NATO laid out the medical evacuation timelines in its Allied Joint Publication 4-10(A) “Allied Joint Medical Doctrine”. Since NATO become involved in Afghanistan it assumed responsibility for managing medical evacuations throughout the entire country. Accordingly, its policies and doctrine drives MEDEVAC operations. Note that the timelines begin AT THE TIME OF WOUNDING, not the time of a completed request for medical evacuation.

The current NATO 1-2-4 timeline requirements are:

  • “Platinum Ten Minutes” – hemorrhage and airway control must be achieved within ten minutes of wounding
  • “Golden Hour” – MEDEVAC and advanced trauma care assets must reach the casualty within one hour of wounding
  • “Damage Control Surgery” – DCS – casualties that require urgent surgery should be under treatment in a facility manned and equipped for this within two hours of wounding – may be performed in a Role 2 medical unit
  • “Primary Surgery” – casualties should receive primary surgery directed at first repair of local damage from wounding not more than four hours after injury – this is usually performed in a Role 3 medical unit

“Following extensive national engagement, the June, 2011 meeting of the NATO Committee of the Chiefs of the Military Medical Services (COMEDS) endorsed a NATO Life & Limb Saving Timeline to replace the 1-2-4 Hour Principle. The new Timeline will be included in the next revisions of NATO medical policy and doctrine. The new timeline will be:

  • Enhanced first aid. Immediate life saving measures applied by personnel trained in tactical combat casualty care. Bleeding and airway control for the most severely injured casualties to be achieved within 10 minutes of wounding.
  • Damage Control resuscitation. Measures commenced by emergency medical personnel within 1 hour of wounding.
  • Damage Control surgery. Depending on the specific and individual requirement the aim is to be able to provide damage control surgery within 1 hour, but no later than 2 hours of wounding.

This completes the action on this Priority Lesson. MEDEVAC is now a Lesson Learned.”

Source: NATO-OTAN Medical Lessons Learned Newsletter – September, 2011

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