1. NATO UNCLASSIFIED Releasable to the INTERNET NATO Staff Maritime Medical Course LO-3 Manage the Recognised Maritme Medical Picture RECOGNIZE HEALTH THREATS NATO Staff Maritime Medical Course LO-3 Manage the Recognised Maritme Medical Picture RECOGNIZE HEALTH THREATS CAPT Jeffery Paulson and CAPT Frank Chapman US Fleet Forces Command and US NAV EUR

2. NATO UNCLASSIFIED Releasable to the INTERNET Recognize Health Threats  Introduction  Objectives  Anticipate Threats  Prepare to prevent  Prepare to respond  Summary

3. NATO UNCLASSIFIED Releasable to the INTERNET Initial Data to Recognize Health Threats  Planned operational environment  Combat  Non-Combat  Know the POE  Operations at Sea  Operations on Shore  Engagements ashore  Liberty

4. NATO UNCLASSIFIED Medical Intelligence and the Threat Assessment ALLIED JOINT MEDICAL DOCTRINE FOR MEDICAL INTELLIGENCE, AJMedP-3

5. NATO UNCLASSIFIED Planned Operational Environment  Questions to ask:  Who is going?  What are they doing?  When are they going?  Where are they going?  How are they doing it?  Open-ended

6. NATO UNCLASSIFIED Threats Afloat  War Damage from Combat Actions  Mines, Missiles, Explosives  Sea Environment  Storms and Sea State  Collisions at Sea  Groundings  Man Overboard

7. NATO UNCLASSIFIED Combat  Opposing forces  Conventional Warfare  Small Arms  Explosives  Asymmetrical Warfare  IEDs  Ashore vs Afloat

8. NATO UNCLASSIFIED Environmental  Heat and Cold  Smoke and Inhalation injuries  Chemical Contamination  Animal Bites – Rabies, Infection  Snake Bites – Venom  Marine Animal Bites and Venom

9. NATO UNCLASSIFIED  Alcohol and Illicit Drugs  Prescribed Drugs  Operational Stress Behavioral Threats

10. NATO UNCLASSIFIED Non Combat Trauma  MVA’s  Motorcycle – Scooters  Boating  Other Recreational Activities

11. NATO UNCLASSIFIED Health Risks – Biological  Infectious disease  Food Borne illnesses  Safe Food and Water are critical  Disease can degrade a fighting force quickly and for a prolonged time

12. NATO UNCLASSIFIED Infectious Disease  Pandemic Illness  Influenza as example  SARS and others

13. NATO UNCLASSIFIED Food Borne  Food Sources  Food Acquisition Policy  Food Handling  Food Storage (frozen, chilled, dry)  Food Preparation (hepatitis and other human vector disease)

14. NATO UNCLASSIFIED Vector Borne  Port calls  Travel or Deployment Ashore  Malaria, Rabies, Dengue, JEV

15. NATO UNCLASSIFIED Operating Environment at Sea  INDUSTRIAL HIGH RISK ENVIRONMENT  High Risk Evolutions:  Underway Replenishment  Vertical Replenishment  Re-fueling at Sea  Cargo and personnel transfer

16. NATO UNCLASSIFIED Occupational Safety  Electrical Work  Small Boat Operations  Helicopter Operations  Fuels, Including Otto Fuel II  Fires  Welding, Cutting, Brazing  Machinery maintenance and operations  Heavy Weather Operations

17. NATO UNCLASSIFIED Ship Distress at Sea  Abandon ship – Immersion Injuries  Oil on Sea  Burning Oil Fire

18. NATO UNCLASSIFIED Survival in the Water  Windchill  Non freezing cold injury  Freezing cold injury  Heat illness and sunburn  Seasickness in the life raft  Osmotic Diarrhea  Oil Contamination  Skin Ulcers  Toxic Chemicals  Triage of Survivors  Psychological considerations

19. NATO UNCLASSIFIED Urgency  Balance:  Risk to Sailor  Threats  Urgency vs Operational Tasking

20. NATO UNCLASSIFIED Biological Chemical and Radiological  Ship capabilities?  Detection of exposure  Confirmation of agent  Air boundaries  Countermeasures - washdown?  Treatment

21. NATO UNCLASSIFIED Stress Management  Management of critical stress and traumatic stress  Stress reactions, PTS, Suicide  Resources?  Medical, Chaplain, Chain of Command, Friends

22. NATO UNCLASSIFIED Threat Assessment Summary  Threat Analysis can provide the commander information critical to mission accomplishment.  Mitigation of potential threats increases chance of mission success.  Medical threats are a critical piece of a proper threat analysis and must not be overlooked in mission planning.

23. NATO UNCLASSIFIED Releasable to the INTERNET Helge Barstrand, Cdr SG, NOR Navy, MSc, KCLJ, (N43) Branch Head Medical, Medical Plans & Concepts, MC Northwood UK +44 (0) 1923 956 675 Email: h.barstrand@manw.nato.int Questions?