NAT/PfP UNCLASSIFIED AMedP-11(A) NATO HANDBOOK ON MARITIME MEDICINE AMedP-11(A) ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) INTENTIONALLY BLANK ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) NATO HANDBOOK ON MARITIME MEDICINE AMedP-11(A) NOVEMBER 2008 i ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) INTENTIONALLY BLANK ii ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11 (A) NORTH ATLANTIC TREATY ORGANIZATION NATO STANDARDIZATION AGENCY (NSA) NATO LETTER OF PROMULGATION 24 November 2008 1. AMedP-11(A) - NATO HANDBOOK ON MARITIME MEDICINE is a NATO/PfP UNCLASSIFIED publication. The agreement of nations to use this publication is recorded in STANAG 1269. 2. AMedP-11 (A) is effective on receipt. It supercedes AMedP-11, which shall be destroyed in accordance with the local procedure for the destruction of documents. Juan . MORENO Vice dmiral, ESP(N) Dir tor, NATO Standardization Agency III ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) INTENTIONALLY BLANK IV ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) THIS PAGE IS RESERVED FOR NATIONAL LETTER OF PROMULGATION V ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) INTENTIONALLY BLANK VI ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) RECORDS OF CHANGES Change No Date inserted NATO Signature Rank/Rate/ Effective Date Grade VII ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) INTENTIONALLY BLANK VIII ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) RECORD OF RESERVATIONS BY NATIONS CHAPTER RECORD OF RESERVATIONS BY NATIONS General FRA 2 TUR 3 TUR 4 TUR 14 TUR 16 TUR 20 TUR Annex A TUR IX ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) INTENTIONALLY BLANK X ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) RECORD OF SPECIFIC RESERVATIONS COUNTRY SPECIFIC RESERVATIONS France considers AMedP‑11 as an interesting guide, but this publication does not constitute a national technical guideline. It can FRA be ratified and implemented, but it is important to note that the publication does not provide any binding framework for diagnosis and prescription (fundamental freedoms in the code of ethics Some facilities and required personnel such as telemedicine, dental facility and dentist, laboratory, medical communications and information system are not available in Turkish Navy Forces' ships. In addition to some facilities, as principle pregnant personnel are not assigned to ships and escharatomomie incisions are not applicable. For the abovementioned reasons the following items in the reference can not be implemmented: Page 2-13, Para 2.2.6 TUR Page 4-6, Para 4.2.3 Page 3-9, 3-10, Para 3.4.5 Page 3-9, Para 3.4.4 Page 4-4, 4-5, Para 4.2, 4.2.1 Page 14-9, Para 14.4.1, 14.4.2, 14.4.3, 14.4.4, 14.4.4.1, 14.4.4.2, 14.4.5, 14.4.5.1, 14.4.5.2, 14.4.6, 14.4.6.1, 14.5.6.2, 14.4.6.3 Page 16-21, Para 16.5.3.1, 16.5.3.2, 16.5.3.3 Page 20-1 to 20-24 Page A-16-2.1 XI ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) INTENTIONALLY BLANK XII ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) List of Content Introduction CHAPTER 1- NATO Publications and Standards 1.1 Allied Publications 1.2 NATO Standards 1.3 Civil Standards CHAPTER 2 - Medical Officer Responsibilities and Shipboard Health Care 2.1 Medical Officer Responsibility 2.1.1 Medical Records 2.1.2 Dental Records 2.1.3 Medical Treatments 2.1.4 Controlled Medical Substances 2.1.5 Intravenous Therapy 2.1.6 Non-Medical Treatment 2.1.7 Laboratory 2.1.8 X-Rays 2.1.9 Quality Assurance 2.1.10 MEDEVAC 2.1.11 Medical Guardship Assignment 2.1.12 Pre-deployment Schedule 2.1.13 Embarked Medical Personnel 2.2 Shipboard Health Care 2.2.1 Medical Practise on Board 2.2.2 Sick Call 2.2.3 Crew Medical Examinations 2.2.4 Fitness for Duty Examinations 2.2.5 Management of Patients with Altered State of Consciousness 2.2.6 Operating Rooms 2.2.7 Ward Patient Care 2.2.8 Referrals 2.2.9 Appointments CHAPTER 3 - Medical Rooms & Equipment XIII ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) 3.1 Safety in Medical and Dental Facilities 3.1.1 General Precautions for Safety 3.1.2 Special Precautions 3.1.3 General Equipment and Treatment Precautions 3.2 Operating Rooms 3.2.1 General Remarks 3.2.2 Electro-Cautery 3.2.3 Defibrillator 3.2.4 Anaesthesia Machine 3.3 Ward Patients Care 3.3.1 General Remarks 3.3.2 Hygiene Considerations 3.4 Equipment 3.4.1 General Remarks 3.4.2 Specific Areas of Concern 3.4.3 X-Ray 3.4.3.1 General Remarks 3.4.3.2 Standard Operation Procedures 3.4.3.3 Personnel Protection 3.4.3.4 X-Ray and Film Processor Unit 3.4.4 Laboratory 3.4.5 Dental CHAPTER 4 - Communication and Reports 4.1 Naval Correspondence 4.1.1 Message Traffic 4.1.2 Radio Communication 4.1.3 Email Messages 4.1.4 Other Forms of Communication 4.2 Medical Communication and Information System (CIS) 4.2.1 Medical CIS Requirements 4.2.2 Medical Verbal Communication 4.2.3 Telemedicine 4.3 Medical Documentation 4.4 Medical Reports 4.4.1 Periodical Internal Requirements/Reports 4.4.2 Periodical External Requirements/Reports 4.4.3 Post-Deployment After Action Critique XIV ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) CHAPTER 5 - Maritime Medical Support 5.1 Introduction 5.2 Medical Mission in Maritime Operations 5.3 NATO Multinational Maritime Forces Medical Support Organisation 5.3.1 Shore Medical Support 5.3.2 Afloat Medical Support 5.3.3 Levels of Medical Care 5.4 Medical Support Principles 5.4.1 Entitlement to Medical Care 5.4.2 Standards of Medical Care 5.4.3 Medical Evacuation 5.4.4 Time–Related Constraints of Medical Care 5.4.5 Continuity of Care 5.5 Maritime Medical Support Planning 5.5.1 Multinational Maritime Force 5.5.1 Medical Support Plan 5.5.3 Casualty Estimates 5.5.4 Medical Capabilities in the Area of the Operation 5.5.5 Mass Casualty Situation 5.6 References CHAPTER 6 - Inspections 6.1 General Remarks 6.2 Medical Readiness Assessment (MRA) 6.3 Inspections Performed by the Medical Officer 6.3.1 General Cleanliness 6.3.2 Zone Inspections 6.3.3 Personnel Inspections 6.3.4 Health and Sanitation 6.3.5 Galley Inspections 6.3.6 Coffee Mess 6.3.7 Berthing Spaces Inspections 6.3.8 Head Sanitation 6.3.9 Laundry and Dry Cleaning 6.3.10 Potable Water System 6.3.11 Others XV ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) CHAPTER 7- Preventive Medicine 7.1 International Health Regulations (IHR) 7.1.1 General Rules 7.1.2 Arrivals, Pratique and Quarantine 7.1.3 Diseases Subject to the IHR 7.1.4 Plague, Deratting Exemption Certificates 7.1.5 Cholera and Yellow Fever 7.1.6 General Hygiene, Rodent and Insect Vectors 7.1.7 Food and Water Borne Diseases (Food Poisoning) 7.1.8 Bacterial Intoxications 7.1.9 Bacterial Infection 7.1.10 Chemical and Fungal Food Poisoning 7.1.11 Management of Outbreak of Food Poisoning 7.1.12 Containment of the Outbreak 7.1.13 Investigation to Determine Cause 7.1.14 Administrative Sequelae 7.1.15 Other Food and/or Water Borne Diseases 7.1.16 Perspective 7.2 Rules for Quarantine 7.2.1 Isolation 7.2.2 Quarantine 7.2.3 Use of Isolation and Quarantine on Board 7.3 Disinfection 7.3 Ships 7.4 Physical Fitness and Weight Control 7.4.1 Introduction 7.4.2 Energy Supply and Nutrition 7.4.3 Health Programs and Physical Fitness Testing 7.4.4 Energy Consumption, Movement and Sports CHAPTER 8 - Alcohol and Drug Abuse 8.1 Introduction 8.2 Definitions 8.3 Alcohol 8.3.1 Symptoms of Alcoholism 8.3.2 Treatment of Alcoholism 8.3.2.1 First Contact 8.3.2.2 Further Procedure 8.3.2.3 Alcohol Withdrawal XVI ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) 8.4 Cannabis 8.4.1 Effects 8.4.2 Long Term Abuse 8.4.3 Overdose 8.4.4 Withdrawal 8.5 Stimulants 8.5.1 Extasy, XTC 8.5.1.1 Effects 8.5.1.2 Long Term Abuse 8.5.1.3 Overdose 8.5.1.4 Withdrawal 8.5.2 Cocaine 8.5.2.1 Effects 8.5.2.2 Long Term Abuse 8.5.2.3 Overdose 8.5.2.4 Withdrawal 8.5.3 Amphetamines (Speed) 8.5.3.1 Effects 8.5.3.2 Long Term Abuse 8.5.3.3 Overdose 8.5.3.4 Withdrawal 8.6 Narcotics 8.6.1 Heroin 8.6.1.1 Effects 8.6.1.2 Long Term Abuse 8.6.1.3 Overdose 8.6.1.4 Withdrawal 8.6.2 Tranquilizers 8.6.2.1 Effects 8.6.2.2 Long Term Abuse 8.6.2.3 Overdose 8.6.2.4 Withdrawal 8.6.3 Barbiturates 8.6.3.1 Effects 8.6.3.2 Long Term Abuse 8.6.3.3 Overdose 8.6.3.4 Withdrawal 8.7 Hallucinogetic Drugs 8.7.1 LSD 8.7.1.1 Effects 8.7.1.2 Long Term Abuse 8.7.1.3 Overdose 8.7.1.4 Withdrawal 8.7.2 Other Hallucinogetic Drugs XVII ORIGINAL NAT/PfP UNCLASSIFIED NAT/PfP UNCLASSIFIED AMedP-11(A) 8.8 Other Drugs 8.9 Treatment 8.10 Drug Screening 8.11 Naval Medical Aspect of Drug Abuse CHAPTER 9 - Occupational Hygiene 9.1 Maritime Occupational Health 9.1.1 Ship’s Design and Habitability 9.1.2 Noise Stress and Hearing Conservation 9.1.2.1 Definition of Airborne Noise Categories 9.1.2.2 Noise Category Assignments 9.1.2.3 Acceptable Airborne Noise Levels 9.1.3 Ventilation and Air Conditioning 9.1.3.1 Requirements for Fresh Air 9.1.3.2 Spot Cooling 9.1.3.3 Uneven Airflow Distribution 9.1.3.4 Air Velocity by Ventilation and Air Conditioning 9.1.3.5 Considerations for Medical Officers 9.1.3.6 Conditioning the Thermal Environment 9.1.4 Heat Stress 9.1.4.1 Environmental Considerations 9.1.4.2 Monitoring Heat Stress 9.1.4.3 Minimizing Heat Stress Conditions by Design 9.1.5 Vibrations 9.1.6 Asbestos 9.1.8 Fuels 9.1.9 Heavy Metals 9.1.9.1 Mercury Control 9.1.9.2 Lead Control 9.1.9.10 Halogenated Hydrocarbons 9.1.9.11 Radiation Health 9.2 Safety of Personnel 9.2.1 Prevention of Injuries and Casualties 9.2.2 Protective Clothing