MEDEVAC Matters

Levels of Medical Care

Medical care is provided in a progressive manner, ranging from immediate first aid at the point of wounding to definitive, specialized care and rehabilitation provided at medical treatment facilities. This may comprise resuscitation and stabilization of vital functions, damage control resuscitation, and definitive treatment and rehabilitation. Linking all these interventions is the requirement to evacuate to the next appropriate level of care in a timely manner to maximize the chances of survival and minimize the risk of future disability.

In NATO terminology military Medical Treatment Facilities (MTFs) are designated a Role number to describe their functional capability to deliver a specific level of care. In NATO doctrine it is implicit that higher levels of Role incorporate the functions of lower levels but UK doctrine is more capability focused and does not necessarily replicate this approach, for example Role 2 may not routinely include primary care.  A detailed breakdown of specific Roles may be found in AJP-4.10(A)5 but a summary of the broad capabilities that may be expected at each level is given below:

Role 1.

This includes the provision of primary care, emergency treatment (resuscitation and stabilization) and preparation for transfer usually under the guidance of a medical officer. This capability is normally integral to a major land-based unit and also reflects the provision of medical support inherent to an afloat platform.

Role 2.

This includes the reception and sorting of patients as well as the ability to provide elements of damage control resuscitation and the treatment of casualties. This is bolstered by a wider range of medical and nursing interventions and enhanced laboratory and imaging facilities. In addition, this level of care will prepare patients for further transfer with a limited holding capacity to prepare casualties for onward evacuation or for return to duties.

Role 3.

This incorporates reception from Role 2 MTFs as well as direct receipt from local incidents. Major specialist facilities are available at this level of care with intensive care, holding and nursing capabilities. Final sorting of casualties for transfer to Role 4 or return to duties will occur here.

Role 4.

Role 4 ‘provides the full spectrum of definitive medical care that cannot be deployed to theater or is too time consuming to be conducted there’. This would normally include definitive care, specialist surgical and medical procedures, reconstructive surgery and rehabilitation. This care is highly specialized, time consuming and normally provided in the casualty’s country of origin.