NATO/PfP UNCLASSIFIED RECORD OF AMENDMENTS No. Reference/date of Date Signature Amendment Entered EXPLANATORY NOTES AGREEMENT 1. This NATO Standardization Agreement (STANAG) is promulgated by the Director NATO Standardization Agency under the authority vested in him by the NATO Standardization Organisation Charter. 2. No departure may be made from the agreement without informing the tasking authority in the form of a reservation. Nations may propose changes at any time to the tasking authority where they will be processed in the same manner as the original agreement. 3. Ratifying nations have agreed that national orders, manuals and instructions implementing this STANAG will include a reference to the STANAG number for purposes of identification. RATIFICATION, IMPLEMENTATION AND RESERVATIONS 4. Ratification, implementation and reservation details are available on request or through the NSA websites (internet http://nsa.nato.int; NATO Secure WAN http://nsa.hq.nato.int). FEEDBACK 5. Any comments concerning this publication should be directed to NATO/NSA – Bvd Leopold III - 1110 Brussels - BEL. ii NATO/PfP UNCLASSIFIED NATO/PfP UNCLASSIFIED STANAG 3745 (Edition 4) NAVY/ARMY/AIR NATO STANDARDIZATION AGREEMENT (STANAG) MEDICAL TRAINING AND EQUIPMENT REQUIREMENTS FOR SEARCH AND RESCUE (SAR) AND COMBAT SEARCH AND RESCUE (CSAR) MISSIONS Annexes: A. Medical Training of Personnel involved in SAR or CSAR Missions B. Minimum Medical Equipment Scale for SAR and CSAR Missions Related documents: ATP-10 - SEARCH AND RESCUE ATP-62 - COMBAT SEARCH AND RESCUE (CSAR) AIM 1. The Aim of this agreement is to establish the scope of training and medical equipment scales available to Search and Rescue (SAR) personnel, ensuring that the training procedures and medical equipment for qualified personnel are standardized and can be provided by participating NATO Nation’s Armed Forces. The target population is SAR personnel responsible for the handling and treatment of patients in flight. AGREEMENT 2. Participating Nations agree to standardize: a. A minimal list of topics important for the training of SAR personnel employed to provide casualty care during SAR or CSAR missions. b. A minimum scale of equipment to be available to SAR personnel on board aircraft employed in SAR or CSAR missions. GENERAL 3. The standardized list of training topics for SAR personnel by NATO Military SAR Services assists in inter Allied co-operation and mutual support, thus maximizing the effectiveness of treatment given by SAR personnel. -1- NATOPfP UNCLASSIFIED NATO/PfP UNCLASSIFIED IMPLEMENTATION OF THE AGREEMENT 4. This STANAG is implemented when a Nation has issued the necessary orders and instructions to the Forces concerned, thereby putting into effect the procedures detailed in this agreement. -2- NATOPfP UNCLASSIFIED NATO/PfP UNCLASSIFIED ANNEX A TO STANAG 3745 (Edition 4) MEDICAL TRAINING OF PERSONNEL INVOLVED IN SEARCH AND RESCUE (SAR) OR COMBAT SEARCH AND RESCUE (CSAR) MISSIONS GENERAL 1. The training included in this Annex must meet the highest standards of first aid and Basic Life Support (BLS), thus ensuring that SAR/CSAR personnel will be able to provide life saving treatment. Treatment will be required before, and for the duration of, any SAR/CSAR flight until casualty hand over to continuing medical care. Further non-medical training, described generally as rescue training will be required at the respective Nation’s discretion. Moreover, survival training, escape and evasion and conduct after capture training will be at the respective Nation’s discretion and operational requirement. 2. The list of training topics is designed to provide SAR/CSAR personnel with the minimum skills to manage both military and civilian SAR missions. However, extended casualty care training in Advanced Life Support (ALS), while recommended, is at the respective Nation’s discretion. Continuation training, periodic re-validation and, if necessary, re-certification in all aspects of life support is to be maintained by Nations. TRAINING TOPICS 3. Basic Medical Training Syllabus. The following topics will be taught during the training of SAR/CSAR personnel (extended training topics in italics): a. Basic physiology of flight and aero-medical implications for casualty care. b. Principles of First Aid and Basic Life Support (Advanced Life Support Techniques Training at the discretion of Nations). c. Emergency Treatment: (1) Cardio-pulmonary resuscitation: (a) Airway Management (Comprising: Airway assessment, exhaled air ventilation, insertion of oro-pharyngeal airways, needle thoracotomy, intubation, pharyngeal airways, emergency crico- thyrotomy, chest drain insertion). (b) External Cardiac Massage. (c) Use of automated and semi-automated defibrillators. (d) Principles and techniques of manual and mechanical assisted ventilation. A - 1 NATO/PfP UNCLASSIFIED NATO/PfP UNCLASSIFIED (e) Recognition and treatment of complications of manual and mechanical assisted ventilation. (2) Control of bleeding (application and management of pressure dressings, digital pressure techniques, use of haemostatic dressings). (3) Treatment of haemorrhagic shock (IV Infusion management). (4) Hypoxia (secondary to altitude and trauma) and Oxygen therapy. (5) Principles of pain management and its implications (IM & IV analgesic administration). (6) Thoracic injury management (rib fractures, pneumothorax, haemothorax, mediastinal injury). (7) Spinal fracture management (patient handling, immobilization techniques, spinal board). (8) Ocular Injury. (9) Abdominal Injury. (10) Genito-urinary injury. (11) Burns management. (12) Fracture management (including splintage techniques, application of splints and observation of the fractured limb) (13) Head and facio-maxillary injuries (including dental injury). (14) Thermal Injury (heat injury, hypothermia, freezing and non freezing cold injury). d. Injuries: (1) Wounds (including ballistic injuries, blast, wound contamination). (2) Multiple injuries (secondary survey techniques, assessment of vascular and neurological deficit in limbs, early and late complications of multiple injuries, head injury, coma and trauma scales). e. Signs of death and subsequent actions. f. BLS in a NBC environment (including decontamination techniques). A - 2 NATO/PfP UNCLASSIFIED NATO/PfP UNCLASSIFIED 4. Extended Medical Training Syllabus. Further to the preceding topics, the following subjects are to be taught at the Nation’s discretion dependant upon the scope and role of their SAR/CSAR personnel: a. Environment: (1) Drowning and near drowning (comprising resuscitation and subsequent management). b. Pregnancy (including precipitous delivery techniques). c. Casualty Administration: (1) Handling of mass casualties. (2) Use of medical equipment. 5. Rescue Training. a. Underwater escape training. b. Dinghy drills. c. Winch drills. d. Emergency Underwater Breathing Apparatus. 6. Combat Search and Rescue Extended Training. a. Escape and Evasion training. b. Conduct after Capture Training. c. Land Survival Training (Winter). A - 3 NATO/PfP UNCLASSIFIED NATO/PfP UNCLASSIFIED ANNEX B TO STANAG 3745 (Edition 4) MINIMUM MEDICAL EQUIPMENT SCALE FOR SEARCH AND RESCUE (SAR) AND COMBAT SEARCH AND RESCUE (CSAR) MISSIONS GENERAL 1. This Annex lists the minimum scale of equipment to be used in the event of patient transportation by NATO military SAR or CSAR aircraft. Extended role equipment is shown in italics and is dependent on the training and expertise of SAR personnel. Such equipment may be added to the minimum list at each Nation’s discretion. The equipment listed complements the clinical management training minima presented at Annex A. The individual item quantities to be carried are dependent upon the mission and the aircraft casualty carrying capacity. 2. The standardization of a minimum medical equipment list will ensure acceptable inter- allied interoperability in support of SAR and CSAR missions. EQUIPMENT 3. Airway Management. a. Manual suction device. b. Oro-pharyngeal airway, laryngeal mask, endo-tracheal tube. c. Oxygen source, oxygen regulator, flow meter. d. Oxygen mask, oxygen tubing. 4. Ventilation Support. a. Manual ventilation device, mechanical ventilator system. b. Re-breathing reservoir. c. Chest drains with Heimlich valves. 5. Circulation Support. a. Intravenous Catheters. b. Intravenous fluids (Crystalloid, colloid). c. Intravenous administration lines. d. Fluid bag warmers. B - 1 NATO/PfP UNCLASSIFIED NATO/PfP UNCLASSIFIED e. Compression bandages. 6. Assessment and Monitoring Equipment. a. Stethoscope. b. Non-mercury sphygmomanometer. c. Peripheral pulse oximeter, integrated BP/Pulse/Oximetry device. d. Torch. e. Digital thermometer, Low temperature thermometer, digital rectal thermometer, tympanic thermometer. f. Automated or semi-automated defibrillator. 7. Fracture Stabilization. a. Stiff Cervical Collars. b. Spinal stabilization board, vacuum stretcher system. c. Box splint set. d. Triangular bandages, plastic splints. 8. Analgesia. a. Intravenous analgesic b. Inhaled analgesic. c. Oral analgesia. d. Intra-muscular analgesia. 9. Additional Equipment. a. Scissors, bandage scissors. b. Plaster cutter. c. Adhesive tape. d. Sterile gauze pads. e. Gauze bandages. B - 2 NATO/PfP UNCLASSIFIED NATO/PfP UNCLASSIFIED f. Burns dressings. g. Lubricant jelly. h. Syringes, needles. i. Surgical gloves. 10. ALS Drugs. a. Adrenaline/epinephrine. b. Atropine. c. Naloxone. d. Diazepam. 11. Patient Transport. a. Stretchers. b. Blankets. c. Stretcher Harness. d. Winch capable stretcher system. B - 3 NATO/PfP UNCLASSIFIED .