责任。 确保个案会议资源的预算列入特派团的年度预算要求。 确保任务资产，无论是UNOE或COE，包括医疗、运输（空中、陆地和海上）、通信资产等。充分、充分整合，并始终处于最佳职能状态，以支助特派团的个案活动。 与所有利益相关者合作，制定和发布特定任务的个案标准操作程序（建议格式见附件B）。该SOP必须说明所有利益相关者的权力、角色和责任，包括沟通渠道和报告渠道、程序、可用资源及其分配等。 建立获得符合联合国医疗标准的医疗设施，以在必要时增加军事和警察部门提供的医疗设施。 与军事和警察部分指挥官和其他主要利益攸关方合作建立机构33特派团个案委员会的综合培训方案。 确保按照参考文献F的指示向UNHQ提交正式的伤亡通知（通知）记录。 按照主管机构的指示，为个案管理系统指定运作中心的建立和正常运作提供支助。 执行东道主义组织关于向办事处办事处、政府和非政府组织、人道主义组织、外交使团成员以及国民和其他基于医疗和人道主义理由提供个案支助的所有指示。 **E.2.4参谋长（硫化羰）** 参谋长将确保程序和能力到位，以支持协调特派团负责区域内的所有伤员疏散。34 **E.2.5首席医务官（CMO）** CMO对CMS/DMS负责： 病例分析系统内的临床标准。 维护值班系统，以确保D/EvacMO始终可用(24小时）。 确保所有任务AMET都保持在CMS/DMS指示的准备水平。 确保数据输入联合国地球环境案例模块。 根据CMS/DMS或HOM指定的个人的指示，对每个案例进行行动后审查。 制定和监督培训特派团保健工作人员进行个案行动的课程。 **E.2.6部队医务官** FMO对首席营销官负责： 33比如那些负责联合国文职人员的人员。 34有关硫化羰角色的完整解释，请参见DPO-DOS关于权限、命令和控制的策略（参考C）。  *未分类的* ·确保按照可接受的联合国标准、符合参考文献B和特遣队具体谅解备忘录，提供和维持军事医疗能力 ·培训穿制服的卫生人员进行个案行动。 **E.2.7首席航空官** 46.首席航空官应向DMS/CMS负责： ·提供空中资产以支持个案运营。 ·确保飞机和机组人员处于DMS指示的准备水平，并遵守其适用的合同或LOA。 ·确认直升机着陆地点（HLS）清单的货币情况，并提供全部 及时向有关特派团实体提供必要的卫生后勤系统资料。·维护值班系统，以确保D/AirOpsO始终可用(24小时）。 **E.2.8首席/首席安全顾问/首席安全官** 47.首席/首席安全顾问/首席安全官应在安全计划中包括案例计划，这些计划已与负责任务和UNSMS组织中案例系统的整体所有权/管理的高级领导制定和协调。 48.与负责任务和UNSMS组织中案例分析系统的总体所有权/管理的高级领导合作，确保计划是一致、协调的，并确保有凝聚力的响应，包括影响任务和其他UNSMS人员的事件。 **E.2.9接受医疗设施的指挥官/经理** 49.接收医疗设施的指挥官/经理应： 49.1.确保在要求的时间和格式内完成并提交第一次医疗报告。 49.2.根据CMO的要求，通过提供临床和其他信息，协助CMO完成AAR。 **F. 参考文献** 50.本政策应与以下文件一起阅读。 a.2015.12联合国外地特派团医疗支助手册-第三版。 b. 关于偿还和控制参加维持和平特派团的部队/警察部队拥有的特遣队装备的政策和程序手册（GA，A/72/2882017） c.2019.23关于联合国项目知识产权组织的权力、指挥和控制的政策 d.2018.21航空手册 e. 联合国安全管理系统安全政策手册和安全手册 *管理操作手册* f.2017.22关于维和行动和特别政治特派团伤亡人员通知（通知）的SOP g. 联合国危机管理政策（2018年） 野外伤亡疏散政策  *未分类的* **G.监控和合规性** 51.维持和平行动、建设和平和政治事务和业务支助部有权监督和监测在各自领域遵守这一政策的情况。这些部门的负责人应共同努力，确保使团负责人被适当地了解这项政策。 H.**接触** 52.所有关于本SOP的查询和对医疗支持科，SSS/LD/OSCM/DOS的请求。 修正案应 是 送到 负责人 l.**历史** 53.本政策将在三年内进行审查 日期 的颁布。本政策 取代了以前的任何版本，including：2018.12字段。 政策上 伤亡疏散 **批准签字：**  副秘书长 **阿图尔卡雷** 负责业务支援部队的副秘书长 批准日期 负责建设和平和政治事务 批准日期  Jean-Pierre拉克鲁瓦 副秘书长 主管安全和保障事务的副秘书长 批准日期 和平行动 批准日期 野外伤亡疏散政策 **附件A.美国航天飞机发射过程流程图** 卡塞瓦克发射过程 伤害点 消息警报 根据需要使用卡西特里普 更新为 必须的 值班操作 军官 启动 卡塞瓦克 响应 发出警告命令 启动 咨询 发布发布权限 通知“需要” 知道” 领导 确认 1.突发事件的网格参考 2.HLS/拾取点3的网格参考资料。呼叫标志 4.主无线电频率和另类无线电频率 负载空气 操作 奥弗西尔 - D/OpsO - D/AirOpsO -D/EvacMO 5. No伤亡人员要转移的人数 6.MTF的名称和位置 7.EGRA信息。如果需要 值班疏散 医务人员 评估和 建议 卡塞瓦克资产 阿梅特 MTF 直升机部队 阿梅特 MTF 直升机部队 第一医学 报告 （仅来自MTF） **附件B.示例-任务伤亡疏散SOP** **UNXXX标准操作程序** **伤亡疏散（CASEVAC）35** **内容：A。** **B.C.D.E.F.G.H.I.J.K.** **目的：** **范围** **基本原理** **支撑原理** **程序** **非联合国病人的卡塞瓦克** **培训测试和评估** **参考文献** **监控和合规性** **联系** **历史** **目的** 本标准操作程序（SOP）向参与伤亡疏散（案例疏散）操作的所有任务人员提供指示。 **范围** 必须遵守本SOP。它适用于所有特派团文职、警察和军事人员，包括部署在各地、特派团总部、部门总部和其他野战基地的警察部队和特遣队军事单位。 **基本原理** 案例分析是一个复杂的过程，涉及多个利益相关者和相当大的协调。本SOP规定了需要采取的行动，以便从受伤/疾病点（POI）及时疏散到适当的医疗设施。 **支撑的王族** **10-1-2指南。**制定了一个简单的时间度量来指导行动并告知任务个案系统的结构；这是10-1-2指南，要求： 由受过急救培训的人员采取即时救生措施。 **10**出血和气道控制对最严重的伤员是 在10分钟内完成，并发送了伤亡警报信息。 35标准操作人员不应费力地重复保健支助计划或其他特派团业务计划命令/指示中的背景信息，除非它们对要遵循的过程产生重大影响。  *未分类的* 1 2 紧急医务人员在受伤/疾病发病后1小时内开始进行高级复苏/治疗。 如果需要，应尽快开始损伤控制手术（DCS） ***可行，但不迟于受伤/发病后2小时36。*** 58.特派团领导层承认，严格遵守10-1-2的指导方针并不总是可能的。在这种情况下，必须相应地管理风险，积极缓解，以建立替代卫生支助措施。 59.除与人员安全有关的迫在眉睫的威胁外，个案会议优先于所有其他任务活动。 **n.过程** **N.1.Initial受伤点的行动（POl）：** 60.具有医疗设施的任务基地/基地内（1级或以上）：作战人员应在10分钟内提供： 60.1.控制大出血和呼吸气道的基本急救措施；和 60.2.将警报信息发送给现场的值班医生。任务警报信息格式见附件A。 61.在收到警报信息后的10分钟内，复合医疗设施将部署一名医生领导的医疗应急小组（MERT）到POI，以稳定患者，并将其运送到医疗设施，并/或在需要时请求CAEVAC到更高级别的设施。如果MERT决定需要疏散到更高的级别，则程序与任务大院外发生的事件相同。 62.**在任务基地外的POI。**在10分钟内，POI的人员应该： 62.1。提供基本的急救，控制大出血和呼吸气道； 62.2.将附件A的格式的警报信息传送至指定操作中心（DOC）。 **在指定行动中心的N.2.Initial行动** **63.启动咨询和警告命令。**在收到第一个警报后的10分钟内 信息，国防部值班运营主任将按优先顺序： 63.1.提醒并咨询值班航空官员。 63.2.通知并咨询值班医疗疏散官员。37 63.3.进行快速的风险评估。 *职责分配 官作临时 发射38决定* 63.4.向可能参与医疗事故的资产（地面车辆、直升机、接受医疗设施的疏散小组）发出警告令 361012指南累积；从受伤/开始到手术之间的总时间间隔应该在2分钟以下 小时(120分钟）。 联系值班医疗疏散官员 值班工作人员和航空工作人员如果因任何原因不能推迟，不应推迟临时发射决定 这里的“发射”一词用来指空中和地面疏散平台 野外伤亡疏散政策  卡塞瓦克。值班操作官可将此任务委托给航空值班人员和医疗疏散值班人员。39 **值班航空作战官：在临时发射决定后15分钟内：** 64.1.确认距离事故/POI最近的潜在直升机着陆地点（HLS） 以及那些被用于接受医疗设施的药物。 64.2.确认将用于案例计算的空气资产。 64.3.确认航空/发射安全/空域的批准。 国防部值班作战官：在临时发射决定后15分钟内确认：*40* 突发事件的网格参考。 如果与突发事件不同，则提供HLS /拾取点的网格参考。 地面疏散资产至POI/接收点的路线计划。 疏散资产和POI/事故现场指挥官的标志。 主要和任何备用无线电频率和或电话联系细节。 预计将被转移的伤亡人数。 接收MTF的名称和位置。 沙痂已知的威胁。 通知其他行动中心/值班人员，可能需要为案件管理委员会提供额外的资产/支持，例如。MOVECON、安全人员。 **值班疏散医务人员：在临时发射决定后15分钟内：** 66.1.确认案例评估计划，以包括：41 沙痂疏散优先级。 在POI和运输期间需要额外的医疗支持。 从临床角度（地面、空气）确定最合适的疏散方法。 最合适的MERT/AMET协助POI和运输期间。 Subarb确认接收MTF (s)。 66.2.通知接收MTF (s)并提供伤亡状态和 卡塞瓦克航班ETA。 ***不 以后 比 20 分钟 后 临时的 开始从事 决定 – 值班作业 军官 确认发射指令*** 39在一些任务中，可能有必要安排护送机组人员和AMET从他们的住所转移到他们的飞机上。 40一些任务可能需要实施一个快速的“风险评估”矩阵，以指导那些需要的值班人员 他们将在风险高于直接阈值的情况下，寻求更高级别的发射批准。如果实施此，风险评估矩阵应作为本SOP的附件。 41值班疏散医疗官应只应确定与POI有直接接触的优先事项，并且没有更高级的临床医生——否则应信任当地的人来决定优先事项。  *未分类的* **67.任务案例分析/医疗资产。**在收到警告令后的15分钟内42分钟： 67.1.直升机空中和地勤人员将开始飞行前程序。 67.2.航空医疗后送队（AMET）将在飞机上开始飞行前程序。如果这一点可以建立起来，还包括与POI的无线电联系。 67.3.地面疏散车辆的工作人员准备离开，并等待详细的简报 按需要在可能的情况下，已与POl建立无线电/电话联系。 67.4.MTF创伤小组聚集在其相关部门（急诊、操作、病理实验室、医学成像等），准备接收病人。 **N.3.Subsequent的行动-在POI** 68.现场指挥官/项目负责人应确保： 68.1.对伤员的急救工作仍在继续。 68.2.伤亡情况报告（事故记录）每15分钟转发给医生。68.3.如果有多人伤亡，他们将被纳入优先疏散名单。 如附件B中所述的优先事项。 68.4.使用DOC确认HLS/拾取点网格参考。 68.5.根据任务航空标准操作程序准备HLS。如果可以建立，包括与疏散平台建立无线电联系。 **N.4.Subsequent行动-在医生。** **69 .博士值班操作官。**博士的职责是： 69.1.停止所有发出警告令参与案件的资产 一旦建立了这个条件，就不需要了。这可以委托给航空和医疗疏散任务干事。 69.2.在发射后尽快通知以下情况，并按照指示更新： ·根据任务领导层的要求 ·根据任务领导层的要求 69.3.协调案件的运作到结束，作为所有沟通的焦点。 69.4.在个案疏散行动结束后24小时内，领导与航空和医疗疏散值班人员合作起草了一份行动后报告。 70.**博士值班航空运营官** 70.1.协助协调通过空中进行的个案行动。 70.2.在个案评估行动结束后24小时内，与行动和医疗疏散值班官员合作，协助起草一份行动后报告。 42.人们承认，飞机停放、机组人员和AMET人员的住宿安排可能使在某些任务中不可能实现这一点，可能需要使用不同的时间度量， 但是，必须尽一切努力确保这个时间不超过30分钟。 野外伤亡疏散政策 *未分类的* **71.医生疏散医务官** 71.1.协助协调通过空中进行的个案行动。 71.2.根据需要向港口中心的人员提供临床建议。 71.3.将POl的伤亡更新传递给接收医疗小组（AMET、MTF等）。 71.4.在个案行动行动结束后24小时内，协助与航空和行动值班干事起草一份行动后报告。 71.5.起草上述报告的保密医疗附件，需要时列入首席官副本。 71.6.在联合国地球教育案例分析模块中提交报告。 71.7.通过特派团采用的空中资产请求/任务系统提交事后的正式案件请求。 O.**非联合国病人的卡塞瓦克** 72.根据国际人道主义法，联合国必须在联合国卫生系统的能力范围内对待敌对部队的成员，以及无法立即获得替代敌对部队或平民卫生能力的平民。这些伤亡人员应按照附件B中所述的临床优先事项和联合国伤亡人员进行治疗和撤离。在移交给相关当局之前，费用将由联合国承担。 73.根据第三方（非联合国）的要求，通过人道主义协调员办公室，允许提供与联合国行动无关的伤亡案例，并得到卫生部的授权。如果特派团的个案资产用于非联合国实体，则特派团应确保联合国人员的个案资产具有储备能力。 **p.的培训、测试和评估** 74.所有的办公室医生都应接受过培训，并具备在收集和管理警报方面的能力 消息和在收到后要采取的操作。 75.所有参与案件处理的特派团人员都应接受整个过程的程序、设备、技能、沟通和行为方面的培训和测试。 76.特派团应通过不少于每四个月一次的桌面和实地演习来测试和评估个案程序。排练和具体技能也应该通过不少于每六个月的全面练习来进行测试。 **q.引用** A.2019年，现场伤亡疏散 B.《联合国外地特派团医疗支助手册》（第3版）；DPO/DOS，参考文献。2015.012 C. 航空手册；DPO/DOS，Ref.2018.21 D. 权限、命令和控制；DPO/DOS 2019.23 E. 联合国安全管理系统政策手册；DSS，2011年 野外伤亡疏散政策 21 **监控和合规性** *任务将需要确定他们将如何监督和遵守本SOP。本节应明确说明谁代表主持人“拥有”该过程，以及由谁授权获得发射权 预约 不 通过 名字这确保了值班人员理解通过其任命委托给他们的权力。* **接触** *制定案例SOP的任务部门或团队的联系信息。不要使用个人电子邮件地址，而是使用通用的部门电子邮件地址。* **历史** *本节应包含本案例标准OP首次批准和发布的日期。它应包括每次后续审查和修改的日期。它还应表明因发布本标准操作程序而被实质性修改、废除或终止的任何以前案例标准操作程序。如有必要，应增加修改日期清单和所作的修改作为附件。* **批准签字：** **批准日期：** **附件A至SOP** **卡塞瓦克警报消息** **（9行格式）** 线条 **联合国事件的9行警报信息** 日期分组 1 地点： 地图编号： GZD： GPS网格： 2 C/S & FREQ: C/S FREQ： 3 患者人数： CAT A. CAT B B. 猫c C. CAT D D. 4 专家 设备 要求： 无 A. 起重机（以直升机进行吊装） B. 提取（残骸） C. 其他 D. 5 按类型划分的患者人数： 垃圾（担架） L. 行走（可行走） W. 6 皮卡现场的安全： 区域内无威胁 N. 区域内可能的威胁 P. 区域威胁 E. 需要武装护送 X. 7 拾音器标记 地点： AME面板 A. PYRO（星团/耀斑） B. 烟雾（+色） C. 闪光灯 D. 其他 E. 8 按国籍和身份划分的患者人数： 联合国军队 A. 敌军 B. 其他 C. 9 皮卡 地形 障碍： 区域和 坡度%（地面铺设） A. 障碍 C. 皮卡安全 D. 旅客人数 E. 车辆固定地点 F. 威胁部队 G. **（4行格式）** 线条 **联合国事件的4行警报信息** 日期分组 1 位置和呼叫标志 地点名称和描述 A GPS网格参考 B 事故现场指挥官的呼号 C 2 事件详细信息 发生了什么事？（射击、交通事故、爆炸等）。 D 有多少人伤亡？ E 3 行动是 现场拍摄 对疏散进行治疗和准备 4 资源 需要在现场进行治疗和治疗 疏散病人 地面救护车，空中疏散，机场 **SOP附件B** **应急地面风险评估格式*** 1 事故发生时的当前情况 位置/兰辛地点 附近没有战斗人员 战斗人员 在10-20kM内  内部战斗人员 5kM  2 附近地区有战斗吗 不 未知的 是 3 正在使用的武器类型或在该地区使用的武器类型 小型武器、步枪和手枪/无武器 重型武器（例如重型机关枪 车载武器/MANPAD  4 控制部队对邻近地区的联合国人员/部队的情绪 友善的 中性的 敌意 5 控制部队对周边地区的联合国人员/部队的情绪 友善的 中性的 敌意 6 有能够提供安全/保护的友好部队 足够的 最小值 没有一个 7 推荐的风险水平 低 中 高 *主要政策第20段概述了伤员疏散期间所需的绝对最低信息。负责制定任务伤亡疏散SOP的工作人员应适当考虑： 1. 总体威胁级别； 2. 特派团人员的培训和经验； 3. 任何通信系统的限制；以及 4.语言困难 在决定警报信息的格式以及应急地面风险评估（EGRA）和伤亡情况报告（案例代表）的必要性和格式时。获得已确认的EGRA和机密信息不应妨碍发射决定。 **SOP附件C** **伤亡情况报告（机密）*** **A** 患者的年龄和性别： **T** 突发事件或更新报告的时间： **M** 伤害机制： **I** 持续或疑似的疾病： **S** 体征和症状： 气道畅通-是/否 呼吸：是否速率： 脉冲：是/否，速率： 沙痂血压 沙痂温度 意识：警报、声音反应、疼痛反应、无意识 **T** 提供和要求的处理： *主要政策第20段概述了伤员疏散期间所需的绝对最低信息。负责制定任务伤亡疏散SOP的工作人员应适当考虑： 1. 总体威胁级别； 2. 特派团人员的培训和经验； 3. 任何通信系统的限制；以及 4.语言困难 在决定警报信息的格式以及应急地面风险评估（EGRA）和伤亡情况报告（案例代表）的必要性和格式时。获得已确认的EGRA和机密信息不应妨碍发射决定。 **SOP附件D** **病人类别和疏散优先级** 患者类别。根据本SOP，优先考虑医疗护理和疏散的患者类别如下： **类别Alpha（关键）。**生命立即受到威胁。快速疏散，紧急 需要进行复苏和/或手术来挽救生命、肢体或视力。在没有 立即和适当的医疗和/或外科手术，在两小时内有显著的死亡率或发病率增加。 **Bravo类（紧急）。**生命或肢体正处于严重的危险之中。疏散应该是 尽快进行。这一类别仍然是稳定、损伤点治疗和疏散的优先事项，除了预测的恶化或负面结果是 不太可能在6小时内。 **类别查理（延迟或保留）。**生命或肢体并没有严重的危险。疏散 一旦有了合适的运输模式，就应立即受到影响。这一类别仍然是医疗护理的优先事项。损伤的机制和定位并不能预测a 在接下来的24小时内出现负面结果。 **类别Delta（预期）。***这类类别只在特派团总部宣布大规模伤亡事件时使用。*受伤情况与生存情况不一致的伤亡人数。他们将在其他阿尔法类患者出院后被疏散。 **索普附录e** **只分配给卫生工作人员** **首次/更新医疗报告** 1 报告提交的日期和时间 2019年11月12日-13：40 2 名称（家庭/给定） 史密斯彼得罗伯特 3 军队、警察和平民 军事的 4 RANK（军事/警察） 下士（军事） 5 国籍 加拿大人 6 单元 康巴特1 7 当前位置 印度3级戈马 8 主要诊断 左胫骨和腓骨骨折 左截肢术 9 简要临床总结 在简易爆炸装置袭击装甲运兵车时，左臂和腿部受伤。 左胫骨、腓骨下裂部骨折/脱位。左手手腕的创伤性截肢。入院时稳定清醒。入院时未发现其他重大伤害。轻度伏安休克。 10 处理 事故现场腿部固定和夹板。 止血带应用于左上臂，伤口到手包扎与压缩绷带。 在事故部位开始进行镇痛和静脉输液。在进入三级课程时： 开放性减少腿部骨折和外部骨折 应用固定。左侧损伤的清创术-这可能会延迟闭合。已开始的四节 抗生素治疗。抗生素。入院接受术后强化护理。 11 预后 很好。 12 是否需要医疗后送 是的。 13 下次更新日期 2019年11月13日-12：00 14 发布权限：姓名和任命 上校b。罗瓦特指挥官印度戈马三级医院 **只分配给卫生工作人员** ***UNCLASSIFIED*** **United Nations** **Department of Operational Support** **Department of Peace Operations** **Department of Peacebuilding and Political Affairs** **Department of Safety and Security** **Ref.DOS/2020.7** **Policy** **Casualty Evacuation in the Field** Approved by :USG DOS;USG DPO;USG DPPA;USG DSS Effective date :01 March 2020 Contact :Medical Support Section,SSS/LD/OSCM/DOS Review date :01 March 2023 **Provide Feedback Here:**  Table of Contents [A. PURPOSE .3](#bookmark1) [B. SCOPE 3](#bookmark2) [C. RATIONALE 3](#bookmark3) [D. POLICY 3](#bookmark4) [D.1. DEFINITION OF CASEVAC AND GUIDING PRINCIPLES 3](#bookmark5) [D.2. IMPLICATIONS OF 10-1-2 WITHIN UN MISSION CONTEXT 4](#bookmark6) D.3. PROCESS (See Schematic at Annex A) [6](#bookmark7) D.4. PATIENT CATEGORIES AND EVACUATION PRIORITIES [8](#bookmark8) D.4.1 Patient categories [8](#bookmark9) [D.4.2 Evacuation priorities 9](#bookmark10) D.5. CASEVAC SERVICES FOR NON-MISSION INDIVIDUALS AND ENTITIES [9](#bookmark11) D.5.1 CASEVAC for non-mission United Nations personnel [9](#bookmark12) [D.5.2 CASEVAC for non-United Nations patients 10](#bookmark13) [D.5.3 Non-United Nations medical treatment facilities 10](#bookmark14) E. AUTHORITIES, ROLES AND RESPONSIBILITIES [10](#bookmark15) E.1. United Nations Headquarters [10](#bookmark16) E.1.1 Under-Secretary-General for Operational Support [10](#bookmark17) [E.1.2 Under-Secretary-General for Peace Operations 11](#bookmark18) [E.1.3 Under-Secretary-General for Peacebuilding and Political Affairs 11](#bookmark19) [E.1.4 Under Secretary-General for Safety and Security 11](#bookmark20) [E.2. In the Field 11](#bookmark21) [E.2.1 Head of Mission 11](#bookmark22) [E.2.2 Head of Military and Police Components 12](#bookmark23) E.2.3 Director/Chief of Mission Support [12](#bookmark24) E.2.4 Chief of Staff (COS) [13](#bookmark25) E.2.5 Chief Medical Officer (CMO) [13](#bookmark26) E.2.6 Force Medical Officer [13](#bookmark27) [E.2.7 Chief Aviation Officer 14](#bookmark28) E.2.8 Principal/Chief Security Adviser/Chief Security Officer [14](#bookmark29) [E.2.9 Commanding Officer / Manager of Receiving Medical Treatment Facilities . 14](#bookmark30) F. REFERENCES [14](#bookmark31) [G. MONITORING AND COMPLIANCE 15](#bookmark32) [H. CONTACT 15](#bookmark33) [I. HISTORY 15](#bookmark34) [Annex A. CASEVAC Launch Process Flow Chart 16](#bookmark35) Annex B. Example – Missions Casualty Evacuation SOP [17](#bookmark36) ***UNCLASSIFIED*** **POLICY ON** **CASUALTY EVACUATION IN THE FIELD** **A.PURPOSE** 1. The purpose of this document is to provide policy direction on the management of casualty evacuation (CASEVAC)across United Nations (UN)field missions.The policy adopts a patient centred approach where timeliness and speed of evacuation are paramount. **B.SCOPE** 2. This Policy applies to all UN field missions administered by the Department of Peace Operations,Department of Peacebuilding and Political Affairs and Department of Operational Support.It does not address resourcing implications and defers to Mission leadership to prioritise resources to meet CASEVAC tasks.Medical evacuation (MEDEVAC)¹operations and the transportation of human remains are not within the scope of this policy. C**.RATIONALE** 3. UN field and special political missions are typically conducted in a high threat and austere operating environment.This drives the requirement for the UN to provide capabilitiesfor the evacuation and treatment that recognises there is direct correlation between timely evacuation and survival in those suffering traumatic injury and acute life-threatening medical conditions.Efficient evacuation requires the orchestration of a range of organisations and assets.This Policy articulates the tangible actions required for timely evacuation of UN personnel from thepoint of injurylillness (POl)to an appropriate medical treatment facility (MTF)² . D. **POLICY** **D.1.DEFINITION OF CASEVAC AND GUIDING PRINCIPLES** 4. CASEVAC is defined as the evacuation of a casualty3 from the POI to the closest appropriate MTF,utilising the most effective means of transportation.4 It is a continuum of care that supports a resuscitative process from the POI,through evacuation,into surgery and on to intensive care where this is required. 5. Responsibility for the Mission's casualty evacuation system rests with the Head of Mission (HoM),though normally managed by the Director or Chief of Mission Support (DMS/CMS) and Chief Medical Officer (CMO)or other officials delegated to fulfil this task.Thé CASEVAC system must be simple in structure,lean in management and easily understood by those who use it. 1 Medical evacuation (MEDEVAC)is the process of evacuation from one medical facility to another.Once a casualty has beenadmitted to a medical facility,all onward movement for medical purposes is considered to be 2 MTFs are UN Level 1,1+,2 and 3 medical facilities.Surgical intervention is available at all levels from Level 2 MEDEVAC. and may be available in some Level 1+facilities 3Casualty here is used to mean those suffering a trauma injury and those with sudden onset,acute life- threatening conditions requiring immediate expert medical intervention. 4 In extremis,this may mean exploiting any means of transport available. Policy on Casualty Evacuation in the Field can be devolved,including to the sector level as required. better understand the risks being accepted and provides the basis for informed decision making int the future. 8Collection of epidemiological data across missionsand over time against specific risk profiles allows the UN to 7The lowest possible level will be the Designated Operations Centre or Centers where CASEVAC responsibilities ***UNCLASSIFIED*** 6. CASEVAC takes priority over all other Mission activities except actions to counter immediate threats to UN personnel.CASEVAC operations will be further prioritised taking into consideration the category and number of patients. 7. In the case of penetrating trauma,there is no inflection point in time after injury at which death or residual disability rates rise sharply,rather there is a progressive,largely linear, increase.Consequently,delay in treatment leads to an increased rate of death and disability.For operational health planning purposes,guidelines have emerged that seek to trade-off clinicai need against operational risk.The metric adopted in the UN system is the “10-1-2”guideline⁵;this requires: Immediate lifesaving measures are applied by personnel trained in first aid. Bleeding and airway control for the most severely injured casualties is to be achieved **within 10minutes** and a casualty alert message transmitted. Advanced resuscitation /treatment is commenced by emergency medical personnel **within 1 hour** of injury /illness onset. Where required damage control surgery (DCS)is commenced as soon as *practicable,* ***but no later than 2 hours*** *after injury /illness onset6.* **10** 1 2 8. To meet this demanding timeframe a philosophy of 'ownership at the highest level and execution at the lowest level'will be adopted (see para 17).While the ownership of the CASEVAC system is invested in senior mission leadership,authority to launch CASEVAC operations is devolved to the lowest practical level⁷without the need to seek permission from the ownership level'. **D.2.IMPLICATIONS OF 10-1-2 WITHIN UN MISSION CONTEXT** 9. Resources. Adherence to the 10-1-2 guideline should be given equal weight to that of other mission essential planning factors when establishing the mission medical system structure. It demands that a matrix of ground and aerial evacuation platforms is provided and that there are enough MTFs able to provide resuscitative surgery.This may be a mix of Contingent,UN owned,contracted and host nation capabilities.In peacekeeping missions, all available assets will be referenced in the Mission Health Support Plan (HSP)as should associated assets,such as attack helicopters,needed to support CASEVAC operations. Responsibility for the Mission's health system ultimately rests with the Head of Mission (HoM),though managed by the Director or Chief of Mission Support (DMS/CMS)and Chief Medical Officer (CMO)or other official delegated to fulfil this task. 10. Risk management.If adherence to the 10-1-2 guideline is not achievable,the HoM must decide whether or not the risks are acceptable within the provisions of the mission mandate. This decision should be based on a comprehensive risk assessment including advice from the CMO and articulated in the Mission HSP.Formal risk acceptance should also be notified to the Medical Director at UNHQ for information.8 11. The CMO must ensure that the mission leadership has a clear understanding of the medical risks for which they are responsible.If the HoM decides to accept risks related to a foreseeable inability to implement elements of the 10-1-2 guideline,this should be formally detailed in the Mission Plan,risk register or Health Support Plan (or other appropriate 5The 10-1-2 guideline was developed in relation to the type of penetrating trauma typically seen on the battlefield.AS UN personnel are exposed to these typesof injury,this guideline informs the sructure of UN CASEVAC systems.See Reference A. 6 The 10-1-2guideline cumulative;the total time lapse between injury/lonset and surgery should be under two hours(120 minutes). Policyon Casualty Evacuation in the Field 4  Additionally,in locations where the Security Risk Management process has identified the *UNCLASSIFIED* document)and every reasonable effort should be made to mitigate the risk.The decision to accept risks of non-implementation should be regularly reviewed by the mission leadership;and,if or when circumstances allow,or the risk profile changes to a level unacceptable to the HoM,the deviation from the timelines should be rectified,or operations modified so that risk exposure is reduced to an acceptable level. 12. **First Aid.** Actions taken in the first minutes after injury are among the most important in determining survival.Consequently,all military and police personnel deployed in any UN Mission should be trained and certified in basic trauma First Aid to the UN directed standard and supplied with trauma focussed equipment to facilitate 'Self and 'Buddy First Aid'9. need for a First Responder Programme,the Head of Mission,in their function as the Designated Official (DO),will appoint the United Nations Security Management (UNSMS) First Responders from among civilian personnel (please refer to Security Policy Manual Chapter iV Section A on Security Risk Management and Security Management Operations Manual Chapter Ill on Guidelines on First Responder Programme).10 Equipment and training must emphasise the control of catastrophic bleeding and securing a patent airway. 13. **First Responders and extended field care**.First Responders are individual non-medica personnel trained in advanced First Aid who are able to treat a casualty at the POI for an extended period before emergency medicine trained personnel arrive.11 Within the UN,First Responders are referred to as Field Medic Assistants (FMA).They must be trained to manage a casualty for an extended period until emergency care personnel arrive. Consequently,their skills extend beyond the initial care of the first 10 minutes and sometimes beyond the first hour of the 10-1-2 metric.First Responders must be equipped appropriately to fulfil this role12. 14. **Emergency care personnel.** Emergency care personnel are normally members of the health services/medical branch of the of the Troop/Police Contributing Country (TCC/PCC) or civilian UN or contracted staff employed to fulfil this role.This includes ambulance crew, field/combat medical technicians,paramedics,nurses and doctors trained in pre-hospital trauma care. 15. **En-route care**.Evacuation must be effected by a team able to deliver advanced emergency medical care en-route,irrespective of the platform used.In the case of Aeromedical Evacuation Teams(AMET),the team willbe led by a doctor trained in pre-hospital emergency care.13 16. **Initial surgery.** The initial surgical intervention is conducted within the philosophy of Damage Control Surgery (DCS)with rapid onward medical evacuation(MEDEVAC)for definitive care if required. 17. **Command and control philosophy**.While the ownership of the CASEVAC system is invested in a senior Mission leader -normally the DMS/CMS -authority to launch CASEVAC operations will be devolved to the lowest practical level without the need to seek 9 This must meet the standard of the UN Buddy First Aid Course (UNBFAC)as a minimum 10 These First Responders includesthose civilian personnel who successfully complete the Emergency Trauma Bag First Responder Course (ETBFRC)and/or the Individual First Aid Kit (IFAK)course. 11 First responders must be able to deal with those factors resulting in most trauma deaths,the so called lethal triad'. 12 Minimum first aid equipment requirements have been included in Reference B.The equipment provided is more comprehensive than that of the IFAK and is designed for team use. 13 The standard UN staffing requirement for an AMET provides for two sub-teams each consisting of one doctor and two nurses or paramedics-total six personnel-trained in emergency care and aeromedical evacuation.In the absence of internationally agreed standards of training for certain medical specialisations -notably Emergency Medicine -the required clinical skill set,and necessary credentialing documentation required to d ntiniint fe nretilajt to a Reference B,Chapter 3,Annex C,Appendix 8. Policy on Casualty Evacuation in the Field *permission from* the ‘ownership level’. Timely evacuation requires high levels of trust between the senior leader and those subordinates given delegated authority to execute CASEVAC operations. In most missions, launch authority will be delegated to a headquarters staff with situational awareness of the security, air and medical asset situation across the whole mission area. In larger missions, where Field Offices, Sector Headquarters are established at the sub-national level (Heads of Office, Police, Military Sectors), authority for CASEVAC operations may be decentralised and delegated to these headquarters where appropriate. This will require staff in those headquarters to undertake Duty Officer functions as articulated below in the Process section. The Mission Operational and Health Support Plans must articulate where delegated authorities within the CASEVAC system rest. **Temporary allocation of resources and Operational Control (OPCON).** Health support is a key component of operational planning. The availability of CASEVAC capabilities must betaken into account in operational planning on all levels. Risks to timely evacuation, such as adverse weather conditions or technical impediments, must be reflected in mission planning and execution and may constrain operational activity. Risk mitigation may involve the temporary relocation of treatment and evacuation assets. During the conduct high-risk operations, it may be necessary for a specified time period – typically for the duration of the high-risk operation – to allocate resources, particularly helicopters with an Aero-Medical Evacuation Team (AMET), exclusively to support these operations. This would include the temporary operational control of these assets in response to a CASEVAC as necessary. This allocation is approved by the HoM. Command and Control (C2) arrangements must be aligned to the DPO-DOS Policy on Authority, Command and Control (Reference C).  **Special Political Missions (SPM)**. In SPMs where a designated operations centre which could coordinate CASEVAC support does not exist, the HoM will need to establish a system for the management of wounded, injured or ill individuals tailored to the needs of the mission. The system should seek to comply with the 10-1-2 guideline and align with the processes articulated in this policy using a combination of UN and other assets available in the mission area. Once established, the system should be tested on a periodic basis as for other missions. The HOM is to appoint an individual responsible for the CASEVAC system and this should be articulated in the Mission Operational and Health Support Plans. **D.3. PROCESS (See Schematic at Annex A)**  **Alert message**: As soon as possible after injury an alert message must be transmitted to a Mission Designated Operations Centre (DOC)14 to initiate a CASEVAC response. The alert message format will be defined in the mission CASEVAC SOP but mandatorily comprises of these minimum four separate pieces of information: • Location of event, including grid reference and callsign. • Nature of incident (IED strike, motor vehicle accident etc). • Actions currently being taken at the scene (treatment and security). • Number of casualties and special resources required due to the patients’ conditions.15  Verbal transmission of this information should be direct from the incident site to the DOC where the Mission communications architecture facilitates this. Where this is not achievable, as few intermediate nodes as possible should be involved in the passage of this information. Intermediate HQs between the incident site and the DOC – such as Battalion, Sector and UNPOL HQs – will be bypassed during the initial alert message where 14 The Mission Health Support Plan and CASEVAC SOP should clearly articulate a single designated operations centre (this may be the JOC, MOC, TOC, MAOC, POC, MSC etc) responsible for CASEVAC operations, this may be at ‘Mission’ level or where appropriate delegated to Sector level as per paragraph 16. The Head of Mission is to designate which HQ will own the Designated Operations Centre responsibility. 15 An example alert message format - “the ‘9 liner” - appears in the SOP template at Annex B.  *UNCLASSIFIED* the communications architecture permits,although these HQs must be informed as soon as reasonably practical.Receipt of the alert message by the DOC MUST trigger a speedy CASEVAC response. 21. **Warning Order (WngO).** On receipt of Alert Message,the DOC Duty Operations Officer (D/OpsO)issues an immediate WngO to those assets most likely to be used for the evacuation,typically a helicopter unit,Aeromedical Evacuation Team(AMET)and a receiving MTF;typically,a Level 2 facility.Where there may be several alternative assets that could be used to fulfil a task,a WngO should be communicated to all pending final determination as to the precise assets required.The WngO should include all information from the Alert Message.Where not co-located,AMETs that have received a WngO must move immediately to the location of their designated evacuation platform. 22. **Launch consult**.Immediately after,or simultaneously with the issuing of the WngO,the D/OpsO will consult with the Duty Air Operations Officer (D/Air OpsO)16 and Duty Evacuation Medical Officer (D/EvacMO)to confirm the requirement for the CASEVAC launch,clarify the aviation and general security situation (a formal Emergency Ground Risk Assessment -EGRA-may be required in some high risk missions17)and confirm a receiving MTF.18 Once these three authorities have confirmed the need for CASEVAC launch,the D/OpsO will transmit the launch authority to the aviation or ground evacuation asset and the associated AMET/evacuation team.19They will also inform the receiving MTF and provide an estimated time of arrival (ETA)and estimated number of casualties.If for any reason the D/OpsO and D/Air OpsO cannot rapidly obtain medical advice,they have authority to launch aCASEVAC without reference to the D/EvacMO.The D/OpsO may also authorise the use of ground evacuation assets without reference to the D/Air OpsO when air evacuation is not required.Where air evacuation is to be used,the D/Air OpsO must confirm the launch in order to comply with aviation safety requirements.20 The D/OpsO is responsible for all aspects of coordinating the CASEVAC process from receipt of the alert message to the arrival of the last patient at an MTF. 23. **Coordinating information.** The D/OpsO is to ensure that coordinating information is known to those at the incident site,Air Ops and the evacuation asset/AMET (air or ground), this information is required before they issue the launch authority.This includes: · Grid reference of incident. ·Grid reference of helicopter Landing Site (HLS)/pick-up point if diferent from incident. ● Call signs of evacuation asset and incident site commander. ·Main and any alternate radio frequencies. ·Number of casualties expected to be moved. ·Name and location of receiving Medical Treatment Facility (MTF). ·EGRA information (if required). 2**4. Casualty situation report (CASSITREP)**.The purpose of a casualty situation report is to inform the D/EvacMO of the status of the casualty.This is usually compiled by first responders who must be trained and equipped to provide the information required.This report should be updated and transmitted at regular intervals to the D/EvacMO at the DOC where the communications architecture permits.The D/EvacMO is to transmit all relevant clinical information to the receiving MTF(s)-and AMET teams en-route if possible - 16 Typically located in the Mission Air Operations Centre (MAOC).See Reference D. 17 An example EGRA format appears in the SOP template at Annex B. 18 There may be more than one MTF where there are multiple casualties. 19 The D/OpsO may delegate the task of transmitting the launch authority to the relevant aviation unit and MTF to the D/AirOpsO and D/EvacMO respectively **where doing so will speed the process**. 20 The Mission CASEVAC SOP must state who (by appointment)the D/OpsO is to contact if there is disagreement on the launch decision between the D/OpsO and D/Air OpsOfor a final decision on launch. Policyon Casualty Evacuation in the Field  *UNCLASSIFIED* including the number of casualties they can expect to receive and estimated time of arrival. A CASSITREP is not required to make a launch decision and receipt of this information must not delay this decision.21 25. First Medical Report(FMR):The FMR is provided by the MTF(s)receiving casualties and transmitted directly tothe D/EvacMO within one hour of a casualty's arrival.This report informs the mission leadership of the status of the casualty and forms the basis for a decision on possible further medical evacuation (MEDEVAC).22 26. 'Need to know'.During the launch approval process,there is no need to routinely consult or inform individuals outside the DOC however this must be done by the D/OpsO,or their staff,as soon as reasonably practical after all other higher priority coordinating actions are complete.This information can,in most cases,be transmitted by email during the normal working day,although may require telephone communication out of routine working hours. Those not directly involved in the decision making and coordination of the CASEVAC must refrain from seeking information from the DOC staff until after casualties have arrived at the receiving MTFs,however,within the capacity of the DOC and the incident being managed, the D/OpsO through should keep key external stakeholders informed. 27. After Action Review (AAR).Within 72 hours of a CASEVAC event,the CMO is to conduct a formal AAR to confirm the CASEVAC processes and identify lessons learned and make recommendations for improvement to the system.This is to be submitted to the CMS/DMS or individual appointed by the HOM for the overall quality management of the CASEVAC system. **D.4.PATIENT CATEGORIES AND EVACUATION PRIORITIES** **D.4.1 Patient categories** 28. For the purposes of this policy,patients are triaged and categories in relation to the priority of medical attention and evacuation are as follows:23 · **Category Alpha(Critical)**.Life is immediately threatened.Rapid evacuation,urgent resuscitationand/or surgery are required to save life,limb or sight.In the absence of immediate and appropriate medical and/or surgical procedure,there will be a significant chance of mortality or significantly increased morbidity. · **Category Bravo (Urgent)**.Life,limb or eye is in serious jeopardy.Evacuation should be conducted as soon as possible.This category remains a priority for stabilisation, treatment at point of injury and evacuation except that predicted deterioration or a negative outcome is unlikely within six hours. ● **Category Charlie (Delayed or Hold)**.Life,limb or eye is not in serious jeopardy. Evacuation should be affected as soon as a suitable transport mode is available. This category remains a priority for medical attention.The mechanism and localisation of injurylillness do not predict a negative outcome in the next 24 hours. · **Category Delta(Expectant).** Casualties who have injuries inconsistent with survival.They will be evacuated after other Category Bravo patients. 29.Triage of patients into these categories is dynamic and may be changed as they are reassessed while awaiting evacuation or when assessed by a more senior clinician during any stage of the evacuation.For example,an AMET doctor arriving at the scene of a mass casualty event where there is no doctor,may re-triage casualties if the number exceed the capacity of the aircraft to ensure the most il/injured are moved first. 21 An example CASSITREP message format appears in the SOP template at Annex B. 22 An example FMR format appears in the SOP template at Annex B. 23 Categorisation of casualties is conducted on site bythe individual with the highest level of clinical training. Policy on Casualty Evacuation in the Field  *UNCLASSIFIED* **D.4.2 Evacuation priorities** 30. **General principles**.CASEVAC takes priority over all other Mission activities except actions to counter immediate threats to UN personnel.CASEVAC operations will be prioritised taking into consideration the category and number of patients. 3**1. Mass casualty incident**.A mass casualty incident (MCl)occurs when the number of live patients is greater than the resources available to evacuate or treat them in a timely manner and where delay is likely to result in otherwise preventable death.A MCl is usually declared 'bottom up',from each level of command or medical facility.A MCI may have a significant impact on current operations and therefore needs to be managed 'top down'.Where an MCl has been declared the CMO or their nominated delegate must be available in the DOC in order to advise on the regulation of casualties to appropriate MTFs and the use of clinical and evacuation resources.The principles of treatment may need to be changed from focusing on the individual patient needs to achieve the best outcome for the greatest number of casualties.AMCi may also be declared'top down'by the D/OpsO on the advice of the D/EvacMO or CMO.Oncea mass casualty incident has been declared,the following principles apply: · Category Alpha patients have the highest priority.These patients shall be evacuated directly to the most appropriate medical treatment facility; · Category Delta patients will be evacuated after Category Alpha and Bravo casualties; ·Category Charlie patients shall remain at the point of injury/illness until all category Alpha,Bravo and Delta patients are evacuated. · Category Bravo and Charlie patients may first be evacuated to a Level I MTF for initial care in order to relieve pressure on Level 1+(surgical),Level 2 and Level 3 facilities. ·Should there be remaining capacity ina CASEVAC asset arriving at the MCl,but not required for additional category Alpha patients,evacuation of category Bravo and Charlie patients should not be delayed. ·Personnel declared dead at the MCI site will be moved last using an appropriate method of transportation. **D.5.CASEVAC SERVICES FOR NON-MISSION INDIVIDUALS AND ENTITIES** **D.5.1 CASEVAC for non-mission United Nations personnel** 32. In mission areas where there is United Nations Country Team (UNCT),the United Nations Security Management System(UNSMS)develops Security Plans approved by the Designated Official in consultation with the Security Management Team,and in accordance with the relevant policies and guidelines of the UNSMS.The Security Plan(s)include a CASEVAC Plan as part of the medical plans.In mission settings,the Principal/Chief Security Adviser or the Chief Security Officer where relevant,supports the DO in including in the Security Plans,the CASEVAC plans,which have been developed and coordinated with the Senior Leaders responsible for the overall ownership/management of the CASEVAC system in the mission and UNSMS organizations.In this respect,they should all work together to ensure a cohesive response including in instances of incidents impacting both Mission and other UNSMS personnel.24 24 UNSMS personnel are those personnel as defined by the UN-system wide policy on“Applicability of the United Nations Security Management System”(Security Policy Manuel Chapter Ⅲ,Section A.) Policy on Casualty Evacuation in the Field  *UNCLASSIFIED* **D.5.2 CASEVAC for non-United Nations patients** 33.Hostile combatants and civilians injured by UN forces during the conduct of UN operations must be treated and evacuated along with UN personnel in order of clinical priority.25 Evacuation of non-UN civilians will normally be to non-UN facilities and may be achieved in cooperation with local health services where available.Individuals deemed to be hostile combatants are to be evacuated to either a UN facility or other facility directed by the HoM in the HSP 26 34. Non-UN patients who have been injured or become ill in circumstances that are not attributable to UN action may also be provided CASEVAC assistance.This may be initiated upon request from a third-party (non-UN)through the Office of the Head of Mission or other Office as directed by the Head of Mission and be authorized by the HoM or by an individual delegated by them to make this decision.When mission CASEVAC assets are used for non-UN entities,the HoM or delegate must ensure that reserve capacities are available for the CASEVAC of UN personnel and other personnel where directed in their mandate. **D.5.3 Non-United Nations medical treatment facilities** 35.Patients may be evacuated to a local or a neighbouring country MTF to get proper and timely treatment should it be more feasible or if the situation requires.Missions are responsible for establishing arrangements for access to Non-United Nations medical treatment facilities as necessary.This may include inspection,certification,contracting and approvals (including flight approvals)for cross-border CASEVAC.Location and contact information of the local and neighbouring country medical facilities shall be included in the mission CASEVAC plan. **E.AUTHORITIES,ROLES AND RESPONSIBILITIES** **E.1.United Nations Headquarters** **E.1.1 Under-Secretary-General for Operational Support** 36.The Under-Secretary-General for Operational Support is accountable to the Secretary- General to: · Confirm that CASEVAC system specific to each United Nations field mission is established,appropriately resourced,supported and monitored throughout the mission lifecycle ·Provide strategic guidance for budgeting,staffing and logistics resources to support the Mission CÄSEVAC systems. · Ensure that United Nations health governance standards are established for CASEVAC systems and are monitored and enforced. **E.1.2 Under-Secretary-General for Peace Operations** 37.The Under-Secretary-General for Peace Operations is accountable to the Secretary- General to 25 This is a requirement of the Laws of Armed Conflict.See:https://ihl- databases.icrc.org/applic/ih/ihl.nsf/Comment.xsp?action=openDocument&documentld=CECD58D1E2A2AF30C1 257F15 26 It may be necessary toprovide security during evacuation and in thefacilities where hostile combatants are cared for.Where missions developa formal EGRA process this issue must be included.Every effort must be made to ensure this decision does not cause any unnecessary delayin evacuation. Policy on Casualty Evacuation in the Field • Ensure that at the mission start-up phase, CASEVAC is included in the Mission Concept27 . • Ensure that all peacekeepers comply with this and related UN Policies. • Ensure the generation of relevant contingent resources for use in CASEVAC. **E.1.3 Under-Secretary-General for Peacebuilding and Political Affairs**  The Under-Secretary-General for Peacebuilding and Political Affairs is accountable to the Secretary-General to: • In coordination with relevant Departments at HQ, support the respective field based Special Political Missions in establishing CASEVAC arrangements. • Ensure that at mission start-up phase, CASEVAC is included in the mission concept. **E.1.4 Under Secretary-General for Safety and Security**  The Under-Secretary-General for Safety and Security is accountable to the Secretary- General to ensure implementation, compliance and support for security aspects of the activities of the UNSMS for the protection of United Nations Personnel, who are covered by the applicability of the United Nations Security Management System. **E.2. In the Field** **E.2.1 Head of Mission**  The HoM is accountable to the Secretary-General to: • Ensure that an integrated CASEVAC system is in place and tested as soon as possible after the establishment of the mission area of responsibility. • Ensure that the Mission has in place the administrative and logistical support to conduct CASEVAC operations and that all mission personnel are aware of their authorities, roles and responsibilities within the system through the conduct of regular exercises of the system. • Designate a Senior Leader responsible for the overall ownership/management of the CASEVAC system. • Direct a single Designated Operations Centre to lead in the coordination of CASEVAC operations at Mission level, and where appropriate sub-national/sector level. • Conducts regular training exercises to test the CASEVAC system at intervals of not greater than four months. 28 • Seek opportunities to rationalise CASEVAC resources in the Mission area with other UN, local, NGO and other recognised international entities present in the mission area. • Work with Host Country governments to create an environment that enables the CASEVAC system and where possible conduct joint CASEVAC exercises. • Ensure that where the Mission CASEVAC system is to be extended to other UN entities, other governmental and non-governmental organizations, members of diplomatic corps, or to nationals and other non-entitled personnel on humanitarian grounds, the terms and conditions under which the support is to be provided are 27 It should also be included in the Mission Support Concept and Mission Plan. 28 Four monthly exercises must be regarded as the absolute minimum for the conduct of such exercises, the ideal interval is two monthly and should wherever possible be aligned with major troop rotations to ensure newly arrived units are familiar with the processes involved. clearly spelt out including the administrative, financial and logistics parameters in a separate agreement.29 • For the protection of United Nations Personnel as defined by the Organization's system-wide policy on "Applicability of United Nations Security Management System" (see Reference E), the HoM, in their function as the Designated Official (DO), is accountable to the Secretary-General through the USG for Department of Safety and Security (DSS) for the implementation of UNSMS policies and guidelines including those related to security risk management. • The responsibility and authority for the implementation of this Policy, rests with the HoM who can delegate in writing to any senior mission official ownership and management (command and control) responsibility for the Mission CASEVAC system, although this would normally be the DMS/CMS.30 **E.2.2 Head of Military and Police Components**  The Head of Military and Police components are accountable to HoM for: • Issuing and implementation of instructions to ensure that the military and police components comply with this Policy and the associated mission framework. • Ensuring that operational planning includes a risk assessment / casualty estimate that articulates the need for CASEVAC resources. • Contribute information, control ground evacuation routes, securing landing zones and provide protection to ground and air evacuation teams as required. • Ensuring that the conduct of casualty evacuation is described or referenced31 in all operational orders for all military and police activities conducted within their area of responsibility. • Ensuring that all military and police personnel receive a mandatory briefing on the Mission-CASEVAC SOP, and understand their roles responsibilities in the CASEVAC system. • Ensuring assignment and integration of Military and Police personnel into mission structures responsible for coordination/execution of CASEVAC. • Ensuring the Force Medical Officer is aware of their responsibilities in a CASEVAC system. • The provision of training, rehearsal and incorporation of medical assets in all operations. **E.2.3 Director/Chief of Mission Support 32**  The Director/Chief of Mission Support shall implement all delegated authority to ensure the timely and seamless conduct of CASEVAC in the mission and are accountable for: • Ensuring that a coherent and integrated CASEVAC system is in place to meet the requirements of this policy across the entire mission area of operation and to establish and implement the procedures that would support and ensure effective and transparent governance protocol for CASEVAC in the mission. 29 The details of this arrangement *should not* be laid out in detail in the Mission CASEVAC SOP but detailed elsewhere. 30 Note that in those cases where management of the CASEVAC system is attributed to anyone other than the DMS/CMS, where subordinates, such as the CMO, in this policy are held accountable to the DMS/CMS for aspects of the CASEVAC system, this accountability would be to the nominated official rather than the DMS/CMS. 31 The reference will normally be the Mission CASEVAC SOP. 32 This only applies where the HOM has delegated ‘ownership’ of the CASEVAC system. Where another official is given this delegation on a permanent basis that individual assumes these responsibilities. • Ensuring that the budget for CASEVAC resources is included in the Mission's annual budget requirements. • Ensuring that Mission assets, whether UNOE or COE, including medical, transport (air, land and sea), communication assets etc. are adequate, fully integrated and are at optimal functional status at all times to support CASEVAC activities in the Mission. • In collaboration with all stakeholders, developing and issuing Mission-specific SOP for CASEVAC (a suggested format is at Annex B). Such SOP must spell out the authorities, roles and responsibilities of all stakeholders including their channel of communication and reporting lines, procedures, available resources and their distribution, etc. • Establishing access to medical treatment facilities that comply with United Nations medical standards to augment those provided by the Military and Police Components as necessary. • Instituting, in collaboration with Military and Police component commanders and other key stakeholders33 an integrated training programme for CASEVAC in the Mission. • Ensuring an official Notification of Casualty (NOTICAS) record is submitted to UNHQ, as instructed in Reference F. • Providing support for the establishment and proper functioning of the CASEVAC system Designated Operations Centre as directed by the HoM. • Implementing all instructions from the HoM as they relate to the provision of CASEVAC support to UNAFPs, governmental and non-governmental organizations, humanitarian organizations, members of diplomatic corps, as well as nationals and others on medical and humanitarian grounds. **E.2.4 Chief of Staff (COS)**  The Chief of Staff is to ensure that the processes and capability are in place to support coordination of all casualty evacuation in the mission's area of responsibility.34 **E.2.5 Chief Medical Officer (CMO)**  The CMO is accountable to the CMS/DMS for: • Clinical standards within the CASEVAC system. • Maintaining a duty system to ensure that a D/EvacMO is always available (24 hr). • Ensuring all Mission AMET are held at the level of readiness directed by the CMS/DMS. • Ensuring data is entered in the UN EarthMed CASEVAC Module. • Production of an After-Action Review on each CASEVAC as directed by the CMS/DMS or individual appointed by the HOM. • Establishing and supervising a curriculum for the training of mission health staff in the conduct of CASEVAC operations. **E.2.6 Force Medical Officer**  The FMO is accountable to the CMO for: 33 Such as those responsible for UN civilian staff. 34 For a full explanation of the COS role see DPO-DOS Policy on Authority, Command and Control (Reference C).  *UNCLASSIFIED* · Ensuring military medical capabilities are provided and maintained as per the apprlicable UN standards and in compliance with Reference B and the contingent specific MOU ·The training of uniformed health personnel in the conduct of CASEVAC operations. **E.2.7 Chief Aviation Officer** 46.The Chief Aviation Officer is accountable to the DMS/CMS for: ·Availability of air assets in support of CASEVAC operations. · Ensuring that aircraft and crews are held at the level of readiness directed by the DMS and in complicance with their applicable contract or LOA. ·Confirming the currency of helicopter landing site (HLS)lists and providing all necessary HLS information to the relevant Mission entities in a timely manner. ·Maintain a duty system to ensure that a D/AirOpsO is always available (24 hr). **E.2.8 Principal/Chief Security Adviser/Chief Security Officer** 47.The Principal/Chief Security Adviser/Chief Security Officer should include in the Security Plans the CASEVAC plans which have been developed and coordinated with the Senior Leaders responsible for the overall ownership/management of the CASEVAC system in the mission and UNSMS organizations. 48.Work together with the Senior Leaders responsible for theoverall ownership/management of the CASEVAC system in the mission and UNSMS organizations to ensure that plans are aligned,coordinated and to ensure a cohesive response including in instances of incidents impacting both Mission and other UNSMS personnel. **E.2.9 Commanding Officer /Manager of Receiving Medical Treatment Facilities** 49.Commanding Officer /Manager of Receiving Medical Treatment Facilities shall: 49.1.Ensure that First Medical Reports are completed and submitted in the time and format required. 49.2.Assist the CMO in completion of the AAR through the provision of clinical and other information as requested by the CMO. **F.REFERENCES** 50.This Policy should be read in conjunction with the following documents. a.2015.12 Medical Support Manual for United Nations Field Missions-3rd Ed. b.Manual on Policy and Procedures Concerning the Reimbursement and Control of Contingent Owned Equipment of Troop/Police Contributors Participating in Peacekeeping Missions (GA,A/72/2882017) c.2019.23 Policy on Authority,Command and Control in UN PKOs d.2018.21 Aviation Manual e.United Nations Security Management System Security Policy Manual and Security *Management Operations Manual* f.2017.22 SOP on Notification of Casualties (NOTICAS)in Peacekeeping Operations and Special Political Missions g.UN Crisis Management Policy (2018) Policy on Casualty Evacuation in the Field  *UNCLASSIFIED* **G.MONITORING AND COMPLIANCE** 51.The Departments of Peacekeeping Operations,Peacebuilding and Political Affairs and Operational Support have the authority for oversight and monitoring of the compliance to this Policy in their respective areas.The heads of these Departments should work together to ensure that Heads of Missions are properly informed of this policy. H. **CONTACT** 52. All enquiries about this SOP and requests for Medical Support Section,SSS/LD/OSCM/DOS. amendment should be sent to the Chief, l. **HISTORY** 53.This policy shall be reviewed in three years from the date of promulgation.This Policy supercedes any previous versions,including:2018.12 Field. Policy on Casualty Evacuation in the **APPROVAL SIGNATURES:**  Under-Secretary-General **Atul Khare** Under-Secretary-Genera for Operational Suppor DATE OF APPROVAL for Peacebuilding and Political Affairs DATE OF APPROVAL  Jean-Pierre Lacroix Under-Secretary-General Under-Secretary-General for Safety and Security DATE OF APPROVAL for Peace Operations DATE OF APPROVAL Policy on Casualty Evacuation in the Field **Annex A. CASEVAC Launch Process Flow Chart** CASEVAC LAUNCH PROCESS Point of Injury Message Alert CASSITREP as required Update as required Duty Operations Officer Initiate CASEVAC Response Issue Warning Order Launch Consult Issue Launch Authority Inform “Need to Know” leadership CONFIRM 1. Grid Reference of incident 2. Grid reference of HLS/pick‐up point 3. Callsigns 4. Main and alt radio frequencies Duty Air Operations Offcier - D/OpsO - D/AirOpsO -D/EvacMO 5. No of casualties to be moved 6. Name and location of MTF 7. EGRA info. (if needed) Duty evacuation Medical Officer Assess & Advise CASEVAC Assets AMET MTF Helicopter Unit AMET MTF Helicopter Unit First Medical Report (from MTF only) **Annex B. Example - Missions Casualty Evacuation SOP** **UNXXX STANDARD OPERATING PROCEDURE FOR** **CASUALTY EVACUATION (CASEVAC)35** **Contents: A.** **B. C. D. E. F. G. H. I. J. K.** **Purpose** **Scope** **Rationale** **Underpinning Principle** **Procedure** **CASEVAC of non-UN patients** **Training testing and evaluation** **References** **Monitoring and compliance** **Contact** **History**  **PURPOSE**  This Standard Operating Procedure (SOP) provides instruction to all Mission personnel involved in a casualty evacuation (CASEVAC) operation.  **SCOPE**  Compliance with this SOP is mandatory. It applies to all Mission civilian, police and military personnel including formed police units and contingent military units deployed throughout the AOR, in Mission headquarters, sector headquarters, and other field bases.  **RATIONALE**  CASEVAC is a complex process involving multiple stakeholders and considerable coordination. This SOP dictates actions required, to provide timely evacuation from the point of injury/illness (POI) to an appropriate medical facility.  **UNDERPINNING PRINCPLE**  **10-1-2 Guideline**. A simple time metric has been developed to guide actions and inform the structure of the Mission CASEVAC system; this is the 10-1-2 *guideline* which requires: Immediate life saving measures are applied by personnel trained in first aid. **10** Bleeding and airway control for the most severely injured casualties is to be achieved ***within 10* minutes** and a casualty alert message transmitted. 35 SOPs should not laboriously repeat background information from the Health Support Plan or other Mission operational planning orders/instructions unless they materially affect the *process* to be followed.  *UNCLASSIFIED* 1 2 Advanced resuscitation /treatment is commenced by emergency medical personnel **within 1 hour** of injury /illness onset. Where required damage control surgery (DCS)is commenced as soon as *practicable,* ***but no later than 2 hours a****fter injury /illness onset36.* 58.The Mission leadership recognises strict compliance with the 10-1-2 guideline is not always possible.Where this is the case,risks must be managed accordingly,with active mitigation to establish alternate health support measures. 59.CASEVAC takes priority over all other Mission activities except for imminent threats related to safety and security of personnel. **N.PROCEDURE** **N.1.Initial Actions at the Point of Injury/llness(POl):** 60.POl inside a Mission compound/base with a Medical Facility (Level 1 or above):Within 10 minutes personnel at the POl should provide: 60.1.Basic first aid to control major bleeding and airway for breathing;and 60.2.Transmit the alert message to the duty doctor on site.Mission Alert Message format is at Annex A. 61.Within 10 minutes from the receipt of the alert message,the compound medical facility will deploy a doctor led Medical Emergency Response Team(MERT)to the POI to stabilize the patient and transport to the medical facility and/or request CAEVAC to a higher-level facility if required.If the MERT decides evacuation to a higher level is required,the procedure is the same as for incidents occurring outside a Mission compound. 62. **POI outside Mission compound/bae.** Within 10 minutes personnel at the POI should: 62.1.Provide basic first aid to control major bleeding and airway for breathing;and 62.2.Transmit the alert message,in the format at Annex A,to the Designated Operations Centre (DOC). **N.2.Initial Actions at the Designated Operations Centre** 63. **Launch consult and warning order.** Within **10 minutes** from receipt of the first alert message,DOC Duty Operations Officer will,in priority order: 63.1.Alert and consult with the Duty Aviation Officer. 63.2.Alert and consult with the Duty Medical Evacuation Officer.37 63.3.Conduct quick risk assessment. *DUTY OEPRATIONS OFFICER MAKES PROVISIONAL LAUNCH38 DECISION* 63.4.Issue Warning Order to asset(s)(ground vehicles,helicopter,evacuation teams receiving Medical Treatment Facilities {MTF})likely to be involved in the 36 The 10-1-2 guideline cumulative;the total time lapse between injury/onset and surgery should be under two hours(120 minutes). contact the Duty Medical Evacuation Officer 37 Duty Ops and Aviation Staff should not delay the provisional launch decision if for any reason they cannot 38 The term 'Launch'here is used to refer to both air and ground evacuation platforms Policy on Casualty Evacuation in the Field  CASEVAC. The Duty Operations Officer may delegate this task to the Aviation Duty Officer and Medical Evacuation Duty Officer.39 **Duty Aviation Operations Officer**: Within **15 minutes** of the provisional launch decision is to: 64.1. Confirm the closest potential helicopter landing site(s) (HLS) to the incident/POI and those to be used at receiving Medical Treatment Facility. 64.2. Confirm the air asset to be utilised for the CASEVAC. 64.3. Confirm the aviation /launch safety/airspace approvals. **DOC Duty Operations Officer**: Within **15 minutes** of provisional launch decision is to confirm: *40* • Grid reference of incident. • Grid reference of HLS / pick-up point if different from incident. • Route plan for ground evacuation assets to POI/ pickup point. • Call signs of evacuation asset and POI/incident site commander. • Main and any alternate radio frequencies and or telephone contact details. • Number of casualties expected to be moved. • Name and location of receiving MTF(s). • Known threats. • Inform other Operations Centres/duty personnel that may be required to provide additional assets/support for the CASEVAC, e.g. MOVECON, Security personnel. **Duty Evacuation Medical Officer**: Within **15 Minutes** of the provisional launch decision is to: 66.1. Confirm the CASEVAC plan to include: 41 • Evacuation priority. • Additional medical support needed at POI and during transportation. • Confirm the most appropriate means of evacuation from a clinical perspective (ground, air). • The most appropriate MERT/AMET to assist at the POI and during transportation. • Confirm receiving MTF(s). 66.2. Inform the receiving MTF(s) and provide update on the casualty status and CASEVAC flight ETA. ***NO LATER THAN 20 MINUTES AFTER PROVISIONAL LAUNCH DECISION – DUTY OPERATIONS OFFICER CONFIRMS LAUNCH ORDER*** 39 In some missions it may be necessary to arrange escorts for aircrew and AMET to move from their accommodation to their aircraft. 40 Some Missions may need to impose a quick “risk assessment” matrix to guide for duty officers which require them to seek higher level approval for launch where risk is above a directed threshold. Where this is imposed, the risk assessment matrix should be an annex to this SOP. 41 The Duty Evacuation Medical Officer should only determine priorities where they have direct contact with the POI and were no more senior clinician is at the POI – otherwise *trust those on the ground to decide the priority.*  *UNCLASSIFIED* 67. **Tasked CASEVAC/Medical Assets.**Within **15 minutes**42 of receipt of the warning order: 67.1.Helicopter air and ground crew are to be in position commencing pre-flight procedures. 67.2.Aeromedical Evacuation Teams (AMET)are to be at the aircraft commencing pre- flight procedures.Including radio contact with POI if this can be established. 67.3.Ground evacuation vehicle crews ready for departure and awaiting detailed brief as required.Where possible radio/telephone contact with POl is established. 67.4.MTF trauma teams are assembled in their relevant departments (emergency, operating,pathology laboratory,medical imaging etc)preparing for receipt of patients. **N.3.Subsequent actions -At the POI** 68.The site commander /individual in charge is to ensure: 68.1.First Aid for the casualty(s)continues. 68.2.ACasualty Situation Report(CASSITREP)is forwarded to DOCevery 15 minutes. 68.3.Where there are multiple casualties,they are sorted into a priority for evacuation. Priorities as described in Annex B. 68.4.Confirm the HLS/Pickup Point grid reference with the DOC. 68.5.Prepare the HLS in accordance with Mission Aviation SOPs.Including radio contact with evacuation platforms if this can be established. **N.4.Subsequent actions -At the DOC.** 69 **.DOC Duty Operations Officer.** The DOC Duty Operations Officer is to: 69.1.Stand-down all assets issued with a warning orderto participate in the CASEVAC not required once this has been established.This may be delegated to the Aviation and Medical Evacuation Duty Officers. 69.2.Inform the following of the CASEVAC as soon as possible after launch and update them as directed: ·As required by Mission leadership ·As required by Mission leadership 69.3.Coordinate CASEVAC operation through to conclusion acting as focal point for all communications. 69.4.Within 24 hours of the conclusion of the CASEVAC operation lead in the drafting of an After Action Report in collaboration with the Aviation and Medical Evacuation Duty Officers. 70. **DOC Duty Aviation Operations Officer** 70.1.Assist in the Coordination of CASEVAC operations conducted by air through to conclusion. 70.2.Within 24 hours of the conclusion of the CASEVAC operation assist in thedrafting of an After Action Report in collaboration with the Operations and Medical Evacuation Duty Officers. 42 It is acknowledged that the arrangements for the parking of aircraft and the accommodation of aircrew and AMET may make this impossible in some missions and that a differenttime metric may need tobe used, however,every effort must be made to ensure this time is no greater than 30 minutes. Policy on Casualty Evacuation in the Field *UNCLASSIFIED* **71.DOC Duty Evacuation Medical Officer** 71.1.Assist in the Coordination of CASEVAC operations conducted by air through to conclusion. 71.2.Provide clinical advice to personnel at the POl as required. 71.3.Pass casualty updates from POl to receiving medical teams(AMET,MTF etc). 71.4.Within 24 hours of the conclusion of the CASEVAC operation assist in the drafting of an After Action Report with the Aviation and Operations Duty Officers. 71.5.Draft a Medical-in-Confidence annex to the above report for inclusion in the CMO copy if required. 71.6.Submit a report in the UN EarthMed CASEVAC Module. 71.7.Submit post-facto formal CASEVAC request through Mission adopted air assets' requesting/tasking system(s). O. **CASEVAC OF NON-UN PATIENTS** 72.In accordance with international humanitarian law,the UN is required to treat members of hostile forces and civilians injured by UN forces within the capacity of the UN health system where alternate hostile force or civilian health capability is not immediately available.Such casualties are to be treated and evacuated in accordance with the clinical priorities described in Annex B alongside UN casualties.Costs are borne by the UN until handover to a relevant authority. 73.CASEVAC of casualties not associated with UN operations are permitted upon request from a third-party (non-UN)through the Office of the Humanitarian Coordinator and be authorized by the HoM.In cases that mission CASEVAC assets are used for non-UN entities,the Mission should ensure that reserve capacities are available for the CASEVAC of UN personnel. **P.TRAINING,TESTING AND EVALUATION** 74.All DOC should be trained and competent in the collection and management of alert messages and the actions to take upon receipt. 75.All Mission personnel involved in CASEVAC should be trained and tested in procedures, equipment,skills,communication and behaviour of the entire process. 76.The Mission shall test and evaluate the CASEVAC procedures through table-top and field exercises no less than every four months.Rehearsals and specific skills should also be tested through full scale exercises no less than every six months. **Q.REFERENCES** A.Casualty Evacuation in the Field,2019 B.Medical Support Manual for United Nations Field Missions (3rd Edition);DPO/DOS,Ref. 2015.012 C.Aviation Manual;DPO/DOS,Ref.2018.21 D.Authority,Command and Control;DPO/DOS 2019.23 E.United Nations Security Management System Policy Manual;DSS,2011 Policy on Casualty Evacuation in the Field 21  **MONITORING AND COMPLIANCE**  *Missions will need to establish how they will monitor and comply with this SOP. This section should articulate who ‘owns’ the process on behalf of the HoM and to whom delegation for launch authority is delegated by appointment not by name. This ensures that duty personnel understand authorities delegated to them by virtue of their appointment.*  **CONTACT** *The contact information of the mission department or team that developed the CASEVAC SOP. Do not use personal e-mail addresses, but rather generic departmental e-mail address.*  **HISTORY** *This section should contain the date that this CASEVAC SOP was first approved and issued. It should include the dates of each subsequent review and modification. It should also indicate any previous CASEVAC SOPs that were substantively altered, repealed or terminated as a result of the issuance of this SOP. If necessary, a schedule of amendment dates and the amendments made should be added as an attachment.* **APPROVAL SIGNATURE:** **DATE OF APPROVAL:** **ANNEX A to SOP** **CASEVAC Alert Message** **(9 Line Format)** Line **UN CASEVAC 9-LINE ALERT MESSAGE** DTG: 1 LOCATION: MAP NO: GZD: GPS GRID: 2 C/S & FREQ: C/S FREQ: 3 NUMBER OF PATIENTS / PRECEDENCE: CAT A A. CAT B B. CAT C C. CAT D D. 4 SPECIALIST EQUIPMENT REQUIRED: NONE A. HOIST (to hoist in helo) B. EXTRACTION (wreckage) C. OTHER D. 5 NUMBER OF PATIENTS BY TYPE: LITTER (stretcher) L. WALKING (ambulatory) W. 6 SECURITY AT PICKUP SITE: NO THREAT IN AREA N. POSSIBLE THREAT IN AREA P. THREAT IN AREA E. ARMED ESCORT REQUIRED X. 7 MARKING OF PICKUP SITE: AME PANELS A. PYRO (star cluster / flare) B. SMOKE (+ colour) C. STROBE D. OTHER E. 8 NUMBER OF PATIENTS BY NATIONALITY & STATUS: UN MILITARY A. OPPOSING FORCES B. OTHER C. 9 PICKUP TERRAIN OBSTACLES: ZONE & % SLOPE (lay of ground) A. OBSTACLES C. SECURITY AT PICKUP D. NUMBER OF PASSENGERS E. VEHICLES SECURING SITE F. DIR TO THREAT FORCES G. **(4 Line Format)** Line **UN CASEVAC 4-LINE ALERT MESSAGE** DTG: 1 LOCATION AND CALL SIGN PLACE NAME / DESCRIPTION A GPS GRID REFERENCE B CALL SIGN OF INCIDENT SITE COMMANDER C 2 INCIDENT DETAILS WHAT HAS HAPPENED? (Shooting, road accident, explosion etc). D HOW MANY CASUALTIES ARE THERE? E 3 ACTIONS BEING TAKEN AT SCENE TREATMENT BEING GIVEN AND PREPERATIONS FOR EVACUATION 4 RESOURCES REQUIRED AT SCENE TO TREAT AND EVACUATE PATIENT GROUND AMBULANCE, AIR EVACUATION, AMET **ANNEX B to SOP** **Emergency Ground Risk Assessment Format*** 1 Current situation at incident location/Lansing Site No combatants in vicinity Combatants within 10-20kM  Combatants within 5kM  2 Is there fighting in the immediate area No Unknown Yes 3 Type of weapons being used or in the area Small weapons rifles and pistols / No weapons Heavy weapons (e.g. heavy machine guns / RPG  Vehicle mounted weapons/MANPAD  4 Sentiment of controlling forces towards UN personnel/forces in the immediate area Friendly Neutral Hostile 5 Sentiment of controlling forces towards UN personnel/forces in the surrounding area Friendly Neutral Hostile 6 Presence of friendly forces able to provide security/protection Adequate Minimal None 7 Recommended risk level Low Medium  High *The absolute minimum information required during casualty evacuation is outlined at paragraph 20 of the main policy. Staff responsible for creating the Mission Casualty Evacuation SOP should give due consideration to: 1. the overall threat level; 2. the training and experience of Mission personnel; 3. any communications system limitations; and 4. language difficulties when deciding on the format of Alert Messages and the need for and format of Emergency Ground Risk Assessments (EGRA) and Casualty Situation Reports (CASITREP). Obtaining confirmed EGRA and CASSITREPS information should not impede a launch decision. **ANNEX C to SOP** **CASUALTY SITUATON REPORT (CASSITREP)*** **A** Age and Sex of Patient: **T** Time of Incident or Update Report: **M** Mechanism of Injury: **I** Illness/Injuries Sustained or Suspected: **S** Signs & Symptoms: • Airway clear – Yes/No • Breathing – Yes/No Rate: • Pulse – Yes / No Rate: • Blood Pressure • Temperature • Consciousness: Alert / Voice Response / Pain Response / Unconscious **T** Treatment provided and Required: *The absolute minimum information required during casualty evacuation is outlined at paragraph 20 of the main policy. Staff responsible for creating the Mission Casualty Evacuation SOP should give due consideration to: 1. the overall threat level; 2. the training and experience of Mission personnel; 3. any communications system limitations; and 4. language difficulties when deciding on the format of Alert Messages and the need for and format of Emergency Ground Risk Assessments (EGRA) and Casualty Situation Reports (CASITREP). Obtaining confirmed EGRA and CASSITREPS information should not impede a launch decision. **ANNEX D to SOP** **Patient Categories and Evacuation Priorities** Patient categories. For the purposes of this SOP, patient categories in relation to the priority of medical attention and evacuation are as follows: **Category Alpha (Critical).** Life is immediately threatened. Rapid evacuation, urgent resuscitation and/or surgery are required to save life, limb or sight. In the absence of immediate and appropriate medical and/or surgical procedure, there will be a significant chance of mortality or increased morbidity within two hours. **Category Bravo (Urgent).** Life or limb is in serious jeopardy. Evacuation should be conducted as soon as possible. This category remains a priority for stabilisation, treatment at point of injury, and evacuation except that predicted deterioration or a negative outcome is unlikely within six hours. **Category Charlie (Delayed or Hold).** Life or limb is not in serious jeopardy. Evacuation should be affected as soon as a suitable transport mode is available. This category remains a priority for medical attention. The mechanism and localisation of injury do not predict a negative outcome in the next 24 hours. **Category Delta (Expectant)**. *This category is only to be used when the* ***Mission HQ*** *has declared a Mass Casualty event.* Casualties who have injuries inconsistent with survival. They will be evacuated after other Category Alpha patients. **ANNEX E TO SOP** **DISTRIBUTION TO HEALTH STAFF ONLY** **FIRST / UPDATE MEDICAL REPORT** 1 DATE AND TIME OF REPORT 12 NOVEMBER 2019 – 13:40 2 NAME (FAMILY/Given) SMITH Peter Robert 3 MILITARY/POLICE/CIVILIAN MILITARY 4 RANK (Military / Police) CORPORAL (Military) 5 NATIONALITY CANADIAN 6 UNIT CANBAT 1 7 CURRENT LOCATION INDIAN LEVEL 3 GOMA 8 PRINCIPAL DIAGNOSIS FRACTURE LEFT TIBIA AND FIBULA; TRAUMATIC AMPUTATION LEFT HAND 9 BRIEF CLINICAL SUMMARY SUSTAINED INJURY TO LEFT AREM AND LEG IN IED STRIKE ON ARMOURED PERSONNEL CARRIER. FRACTURE/DISLOCATION OF LOWER THIRED OF LEFT TIBIA AND FIBULA. TRAUMATIC AMPUTATION OF LEFT-HAND AT WRIST. STABLE AND CONSCIOUS ON ADMISSION TO LEVEL 3. NIL OTHER MAJOR INJURIES IDENTIFIED ON ADMISSION. MILD HYPOVOLEAMIC SHOCK. 10 TREATMENT LEG STABALISED AND SPLINTED AT INCIDENT SITE. TOURNIQUET APPLIED TO LEFT UPPER ARM, WOUND TO HAND DRESSED WITH COMPRESSION BANDAGE. ANALGESIA AND INTRAVENOUS FLUIDS COMMENCED AT INCIDENT SITE. ON ADMISSION TO LEVEL 3: OPEN REDUCCTION OF LEG FRACTURES AND EXTERNAL FIXATATION APPLIED. DEBRIDEMENT OF LEFT-HAND INJURY – PRIMAY DELAYED CLOSURE. COMMENCED IV ANTIBIOTICS. ADMITTED TO INTENSIVE CARE FOR POST OPERATIVE CARE. 11 PROGNOSIS GOOD. 12 IS MEDICAL EVACUATON OUT OF MISSION AREA REQUIRED YES. 13 DATE OF NEXT UPDATE 13 NOVEMBER 2019 – 12:00 14 RELEASE AUTHORITY:NAME AND APPOINTMENT COLONEL B. RAWAT COMMANDING OFFICER INDIAN LEVEL 3 HOSPITAL GOMA **DISTRIBUTION TO HEALTH STAFF ONLY**
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2024年12月5日 17:02
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