Recent Developments in Medical Evaluation

In the MCIF issue 1/2010 an article was published called “Multinational Approach in Medical support to NATO Operations”. In this article the author, Col Dr Fazekas, explains the need for multinational cooperation and the definition of standards for Multinational Medical Units to ensure minimum quality requirements. This need resulted in the development of the AMedP-27, the NATO Medical Evaluation Manual and the promulgation of its covering STANAG 2650 in 2010.

In a following article from the same author, Col Dr Fazekas describes the design and conduct of the pilot Medical Evaluation (MEDEVAL) Course. In the meantime two medical exercises were evaluated, the MEDEVAL course had evolved tremendously and the preparation for four major international evaluation and certification projects were ongoing. The magnitude of those projects suggests that it will cover some years to complete the whole process for all medical elements involved.

Main Section

Learning by doing – identifying lessons, implementing results

Since the publication of aforementioned articles the NATO Centre of Excellence for Military Medicine (NATO MILMED COE) has successfully conducted more courses and attended exercises to learn, educate and train medical evaluators. The theory of medical evaluation was well considered and the AMedP-27 covered all the topics that needed to be addressed as far as was known in early 2011. In March 2011 NATO MILMED COE was invited by the NETHERLANDS to participate in an exercise with an international evaluation team in order to gain experience and to test the evaluation procedure as described in the MEM. This international Exercise JOINT MEDICAL MODULES was hosted by the ROYAL NETHERLANDS AIR FORCE (RNLAF), supported by the EUROPEAN AIR GROUP (EAG) and the participants came from BELGIUM, NETHERLANDS, SPAIN, SWEDEN and the UNITED STATES OF AMERICA. The Medical Evaluation Team (MET) was formed from MEDEVAL course lecturers and freshly trained evaluators from FRANCE, GERMANY, HUNGARY, NETHERLANDS and representatives from NATO MILMED COE. Based on the available knowledge at that time the evaluation was prepared by assembling a list of questions from the evaluation manual tailored to the exercise. The Modules offered to evaluate were two Primary Healthcare Units, a Casualty Staging Facility, an Ambulance Company, a Rotary AEROMEDEVAC (AE) unit, two fixed Wing AE units, one from BELGIUM and one from SPAIN, both with multinational AE teams (NLD/BEL/SPN and SWEDEN), an Outbreak Response Team (ORT) and a Patient Evacuation Coordination Cell (PECC).

PhotoThe evaluation team writing the First Impression report

There were no exercise SOP’s or other documentation available for analysis prior to the start of the exercise. The MET started to collect information, selected the required questions and prepared the interviews at the moment they arrived at the exercise location.  The MEM does not specify how to start and prepare the evaluation and so the MET spend several hours on discussing the evaluation procedure and figuring out how to implement the Medical Evaluation Manual in the field. The incompatibility between two important annexes of the MEM; the Capability Matrix and the Skillset Matrix resulted in more time required to prepare the evaluation. Tasks within the team were divided, questions to be asked written down and a time schedule for visiting the modules was drafted. Planning the MET composition with the required Subject Matter Experts (SME) and timing the visits is essential. Interfering with the ongoing exercise or mission is not the intention of the evaluation. Priorities have to be set especially for visiting and evaluating mobile units like ambulances, AEROMEDEVAC helicopters and airplanes. This lengthy but thorough preparation did have the desired effect, i.e. a successful completion of the evaluation. The MET presented the results in a First Impression Report (FIR) to the Exercise Director. The experience gained during this evaluation was limited but very valuable. Although steps like the analysis of documentation and writing a Final Evaluation Report (FER) were omitted, important lessons were learned. First and most important is the knowledge that the actual evaluation is only a very small part of the whole evaluation process. The MEM - and so did the first MEDEVAL course - focused primarily on the aim and scope of the evaluations, the responsibilities and the roles of the different players. It told you what to do but not how to do it. 

This experience changed the view of how and what to address in the course. The focus of the course changed from the contents of MEM to the entire evaluation process including all steps to be taken to conduct a medical evaluation as described in the MEM. So, instead of explaining in extend what is said in the MEM and why, the course focuses no on what needs to be done to apply what is described in the MEM. The focus of the MEDEVAL course changed from what to do to how to do it. 

Later that year the NETHERLANDS offered to participate in another exercise to train Medical Evaluators and to validate the MEM. This time it was a ROYAL NETHERLANDS ARMY (RNLA) medical field exercise MEDIC DIAMOND. The RNLA deployed two Field Hospitals, two Role 1 Primary Healthcare Units, an Ambulance Company, a Command and Control element including PECC, Medical and Logistic Support. The exercise started two weeks after the MEDEVAL course in September but the evaluation preparation started several weeks before. For the first time we were able to initiate the evaluation in the way it is described in AMedP-27. It started with appointing an Evaluation Team Leader (TL) and finding potential team members. Although there was more preparation time compared to the previous exercise, it proved not to be enough to appoint a national TL and form the MET with the preferred number of SME’s. NATO MILMED COE Training Branch started the evaluation preparations and adapted the MEM for this exercise. The appropriate questions mentioned in the MEM were sent to the units and modules to be evaluated and they were tasked to return the answers with all available documentation to the MILMED COE for analysis.

PhotoPicture 2: Syndicate work during the MEDEVAL Course

The MEM states that the MET will analyze the information and documentation sent by the units prior to the evaluation. This proved to be a new and impossible challenge. There was simply not time and some team members were just not able to meet before the actual evaluation. Another important lesson learned that will be solved soon is the support of an internet based Medical Evaluation Tool. This tool enables the MET members to analyze, discuss and prepare the evaluation without leaving their home or office. For this exercise the analysis was done by the members of the NATO MILMED COE Training Branch and presented to the other team members after their arrival at the exercise location. The responsibility of the Team Leader was formally handed over to an officer of the Netherlands Army stationed at NRDC ITALY while the task remained with a member of the Training Branch.  

This time the MET and the exercise commander and his staff were better prepared for the evaluation. The MET was briefed about the units and their locations and planning and timing the visits to the different modules went quickly and smoothly. The units and module commanders were informed about the visit of the MET but did not know what to expect. The modules and units were surprised about number of questions and requests to present documentation and forms. MET members learned and understand how to prepare and to conduct a medical evaluation but we also learned that a unit also needs time and specific knowledge about this evaluation process to be able to prepare for a medical evaluation. For this an E-Learning course is currently under development that can be accessed via internet. This course will provide unit and module personnel information about the concept of Medical Evaluation and will explain what is expected from them.

Final Remarks

The way ahead in medical evaluation

The next revision of the MEM is being prepared. The capability matrix and the skillset matrix will no longer be annexes of the MEM but will be published as AMedP-48 and AMedP-49 covered by the same STANAG 2560. These two new documents will be synchronized as much as possible, the MEM will be modified and the evaluation support tool will be available soon. 

What lies ahead? Requests have been submitted to MILMED COE for the formal evaluation and certification of medical assets ranging from a single Role 2 Medical Treatment Facility to a whole Multinational Medical Task Force and Strategic Aeromedevac. The first evaluation and the preparation of the others will already start this year. A second evaluation will probably finish in 2014 and the one is scheduled to end in 2017. For these projects sufficient medical evaluators with the different backgrounds are required. More than one hundred evaluators have attended the MEDEVAL course so far and a small percentage has already been involved in training exercises. The timely availability of evaluators is still limited and needs to increase significantly to guarantee the evaluation support to missions, mission preparation exercises and other exercises. In the near future the Medical Evaluation Manual will be updated. The MEDEVAL course teaches the required skills and tools will be available to prepare, conduct and finalize an evaluation.  We are ready, are you? 


Lieutenant Colonel Rob Meijering

Royal Netherlands Air Force (RNLAF). Deputy Chief Training Branch, Staff Officer Training and Evaluation, Centre of Excellence for Military Medicine.

1979 Entry into the military service as flight nurse;  1981 Officers training at Airbase Gilze Rijen. 1982 – 1984 HAWK Battery Control Officer; 1984-1988 Deputy Squadron Commander; 1988 – 1993 Chief Patriot Education Centre; 1993 Deployed as UNTAC Deputy Base Commander (Cambodia); 1994 – 1999  Plans and operations section RNLAF HQ Operations Centre; 2000 – 2003 Medical Operations at the office of the RNLAF Surgeon General; 2003 – 2006 Medical Operations at the office of the  Surgeon General Royal Netherlands Armed Forces; 2006 Deployed to Kandahar, Afghanistan as Medical Plans and Operations Officer Operation Enduring Freedom;  2007 – 2011 Chief Medical Operations and Training section at RNLAF HQ; 2011 Deputy Chief Training Branch, Staff Officer Training and Evaluation, Centre of Excellence for Military Medicine

Address of the Author:

Centre of Excellence for Military Medicine
 Training Branch
 P.O. Box 113
 H-1255 Budapest, Hungary

Date: 02/07/2019

Source: Medical Corps International Forum (1/2012)