UNIFIL-CMO Standard Operating Procedure January 2011 ——————— MEDICAL Approved by : Force Commander Approval date : 6 January 2011 Contact Chief Medical Officer Review date : 6 January 2012 UN CONFIDENTIALUN CONFIDENTIAL —— STANDARD OPERATING PROCEDURE MEDICAL CONTENT ‘A. Introduction B. Basic Guiding Documents and Sources C. General Principles D. Chapter 1 : Communication between CMO and SMO E. Chapter 2 + Integrated Medical Section F. Chapter 3 : Transportation of the Patients G. Chapter 4 + Medical Support Plan H. Chapter 5 : Mass Casualty Response 1. Chapter 6 : Procedures in the Event of Death or Serious Injury/tliness J. Chapter 7 : Medical Referrals K. Chapter 8 : Repatriation L. Chapter 9 : Dental Care M. Chapter 10 + Medical Reporting N. Chapter 12 : Medical Records ©. Chapter 12 : Health Care to non UN Civilians on Humanitarian Grounds P. Chapter 13 + Hygiene Directives and Veterinary Medicine Q. Dates R. Contact S. History T. SignatureUN CONFIDENTIAL ee ‘ANNEX! ‘Annex A to Chapter 3 + Responsibility Annex B to Chapter 3 Medical Contact Person Annex A to Chapter 4 + Level 1 Hospital Annex B to Chapter 4 + Level 2 Hospital Annex C to Chapter 4 +: Level 3 Hospital/UNIFIL Referral Hospital Annex A to Chapter 5 Methane Message Annex B to Chapter 5 : 9-tine Message Annex C to Chapter 5 : Lay-out of the Triage Center Annex D to Chapter 5 : List of Hospital in Lebanon Annex A to Chapter 6 : Death Certificate Annex B to Chapter 6 Request for Autopsy for UNIFIL Personnel Annex C to Chapter 6 + Request for Embalming Service of UNIFIL Personnel ‘Annex D to Chapter 6 fequest for Mortician Services Annex A to Chapter 7 fequest for Referral Annex B to Chapter 7 Annex A to Chapter 8 Annex B to Chapter 8 ‘lowchart of Procedure tequest for Repatriation lowchart Annex A to Chapter 10 Form for Vaccination and Immunization Report Annex B to Chapter 10 : Form for Medical Staff Aid 1A Report Annex C to Chapter 10 : Form for Medical Staff Aid 18 Report Annex D to Chapter 10 + Form for Medical Staff Aid 2 Report Annex E1toChapter10 _: Form for Medical Staff Aid 3A Report Annex E2toChapter10 —_: Form for Medical Staff Aid 3B Report Annex Fi to Chapter 10 Form for Weekly Report Annex F 2to Chapter 10 Form for Weekly Report with Comments Annex G1 to Chapter 10 Form for Daily Report Annex G2 to Chapter 10 Form for Daily Report with Comments Annex A to Chapter 12, : Medical Waiver of liabilityUN CONFIDENTIAL SS SSS oom A. Introduction 1. The Medical SOP is issued to Military and Civilian Offices at UNIFIL HQ and to Commanding Officers and Medical Staff of all Contingents and Units to provide them with necessary information and guidelines for the medical services in their respective areas of responsibility. 2. UNIFIL Chief Medical Officer (CMO) on behalf of the Force Commander (FC) issues the Medical SOP. Chief Integrated Services Support (CISS) and the Director of Mission Support (DMS) should authorize all amendments to the SOP. 3. A complete revision of the Medical SOP should be made once a year, while amendments should be included in the running text or when necessary. 4. The Medical SOP should be in conformity with directives and guidelines issued by UN Headquarters New York and should also correspond to directives or orders given by other sections/branches of UNIFIL HQ. 5. Furthermore, they should be integrated in the SOP database utilized by UNIFIL HQ in the Lotus ® network environment.UN CONFIDENTIAL i B. _ BASIC GUIDING DOCUMENTS AND SOURCES 1, Documents issued by UN HQ New York a) Reference Guide for Peace Keeping Forces b) Medical support manual for United Nations Peacekeeping Operations of 1999 ¢) Medical Guidelines for Peacekeeping Operations of 2003 Id Administrative Handbook e) Staff Rules f) Medical Insurance Plan 8) Personnel Directives h) Medical Support Manual i) Administrative Instruction ST/Al/2000/14 2. Documents issued by UNIFIL 1. FC'S Directive 2010/08; Health care to non-UN civilians on humanitarian grounds 2. Medical SOP 613 “Health care to non-UN civilians on humanitarian grounds” approved in Oct 2008 3. UNIFIL SOP on Casualty and Medical Evacuation (20 July 2010) 4. Standing Order for the Naqoura Camp and Naqoura Extension Camp of Aug 2009 5. FC Directive 2010/02 on “Security Checks at all UNIFIL positions entrances” 6. FC's Directive 06/2004 -Pets in UNIFIL locations C. GENERAL PRINCIPLES It is the aim of the UN medical support to provide a standard of medical care that approaches that prevailing in times of peace. This is guided by the following principles: @) Provision of a high standard of health care that is acceptable to all participating Troop Contributing Countries (TCC) in the mission and that meets internationally recognized standards.UN CONFIDENTIAL i b) Accessibility of medical facilities and services to all members of UNIFIL and its availability in a timely and responsive manner. c) Continuity of medical care between different levels of medical support linked by effective land and air evacuation services. d) Integration and preservation of local, national and UN medical infrastructure. e) Low mortality and reduction of medical complications and hospitalization time can be achieved only by following strict rules of evacuation and treatment. f) Highly qualified Medical Staff should perform resuscitation and triage as early as possible and the provision of professional medical care for UNIFIL personnel has priority. 2) No Patient should be allowed access to medical resources or priority for transportation unless it is medically justified.UN CONFIDENTIAL —— CHAPTER 1 COMMUNICATION CMO - SMO CONTENT A. Chief Medical officer B. Senior Medical Officer A CHIEF MEDICAL OFFICER, The Chief Medical Officer referred to as the CMO is available 24X7 to support and provide the technical and professional needs of all the Senior Medical Officers, referred to as the ‘SMOs, the respective medical officers and other health care providers in UNIFIL. Whenever the CMO is away from mission area (annual leave, duty trip) or cannot perform his/her duties (sick leave), Officer In Charge of Medical Services shall be appointed and deputize CMO. Deputizing OIC Medical Services should be selected among other civilian Medical Officers. Force Medical Officer may also deputize CMO. Appointment of OIC Medical Services must be approved by CISS and announced on UNIFIL Bulletin Board. The CMO is also available to provide professional guidelines in patient care as needed. The telephone extensions for the CMO are: 1. 6777 and 7677 DECT Phone (limited connection), during office hours only. UN extension at home is 3228, 2. The CMO can be also reached at 7078 (speed dial) 24X7. This number can be dialled from any landline or DECT phone and will connect with cellular telephone (number below). 3. The cellular telephone number is 70915654. The language of communication is English. The CMO encourages direct communication. B. SENIOR MEDICAL OFFICER All SMOs (Senior Medical Officers) must be able and ready to take care for their respective soldiers at Level | Clinics in accordance with the scope & capabilities of Level 1 hospital, For any condition beyond the scope of Level 1 Clinic, the SMO must quickly initiate referral 6UN CONFIDENTIAL EE to a higher-level medical facility. A referral to a Level 2 hospital in the area of operations (AO) can be done by the SMO without authorization of the CMO. Otherwise, a referral to a designated Level 3/Level 4 hospitals must be authorized by the CMO. Request for authorization should be submitted to FMO who in turn shall contact CMO. In exceptional cases when FMO cannot be reached requests may be submitted directly to CMO. In this case, the SMO will state clearly the condition of the patient and the reason for referral. (e.g. transfer to Hammoud Hospital, Saida, for gynaecological evaluation). Final Level 3 destination would be decided by FMO in consultation with CMO keeping in mind the availability of best possible treatment and other administrative concerns. In case of an emergency that cannot wait for routine and planned consultations, CMO (or his designate) will quickly arrange for the transfer of the patient to the designated hospital. Emergencies are to be dealt with 24x7. In case of referral to Level 3 hospital, the SMO shall submit request to CMO (through FMO) along with recommendation note from respective Level 2 hospital. SMO is not authorized to refer his patient directly to Level 3 hospitals. It should be through Level 2 hospitals. Exceptional cases must be authorized by CMO or his designate over the _ phone. It is required that the SMO provide the following information to the CMO in order to facilitate transfer: 1. Name and rank of the patient/soldier Contingent/Nationality . Date of birth ~ UNIFILID number . Date of arrival of patient/soldier in UNIFIL Date of onset of first symptoms of the presenting condition Neuere wen Working diagnosis, a short summary of the case history and what has done so far ina separate case summary as “MEDICAL IN CONFIDENCE” 8. The required specific investigations and/or consultations and/or treatment If the case can wait for routine consultation, the CMO requires the same information to be transmitted to the designated hospital. It is very important to have the referral number. It begins with CMO/0000 and looks as follows: CMO/0000/MONTH/YEAR. For further detailed information, please see Chapter 7.UN CONFIDENTIAL a Getting in touch with the CMO/FMO right at the start will help to expedite the progression of events in the transfer of patients, making the process easier, faster and smoother. Routine communication not needing immediate attention should be avoided. In addition, the Force Medical Officer, the Medical Planner and the Medical Operations Officer should be contacted for general issues and questions concerning their own domain of expertise.UN CONFIDENTIAL a CONTENT: A. Cl CHAPTER 2 INTEGRATED MEDICAL SECTION jan Medical Staff B. Military Personnel-Staff Officer C. Organization Chart of Medical Section D. _UNIFIL Levels of Medical Support £. External Medical Facilities Within and out of Mission Area. Civilian Medical Staff Chief Medical Officer ‘a. Leads the UNIFIL medical section ensuring effective support and contribution to UNIFIL objectives. b. Establishes Civilian Medical Clinic (Clinics) as required and manage their effective functioning. The Chief Medical Officer is tasked to manage all UNIFIL medical facilities, perform clinical, medico-administrative and related duties. c. Follows the United Nations established policies and procedures regarding medical clearances, sick leave and medical evacuations. d. Manages day-to-day mission medical support operations by ensuring availability of supplies and proper functioning of medical equipment. e. Liaises with UN Military Units in the mission, host-nation medical facilities and other UN Offices. f. Ensures that appropriate training programs are implemented in order to maintain and develop the medical capabilities (e.g. health education, HIV/AIDS prevention, first aid and CPR). g. Isa focal point representing UNIFIL medical units to coordinate joint efforts in association with all key partners (WHO, NGOs, UN agencies) in the preparation to minimize effects of pandemics and/or epidemics. h. Attends and participate all the Senior Management Meetings, i. Leads and Supervises the medical section and be responsible for the Medical Section Budget, Finance, & Planning. j. Monitors the UNIFIL Hospital, Laboratories, and Pharmacy Warehouse. k. Leads and supervises the Military staff in the Medical Section |. Inspects UNIFIL Military Medical facilities on a regular basis and submit the status report to DMS. m. Performs other related duties assigned by CISS and DMSUN CONFIDENTIAL LEE 2. Medical Officer / Environmental Health & Occupational Medicine Specialist Occupational medicine and Environmental Health Related Duties a. Analyzes work environments and designs programs to control, eliminate, and prevent disease or injury caused by chemical, physical, radiological, and biological agents or ergonomic factors that involve the impact of equipment design on UNIFIL staff comfort or fatigue. b. Conducts inspections and inform CMO which areas may not be in compliance with UN rules or employer policies. Identifies hazardous conditions and practices. 4. fan injury or illness occurs, occupational health and safety specialist will help investigate unsafe working conditions, study possible causes, and recommend remedial action and will prepare reports including work place accident reports €. Undertakes day-to-day occupational health duties: pre-placement and periodic medical examinations prepare UN staff for travelling providing immunizations, malaria prophylaxis, travel kits, etc. Undertakes day-to-day clinical duties, e.g. walk-in clinic, emergencies, Refers staff to outside specialists as necessary. Follows-up with outside specialists. Provides health education and health promotion programs. Organizes/Participates in addressing work environment and occupational health issues. k, Advises management on the cost and effectiveness of safety and health programs. |. Participates in drafting and implementation of business continuity and. crises preparedness plans for the duty station/mission. m. Manages/Supports day-to-day operations. 1. Deputizes for the Chief Medical Officer during his/her absence Supervises laboratory technicians, nurses and medical administrative staff; ensures availability of drugs and medical supplies and proper functioning of medical equipment. P. Conducts training sessions for management, supervisors, and staff on health and safety Practices and regulations to promote an understanding of a new or existing process, q. Ensures appropriate training programs are implemented in order to maintain and develop the medical capabilities (e.g, health education, first aid and CPR). F. Performs other related duties as required. ze 3. Medical Officer a. Undertakes day-to-day clinical duties, e.g. walk-in clinic, emergencies, pre placement and Periodic medical examinations, immunizations, etc. b. Refers staff to external hospitals as necessary; Follow-up with external hospitals; Provides health education. - Participates in addressing work environment and occupational health issues, and attending the Senior Medical Officer (SMO) Conference. iaises with UNIFIL Military units in the mission and host-nation medical facilities. Follows the United Nations established policies and procedures regarding medical clearances, sick leave and medical evacuations. 10UN CONFIDENTIAL nl zo Assists the Chief Medical Officer (CMO) to ensure availability of supplies and proper functioning of medical equipment. Deputizes for Senior Medical Officer during his/her absence Manages day-to day mission medical support operations by ensuring availability of supplies and proper functioning of medical equipment Ensures appropriate training programs are implemented in order to maintain and develop the medical capabilities (e.g. health education, HIV/AIDS prevention, first aid and CPR). Supervises work of nursing staff under her/his supervision. Stays on emergency calls duty roster after working hours and during off work days and ensures proper work of emergency clinic in Rest House, Tyre. Performs other related duties as required; additional responsibilities as assigned by cmo. Pharmacist / Medical Supply Officer Responsible for acquisition and stock-keeping of all medical equipment and medical supplies for UNIFIL Hospital. S/He is the requisitioning officer and takes part in preparing of the acquisition plan, planning of re-supply, medical supplies budget planning, receiving and inspection of medical stock, write-off of obsolete items. Supervises daily activities of the hospital pharmacy (professional guidance, stock-keeping and issuing of drugs, medical / dental / laboratory expendables to UNIFIL Hospital. Through proactive planning, is responsible to facilitate an unimpeded supply of drugs, medical supplies, medical consumables, vaccines, and blood in the mission. Developes, updates and implements a mission list for drugs and medical consumables, based on generic drugs produced according the World Health Organization (WHO) standards. Develops and maintains a system for ongoing inspections of drug safety in all mission medical facilities. Offers day-to-day advice on pharmaceutical issues. Supervises the Hospital Engineer at UNIFIL Hospital as far as planning of maintenance, calibration, overhaul and repair of medical equipment is concerned. Issues guidelines and directives regarding medical supply procedures as follows: = Requisition of medical supplies = Receipt of medical supplies = Storage of medical supplies = Accounting/audit of medical supplies - Maintenance/repair of medical, dental and laboratory equipment. Issues monthly reports of medicine and medical expendables consumption including statistical follow-up. Reports are forwarded to CMO within one week after the preceding month. Performs other duties as required by CMO. aUN CONFIDENTIAL —_— 5. __ International Nurse FSS a. Assists the CMO to identify and plans clinics’ material, supplies and equipment requirements and raises requisitions accordingly. b. Assist the CMO & Medical Officer to coordinate medical evacuation and cooperates with Medical Services Division in NY and the receiving facilities in home countries. ©. Assists in providing medical support during evacuation and repatriation. d. Advises evacuees on the requirements for evacuation and or escorts patients if needed. ©. Concludes or closes medical evacuation files to enable staff members to submit claims. f. Assist in arrangements for the deceased; Maintains and medical inventory and supplies and distributes medical supplies to outstations. 8. Arranges medical appointments and examinations to mission personnel; Updates the monthly medical reports. h. Perform ECG, x-rays and other medical exams such as blood tests, glucose, cholesterol and urine exams, as required. i. Assess needs of clients visiting the walk-in clinic, provide care/advice (e.g, the benefits of Preventive medicine, etc) accordingly or facilitate referral to the UN Medical Officer or to an outside physician, as indicated. i. Ensure preparedness of staff travelling on missions or reassignments, including administration of appropriate vaccine, instructions on malaria prophylaxis and other travel related ailments. Instruct on the content and potential uses of the travel kit. k. Responds to emergency calls and assist Medical Officers in providing adequate care; ensure effective liaison between patient and private doctor, paramedics, family members, and colleagues as appropriate; document case findings. |. Stays on emergency calls duty roster after working hours and during off work days and ensures proper condition of emergency clinic in Rest House, Tyre, '™m. Coordinates nursing work of junior civilian nurses in the clinic (national staff) 1n. Performs other duties as required by CMO. 6. Nurse GS-5 a. Responds to emergency calls and assist Medical Officers in providing adequate care; ensure effective liaison between patient and private doctor, paramedics, family members, and colleagues as appropriate; document case findings. b. Performs ECG, x-rays and other medical exams such as blood tests, glucose, cholesterol and urine exams, as required. ©. Assesses needs of clients visiting the walk-in clinic, provide care/advice (e.g. the benefits of preventive medicine, etc) accordingly or facilitate referral to the UN Medical Officer or to an outside physician, as indicated. d. Ensures preparedness of staff travelling on missions or reassignments, including administration of appropriate vaccine, instructions on malaria prophylaxis and other travel related ailments. Instruct on the content and potential uses of the travel kit. ©. Assists in providing health education and participate in addressing work environment, occupational health and other specific health issues. f. Stays on emergency calls duty roster after working hours and during off work days. &. Performs other related duties as required. 12UN CONFIDENTIAL SS 7 Medical Administrative Officer P2 ‘Assists CMO in preparation and monitoring of medical budget with respect to mission's budget, trust funds and grants on a regular basis and reallocate resources as necessary. Assists CMO to supervise and/or provide guidance on financial administration and management information issues and practices to the national staff at medical unit. ‘Assists CMO in submission of Medical Clearance to the Personnel Section for the International staff and the National staff together with the Medical Admin Assistant. Assists CMO in preparation of the technical reports. ‘Assists CMO in preparation of all requisition for the medical unit and responsible for billing & receipt of income from various services. Monitors operational travel program, procurement monitoring and evaluation of vendor contracts/ payment to vendors and external contracted hospitals. Assists CMO for human resource activities, such as; recruitment, placement, promotion, performance appraisal, job classification reviews, separation of staff members, training, ete. Performs other related work as required by CMO. Medical Administrative Assistant GS-5 Translation/ Interpretation from English to Arabic and vice-versa, assisting the medical staff and patients communicate with each other. General office work and maintaining a filing system for personal files of patients using the services of the Hospital Receiving Patients preparations of registrations papers, soliciting information regarding Patients/ Clients health complaints. Responsible for interpreting the systems and health problems of the Patients to the Doctors and Nurses and passing on Doctors/Nurses evaluations to the Patients along with the recommended course of medications/ therapy. Managing the Medical Records of Patients, separating records on the basis of category. Undertakes other responsibilities as assigned by CMO. Medical Warehouse Manager Under supervision of Pharmacist / Medical Supply Officer responsible for proper stock keeping of medical consumables, non-consumables, spare parts for medical equipment ‘Assists Pharmacist / Medical Supply Officer in screening of medical consumables and non-consumables in Galileo system. Assists Pharmacist / Medical Supply Officer in initiation write-off of obsolete medical equipment. Ensures proper environmental conditions and hygiene in the medical warehouse. Undertakes other responsibilities as assigned by CMO. 13UN CONFIDENTIAL ES _ 10. Ambulance Driver (on lease from Transport Section) Inspects ambulance and other vehicles at start of shift/movement. Is familiar with routes. Exercises safety and caution when driving. Exercises vehicle security. Ensures vehicle cleanliness. Adheres to vehicle usage policies. Accounts for all ambulance and vehicle fuel and equipment. Provides advice with regards to the maintenance of the ambulance / vehicles of the nic, Assists patients. Stays on emergency call after working hours and during off work days and ensures availability of an ambulance for transportation of urgent cases. 4UN CONFIDENTIAL eS 8. Military Personnel - Staff Officers 1. Force Medical Officer (FMO) Assists Chief Medical Officer (CMO) on mission-wide military medical support matters, Responsible for monitoring health of the Force. Responsible to maintain standards of TCC medical facilities. Responsible for medical briefing to the new international and military staff Plans, coordinates and monitors medical support for the UNIFIL personnel (Military & Civilian), including MEDEVAC, CASEVAC. Participates on behalf of the CMO in the daily update briefings of FC. Coordinates with all the Senior Medical Officers (SMOs) for organizing SMOs' Conference every month. h. Visits on a regular basis military medical facilities in order to be updated on current situations and problems. Is a part of Operational Readiness Inspections team. i. Follows up issues raised by units through their weekly medical reports to the FHQ and inform them to the CMO. j. Assists the CMO in preparing UNIFIL Medical Support Plan, Medical SOPs, Pandemic Contingency Plans, Mass Casualty Plans. k. Deputizes CMO in capacity of OIC Medical Section when necessary. |. Performs duties & responsibilities as assigned by the Chief Medical Officer. ao Medical Planner Under the direct supervision of Chief Medical Officer and Force Medical Officer, the Medical planner shall: a. Act proactively in the medical planning process and assist the FMO in preparing and executing the medical support plan. b. Take part in development / update of UNIFIL Medical SOPs and oversee the dissemination and compliance to the SOPs by TCC medical units. c. Liaise with the Medical personnel of various Contingents in order to coordinate the functioning of various medical facilities in the AO. d. Assist the FMO to oversee and execute the mass casualty plan and other contingency operations of UNIFIL. e. Develop user friendly tools to aid the decision making process £ Collect and collate Medical Intelligence to enhance the overall understanding of the medical situation in the AO and facilitate dissemination of useful information to the environment. g. Coordinate with the CMIC planners during medical assistance programs organized for the local community. h. Plan CASEVAC exercises and organize training programs in Basic Life support, in consultation with the CMO and FMO. Assist the FMO during the Operational Readiness Inspections of various Medical facilities. i. Perform the duties of the Chief Hygiene Officer in his absence. 15UN CONFIDENTIAL ist the CMO and FMO in planning the UNIFIL’s preparedness to tackle the HIN1 Influenza pandemic threat. |. Assist the CMO and FMO in planning & organizing evacuation procedures in the event of a pandemic and organize Table Top exercises for pandemic preparedness. ™m. Collect medical reports from UNIFIL units (weekly report) n. Perform any additional duties as assigned by the Chief Medical Officer. 3. Medical Operations Officer Under the direct supervision of Force Medical Officer shall: . Monitor medical support situation in the mission, including operational status of TCC ‘medical units and Force evacuation assets. b. Assist FMO in ensuring that all TCC medical units maintain standards for self-sustainable in accordance to the COE Manual. ¢. Plan and coordinate medical evacuation in the mission, 4d. Monitor status of all Force personnel who have been admitted in Level2 and above hospitals. €. Coordinate medical support act! the Civilian Mission HQ. f. Where applicable, coordinate medical logistics support activities including transport of blood to TCC hospitals. &. Take part in MOU/COE inspections of medical facilities h. Follow-up completely on procedure for repatriation of military personnel on medical grounds, ies with other staff branches in the Force HQ and with 4 Chief Hygiene Officer Under the direct supervision of Chief Medical Officer and Force Medical Officer shall: Supervise and coordinate activities of Hygiene team in the mission. Inspect water sources and approve it for use. Inspect and advise on the proper use food stores and transport. Condemn food items regarded unfit for human consumption, ‘Screen waste management, and rodent control. Prepare the hygiene portion of the quarterly report Advice CMO on hygiene situation in the mission. Supervise the training of hygiene personnel. Assist the CMO and FMO on all hygiene related issues. rsampange 16UN CONFIDENTIAL C. ORGANISATION CHART : MEDICAL SECTION I esc oncer ret [Geant Medical Oftoer| 2x Pharmacist/ NPO (vacant) wvUN CONFIDENTIAL —— D. UNIFIL Levels of Medical Su 1. UNIFIL Level 1+ Hospital ~ Naqoura This hospital is a UN owned facility. The main task is to provide a medical service to UNIFIL and OGL personnel, both as out and in-patients within UNIFIL Sector West. In accordance UNIFIL policy, humanitarian assistance can be provided to Lebanese civilians on emergency/non emergency basis bases within following specialties: a. Emergency surgery b. Anaesthesia Internal medi d. Orthopaedics e. Ophthalmology f 8 h. i i 1e ENT Gynaecology Radiodiagnosis Dentistry Clinical-chemical and bacteriological laboratory services. (FC Directive 2010/08 and Chapter 12 of this SOP refers) UNIFIL Hospital is expected to provide: a. Primary health care to a peacekeeping force of UNIFIL HQ, with treatment capacity up to 40 ambulatory patients per day. b. Hospitalize up to 20 patients for up to seven days each, for in-patient treatment and care, including intensive care monitoring for 2 patients. ¢ Perform limb and life saving surgery such as laparoscopy, appendectomy, thoracocentesis, wound exploration and debridement, fracture fixation and amputation. Hospital must have the capacity to perform 3-4 major surgical procedures under general anaesthesia per day. d. Perform emergency resuscitation procedures such as maintenance of airway, breathing and circulation and advanced life support, haemorrhage control, and other life and limb saving emergency procedures. ©. Triage, stabilize and evacuate casualties to the next echelon of medical care. f. Perform up to 10 basic radiological (X-ray) examinations per day. & Treat up to 10 dental cases per day, including pain relief, extractions, fillings and infection control, 18UN CONFIDENTIAL —— h. Administer vaccinations and other disease prophylaxis measures as required in the mission area. i. Perform up to 20 diagnostic laboratory tests per day, including basic haematology, blood biochemistry and urinalysis. Constitute and deploy at least 2 X Forward Medical Teams (comprising 1xdoctor, 1x nurse and 1x paramedic) to provide medical care at secondary locations or medical support during land and air evacuation. k. Maintain adequate medical supplies and consumables for up to 60 days, and the capability to resupply Level One units in the Mission area, if required. 1. Conduct entry and routine medical examination for peacekeepers if this is required, including any necessary investigations. m. Hospital has a special ambulances and personnel for transport of the patients to Level 3/4 hospitals in Lebanon. Responsibilities of UNIFIL Hospital Commanding Officer ‘a. CO UNIFIL is responsible for all aspects of daily functioning of the hospital and reports to CMO through FMO. b. Provides medical care for all UNIFIL personnel according to SOP c. Is responsible for work of all military med personnel employed hospital. d. Is the only authorized demanding officer who makes requisitions to CMO from the Medical Equipment Supply Depot and collects the equipment once a week. ‘e. Controls the medical storage, so that it does not contain more supplies than are needed during two weeks. f. Keeps an inventory list on all medical, dental and x-ray equipment. The list and the equipment should be presented at medical inspections. g. Monitors the equipment in the hospital ambulances and ascertains that the personnel have the ability to use it correctly. h. Contacts FMO/CMO before transfer a UN patient to or from Level 3 hospitals. i. Inform CMO in the event of death, serious injury, infectious diseases, admission and discharges from UNIFIL Level 2 Hospital and about any changes in the unit's medical situation. 19UN CONFIDENTIAL ee J. Submits the unit's (Hospital) reports to CMO. k. Initiates and supervises training in First Aid and gives special training to medical personnel in the hospital. |. Ensures that the Red Cross insignias are used according to the Geneva conventions. 2. Chinese 12 Hospital ~ Sector East — UNP 7-1. The mission of this medical facility is to provide second line health care, emergency resuscitation and stabilization, limb and life-saving surgical interventions, basic dental care and casualty evacuation to the next echelon within Sector East. This hospital is under self sustainment working under MOU between Chinese People’s Republic and UN and it is manned and supported by the Chinese contingent. Tasks of Level 2 Chinese Hospital: ‘The main task is to provide a medical service to UNIFIL and OGL personnel, both as out and in Patients within UNIFIL Sector East. In accordance with UNIFIL policy, humanitarian assistance can be provided to Lebanese civilians on emergency/non emergency basis at their and cost within following specialties: Emergency surgery ‘Anaesthesia Internal medicine Orthopaedics Ophthalmology ENT Gynaecology Radiodiagnosis Dentistry Clinical-chemical and bacteriological laboratory services. sR -eance (FC Directive 2010/08 & Chapter 12 of this SOP refers.) Itis expected to provide: a. Provide primary health care to a peacekeeping force of Sector East with treatment capacity up to 40 ambulatory patients per day. b. Hospitalize up to 20 patients for up to seven days each for in-patient treatment and care, including intensive care monitoring for 2 patients. ¢ Perform limb and life saving surgery such as laparoscopy, appendectomy, thoracocentesis, wound exploration and debridement, fracture fixation and amputation, 20UN CONFIDENTIAL a This must have the capacity to perform 3-4 major surgical procedures under general anaesthesia per day. d. Perform emergency resuscitation procedures such as maintenance of airway, breathing and circulation and advanced life support, haemorrhage control, and other life and limb saving emergency procedures. e. Triage, stabilize and evacuate casualties to the next echelon of medical care. f. Perform up to 10 basic radiological (X-ray) examinations per day. g. Treat up to 10 dental cases per day, including pain relief, extractions, Fillings and infection control. h. Administer vaccinations and other disease prophylaxis measures as required in the mission area: i. Perform up to 20 diagnostic laboratory tests per day, including basic haematology, blood biochemistry and urinalysis. j. Constitute and deploy at least 2 Forward Medical Teams (comprising 1xdoctor, 1x Nurse and 1x paramedic) to provide medical care at secondary locations or medical support during land and air evacuation. k. Maintain adequate medical supplies and consumables for up to 60 days, and the capability to resupply Level One units in the Mission area, if required. |. Conduct entry and routine medical examination for peacekeepers if this is required, including any necessary investigations. m. Responsible for manning two qualified Aero Medical Evacuation Teams (AMETs) to cover CASEVAC procedures within Sector East. Responsibilities of Chinese Hospital Commanding Officer ‘a. CO is responsible for all aspects of daily functioning of the hospital and reports to CMO through FMO. b. Provides medical care for all UNIFIL personnel according to SOP c._ Is responsible for work of all military medical personnel employed in the hospital. d. Controls the medical storage along with MOU agreement. e. Keeps an inventory list on all medical, dental and x-ray equipment. The list and the equipment should be presented at medical inspections. aUN CONFIDENTIAL Eee f. Monitors the equipment in the hospital and ambulances and ascertains that the personnel have the ability to use it correctly. 8. He will ensure serviceability and availability of Ambulances and medical equipment at all times. h. Contacts FMO/CMO over phone before transfer a UN patient to or from Level 3 hospitals in case of emergency. i. For routine cases, inform CMO through FMO in writing for any referral to Level 3 Hospital and transfer the patient only after due authorization. Transfer of patients from Level 2 to level 3 would be the responsibility of the CO. j. Inform CMO in the event of death, serious injury, infectious diseases, admission and discharges from UNIFIL Level 2 Hospital and about any changes in the unit's medical situation. k. Submits the unit's (Hospital) reports to CMO. |. Initiates and supervises training in First Aid and gives special training to medical personnel in the hospital. m. Ensures that the Red Cross insignias are used according to the Geneva conventions. Battalion Medical Service The person fully responsible for provision of medical services within his unit is the Commanding Officer of the unit. Within delegated authority he is assisted by Senior Medical Officer/Medical Officer of the unit. All battalions must provide life saving and stabilizing care. The medical units of the battalions provide outpatient treatment and sick bay facilities for military personnel who are assumed to be fit for duty within seven days. This is provided the resources are available within the unit, Patients requiring care beyond contingent capability will be evacuated to Level 2 within or higher levels Hospitals depending on the case. The use of elective consultations outside UNIFIL medical organization will be decided and approved by CMO. 22UN CONFIDENTIAL i Level 1 Clinic This is the first level where medical doctor is available. It provides first line primary health care, emergency resuscitation, stabilization and evacuation of casualties to the next level of medical care within a peacekeeping mission. Tasks of Level One Clinic: a. Provide primary health and emergency treatment care to peacekeeping force in strength of battalion, with at least 20 ambulatory patients per day. b. Conduct entry medical examination for peacekeepers, if this has not already been done, and arrange for any necessary investigations. c. Perform minor surgical procedures under local anaesthesia, e.g. toilet and suture of wounds, excision of lumps. d. Perform emergency resuscitation procedures such as maintenance of airway and breathing, control of haemorrhage and treatment of shock e. Triage, stabilize and evacuate a casualty to the next level of medical care. f. Admit up to 5 patients for up to 2 days each, for monitoring and inpatient treatment. If the expected duration of treatment is over two days or/and necessary level of medical expertise is not available in Level 1 Clinic patient must be transferred to higher level medical facility. g. Administer vaccinations and other disease prophylaxis measures required in the mission area. h. Perform basic field diagnostic and laboratory tests. i. Maintain the capability to split into separate Forward Medical Teams (FMT's) in order to provide medical support simultaneously in two locations. j. Prepare and be ready at all times to provide medical assistance to any MASCAL situation k. Oversees implementation of preventive medicine measures for the contingents and personnel under their care. Battalion Senior Medical Officer a. Through FMO, he/she is responsible to the CMO for all professional aspects of medical services within the unit. b. Provides medical care for all UNIFIL personnel according to the SOP. 23UN CONFIDENTIAL i ¢. Supervises hygiene and sanitation. d. Through FMO informs CMO in the event of death, serious injury, infectious diseases, admission and discharges from Hospital and about any changes in the unit's medical situation. €. Initiates repatriation requests. f, Submits the unit's reports to CMO. (see Chapter 10). jates and supervises training in first aid and gives special training to medical personnel in the unit. h. Ensures that the Red Cross insignias are used according to Geneva conventions. i, Ensure all personnel are trained and informed of CASEVAC procedures being followed in ‘AOR and make them aware in use of METHANE and 9 line Message form, j. Organize regularly first aid refresher training for all personnel of the contingent and maintain all relevant record. 4, Minor Units At each Coy HQ there shall be a Registered Nurse or an experienced Medical Assistant. He shall either visit the different positions within company area or make arrangements to receive the cases that the medical orderly cannot handle on his own. The following units that do not have a Medical Officer are referred as follows: a. FHQ. - medical cover by UNIFIL Hospital b. MP Coy - medical cover by UNIFIL Hospital cc. Italian Aviation Unit - medical cover by UNIFIL Hospital d. Camp Command - medical cover by UNIFIL Hospital e. OGL - medical cover by UNIFIL hospital Each Observation Post (OP) shall have one Medical Assistant (MA). He shall be able to keep airways open and to stop visible bleeding. The SMO of each battalion will decide what equipment should be made available to each MA, based on his experience and qualifications. 24UN CONFIDENTIAL ee ‘Medical equipment in the shelters ‘a. In each OP/compound, one of the shelters shall be designated medical shelter. This shall contain at least one stretcher. The Medical Assistant shall bring his First Aid Kit to that shelter. b. Inaddition to this, each shelter shall have one First Aid Kit, containing: 1. 2 field dressings 2. 2elastic bandages 3. 2 packages of bandages/surgical tape. 4. No prescription drugs or injectables are to be kept in the shelters. c When a Reg. Nurse or Medical Officer is present in a shelter, he will bring equipment suitable for wider use. d, Bandages and other medical equipment in shelters shall be changed every rotation to ensure that the expiry dates are not exceeded. UNIFIL House, Beirut ‘The acting MA is responsible for maintaining proper contents of the First Aid Box in UNIFIL House and of First Aid Bags in the UN cars. Patients needing professional medical aid (consultations and treatment) in elective (non- emergency cases) should visit UNIFIL Level 1+ Hospital, Naqoura. Others In emergency the patients can be directly admitted to university standard hospitals. The recommended ones are: Hammoud Hospital in Saida, Lebanon Hotel Dieu De France Hospital, Beirut Rafik Hariri Hospital in Beirut RAMBAM Health Care campus in Haifa, Israel. For MTF - Hospital in Larnaka, Cyprus parse In case of direct admission of UNIFIL military personnel on emergency bases to local hospital, CMO or FMO must to be informed as soon as possible. The patients are not to pay for any treatment. 6. Maritime Task Force Medical Service MTF is enjoying autonomy and reports directly to Admiral of MTF. It consists of four medical services deployed to frigates and mine sweepers provided by Italian, German, Greek, Turkish, Indonesian and Bangladesh navy. 25UN CONFIDENTIAL ——— One Naval Medical Officer is available on each of the frigates. In most cases Naval MO is supported by one or two registered nurses / advanced life support technicians, ‘Small medical clinics are organized on each vessel and are equipped with basic emergency ‘equipment. Main task of naval MO is to provide medical support to the crew members of the vessels originating from the same contributing country, however in emergency on sea they are obliged to provide support to other UN MTF vessels. Naval MO is also responsible for medical administration and provision of medical advice to the captain of the vessel. Other small units are supported either by nurse or advanced life ‘support technician, There is no dentist or dental clinic within MTF. The Flagship has one helicopter capable of providing casualty evacuation from the vessel. The Table below is an illustration of available medical personnel 7. UNIFIL Hygiene team The hygiene team works under the command of the Chief Hygiene Officer, The teams will assist with, advice on, instruct on, control and inspect the following hygiene tasks: a. Food and water '. Camp hygiene including personnel, accommodation and environmental hygiene 26UN CONFIDENTIAL i 8 oeow-—_—o—m" c. Insect and rodent control d. Disinfecting e. Destruction of contagious materials Unit Hygiene Officer Some UNIFIL military units have unit Hygiene Officer within their structure. Under units SMO s/he is responsible for all aspects of sanitary and hygiene issues in the unit. E. External Medical Facilities Within And Out Of Mission Area. 1. Level 3 Hospital ‘This is the highest level of medical care provided by a deployed UN medical unit. t combines the capabilities of Level One and Two units, with the additional capability of providing specialized in-patient treatment and surgery, as well as extensive diagnostic services. It is important to note that a Level Three unit is rarely deployed, and that this level of support is generally obtained from existing civilian or military hospitals within the Mission area or in @ neighbouring country. Tasks of Level Three Medical Unit: ‘a. Provide primary health care to a peacekeeping force of up to $000 in strength, with the capacity to treat up to 60 ambulatory patients per day. b. Provide specialist medical consultation services, particularly in areas like Internal Medicine, Infectious Diseases, Tropical Medicine, Dermatology, Psychiatry and Gynaecology. c. Perform up to 10 major general and orthopaedic surgical procedures under general anaesthesia per day. Availability of specialist surgical disciplines e.g. (neurosurgery, cardiothoracic surgery, trauma surgery, urology, burns unit) is an advantage. d. Perform emergency resuscitation procedures such as maintenance of airway, breathing and circulation and advanced life support. e. Stabilize casualties for long-haul air evacuation to a Level 4 facility, which may be located in another country. f. Hospitalize up to 50 patients for up to 30 days each for inpatient treatment and care, and up to 4 patients for intensive care and monitoring. 27UN CONFIDENTIAL EEE & Perform up to 20 basic radiological (x-ray) examinations per day. Availability of ultra- sonography or CT scan capability is an advantage. h. Treat 10-20 dental cases per day, including pain relief, extractions, fillings and infection control, as well as limited oral surgery. Administer vaccination and other preventive medicine measures, including vector control in the mission area. Perform up to 40 diagnostic laboratory tests per day. k. Constitute and deploy at least two FMTs (comprising 1x doctor, 1x nurse and 1x paramedic) to provide medical care at secondary locations or medical support during casualty evacuation by land, rotary and fixed-wing aircraft. |. Maintain adequate medical supplies and consumables for up to 60 days, and the capability of limited resupply Level One and Level Two medical units, if required. 2. Level 4 Hospital A Level Four medical facility provides definitive medical care and specialist medical treatment unavailable or impractical to be provided within a Mission area. This includes specialist surgical and medical procedures, reconstruction, rehabilitation and convalescence. Such treatment is highly specialized and costly, and may be required for a long duration. It is neither practical nor cost-effective for the UN to deploy such a unit within the Mission area. Such services are generally sought in the host country, a neighbouring country, or in the troop contributing country itself. The UN can arrange transfer of a patient or casualty to such a facility, and for reasons of cost, compensation and pension, continues to monitor the patient's progress. Indications for UN medical staff to utilize Level 4 facilities include: a. When the distance from Mission area to the country of origin is too far, and the patient or casualty is in urgent need of specialist medical treatment and cannot be repatriated, b. When the patient requires only short-term specialist treatment and is expected to return to duty within 30 days. © When the troop-contributing country is unable to provide appropriate definitive treatment (this excludes chronic medical conditions diagnosed prior to the peacekeepers deployment into the Mission area, or for which he was and is already receiving treatment). d. When the UN receives an offer from a specific nation to provide definitive care, an arrangement requiring a contract or Letter of Assist (LOA) with the respective country 28UN CONFIDENTIAL EEE and allocation of the appropriate funds. UNIFIL has contractual arrangements with the following Level 3/4 Hospitals: a. Hammoud Hospital in Saida, Lebanon b. Rafik El Hariri Hospital in Beirut, Lebanon ©. Hotel Dieu De France Hospital in Beirut, Lebanon dd. Rambam Hospital in Haifa, Israel fe. General Hospital in Larnaka, Cyprus (For MTF) 3. External Paramedical Services Lebanese Red Cross: In the event of an emergency situation the Lebanese Red Cross can also be called upon to assist in rendering first aid within and outside the AOR In the absence of UNIFIL’s own Medical Team, if the situation and condition of the patient demands, the patient can be shifted to nearest level |/II facility of UNIFIL, or to the nearest hospital capable of dealing with polytrauma. However, this option should be exercised only when evacuation of the casualty is not feasible in a reasonable time frame by UNIFIL’s own medical teams and there exists grave danger to the life or limb of the casualty. The Lebanese Red Cross before moving any UNIFIL casualty in their ambulances from the site should take permission for doing so from CMO/FMO or his designate over the phone. 29UN CONFIDENTIAL ————————————— CHAPTER 3 TRANSPORTATION OF PATIENTS CONTENT: A. Introduction 8. AIM C. Levels of Medical Faci D. _ Responsibilities for Patient Transportation by Road E, Conclusion ANNEXES: — Annex A: Responsibility Annex B: Medical Contact Person A. INTRODUCTION The expanded United Nations Interim Force in Lebanon (hereinafter referred to as “UNIFIL” or “the Mission”) commenced operations in August 2006. B. AIM The purpose of this chapter is to describe the procedures and responsibilities of the different levels of medical facilities and TCCs for transportation of patients from one role to another 50 as to ensure smooth movement. C. LEVELS OF MEDICAL FACILITIES 1. TCC Level 1 Medical Clinics 2. Level 2 Hospitals a. CHINMEDCOY Level 2 Hospital, Sector East HQ b)_UNIFIL Level 1+ Hospital, Nagoura, UNIFIL HQ 3. Level 3/4 Hospitals: a. Hammoud Hospital and University Medical Centre, Saida b) Rafik Hariri University Hospital, Beirut ©) Hotel Dieu de France Beirut d) RAMBAM Medical Centre Haifa, Israel ©) General Hospital, Larnaka, Cyprus (for MTF) f) Designate hospital of TCC in Home Country D. RESPONSIBILITIES FOR PATIENT TRANSPORTATION BY ROAD 1. The responsibilities for transport of patients are enumerated in Annex ‘A’ to Chapter 3. 2. The following cases should be transported by road in ambulance vehicles: All urgent 30UN CONFIDENTIAL —————— cases for admission to higher level of medical facilities for tertiary care and hospitalization a. All Lying cases. b. All cases requiring medical supervision on the way to the medical facility. c. Allother cases as decided by the concerned Medical Officer. However, patients who are not acutely ill and are able to use transport other than the Ambulance vehicles should use their own contingent vehicles for transportation to a higher medical facility. This will enhance availability of Ambulances for dire emergencies in the hospitals. 3, The SMOs, COs Hospitals will seek approval of CMO and confirm the same for all referrals, (specialist consultations and investigations), admissions for further management, reviews and follow ups involving Level 3/4 Medical Facility on the prescribed forms. 4, They will confirm the date and time of appointments and discharges involving Level 3/4 Medical Facility from CMO through FMO before moving the vehicles outside the AO. 5. All vehicle movements for medical purposes, both inside and outside the AO will be done in accordance with the ongoing FRAGOs and security instructions issued by the FHQ and Sector HQ. 6. The CMO office in FHQ may be contacted for any clarifications or if any difficulties are experienced. The contact details of the same are as per Annex ‘B’ to chapter 3. E, CONCLUSION It is reiterated that these responsibilities are fixed in the best interest of the patients to ensure a smooth movement. However, a mutual coordination and agreement between ifferent agencies and Medical Facilities to ensure better patient and medical care takes precedence over laid down procedures. 31UN CONFIDENTIAL ee CHAPTER 4 MEDICAL SUPPORT PLAN CONTENT: A. —_Preparation of the Different TCC B. Medical Mean in the AO Mission D. Medical Support Plan Sector West £. Medical Support Plan Sector East F. Medical Support Plan FH, Naqoura G. Medical Evacuation by Helicopter ANNEXES: — AnnexA: —_—_Level 1 Hospital AnnexB: Level 2 Hospital AnnexC: Level 3 Hospital/UNIFIL Referral Hospital e PREPARATION OF THE DIFFERENT TCC Military Contingents National responsibility National standards have to be used but the UN-standards should be taken as a minimum acceptable standard. Military Observers, Civilian Police National responsibility National standards have to be used but the UN standards should be taken as a minimum acceptable standard, MEDICAL MEANS IN THE AO Level 1: see Annex A Level 2: see Annex B Level 3: see Annex C MISSION To provide effective medical and health care at all levels to all Triage and resuscitation followed by evacuation for trauma cases Stabilize the patient requiring critical care and making them ready for transportation to a higher level for further definitive care. 32UN CONFIDENTIAL EE D. Medical Support Plan Sector WEST 1 Treatment and hospitalization: Point of injury (POI): Buddy Aid, First Aid Level 1: National Responsibility Level 2: UNIFIL Hospital, Naqoura Level 3: In consultation with CMO to a designate hospital Evacuation: a. See Chapter 3: Transportation of Patient b. Theatre Evacuation Policy: Soldiers admitted in a Med Treatment Facility that cannot return to duty within 30 days will be evacuated to home country as soon as the medical condition allows and evacuation assets are available. Medical Support Plan Sector EAST Treatment and hospitalization: Point of injury (PO!): Buddy Aid, First Aid Level 1: National Responsibility Level 2: Chinese Level 2 hospital (Marjayoun) Level 3: In consultation with CMO to a designate hospital eaoge Evacuation: a, See Chapter 3: Transportation of Patients b. Theatre Evacuation Policy: Soldiers admitted in a Med Treatment Facility that cannot return to duty within 30 days will be evacuated to home country as soon as the medical condition allows and evacuation assets are available. Medical Support Plan FHQ NAQOURA ‘Treatment and hospitalization: Point of injury (POI): Buddy Aid, First Aid Level 1: UNIFIL Hospital NAQOURA Level 2: UNIFIL Hospital NAQOURA Level 3: In consultation with CMO to a designate hospital aoge Evacuation a. See Chapter 3: Transportation of Patients 33UN CONFIDENTIAL —— b. Theatre Evacuation Policy: Soldiers admitted in a Med Treatment Facility that cannot return to duty within 30 days will be evacuated to home country as soon as the medical condition allows. and evacuation assets are__ available. G. EVACUATION BY HELICOPTER As outlined in UNIFIL SOP “Casualty and Medical Evacuation” approval date 20 Jul 2010. 34UN CONFIDENTIAL TT CHAPTER 5 MASS CASUALTY RESPONSE CONTENT: A. General B. Actions at the UNIFIL HQ Management of the MASCAL Situation D. Additional Notes and Comments ANNEXES: ‘Annex C to Chapter 5: Lay-out of the triage centre Annex D to Chapter 5: List of Hospital in Lebanon A. GENERAL 1. The Purpose of this SOP is ‘a. To have a standard procedure that will be used in the event of a mass casualty situation and that could be incorporated into the mission’s SOP. b. Tore-organize the existing resources for efficient management of MASCAL. c. To minimize the loss of lives and limbs of the affected mass. d. To provide speedy medical rescue, first aid and evacuation to specialized center. e. Effective treatment and holding of Casualty till final disposal. 2. The term MASS CASUALTY SITUATION or MAJOR INCIDENT refers to any incident where the number, severity or type of casualties, or by its location, requires extraordinary resources, or where the capacity of the medical facility is exceeded. In any given situation, UNIFIL will not act in isolation 3. There will be collaboration with the Lebanese Red Cross Society, Civil Defense, and civilian population for the displacement of the injured and the eventual clearance of the dead to the UN designated facility or base. 4, UNIFIL Contingency plan should be carried out only after the chief of operations gives clearance for any operational risks at the scene. This applies to the forms of mass casualty scenarios identified in contingency plans UNIFIL. B. ACTIONS AT THE UNIFIL HQ 1. The following actions would be taken at UNIFIL HQ: 35UN CONFIDENTIAL ES a. Activation of command Control Cell at JOC b. Activation of FMT's, . Resource Mobilization 2. Upon receiving the news of the accident, the JOC activates the emergency response system. The METHANE message (Annex A to Chapter 5) should be used to clearly give all the essential information about the incident that occurred. Subsequently additional information should be conveyed through the 9-Line message.(Annex B to Chapter 5) 3. JOC duty officer calls all those responsible, including the FMO and CMO. FMO moves to the 4OC and alerts all UNIFIL medical units, which go into standby 3-minute alert mode. Three (3) minutes therefore is the response time for all medical units in UNIFIL after the units are Put on alert to mobilize their Forward Medical Teams (FMT) to the site of incident. If necessary, supported by other, CMO reports to UNIFIL HQ and directs the entire operation from his office. com AND CONTROL FLOW CHART Information about incident to JOC Admin Duty Officer JOC Duty Officer cTo (MO /FMO UNIFIL Hospital Level Il Sec East Tee ees ia CIVIL DEFENSE LEB RED CROSS HAMMOUD HOSPITAL SAIDA NATIONAL BURN CENTER JTAOUI RHU HOSPITAL BEIRUT RAMBAM HOSPITAL HAIFA HOTEL DIEU HOSP BEIRUT |———* 4. Quick Reaction Medical Team consisting of 1 x Medical Officer, 1x Nurse and 1 x Paramedic from UNIFIL Hospital will be put on standby to move at short notice on orders of CMO/FMO. Simultaneously, hospital will start preparing to receive mass casualties. 5. Atthe UNIFIL HQ the driver from transport section will hook-up the medical supplies stores caravan, placed in front of the UNIFIL Hospital, to his vehicle and will remain in the vehicle ready to move to the site of the incident with the medical convoy upon instructions of the 36UN CONFIDENTIAL a ———— c MO/FMO. Likewise the Engineering team consisting of five men with stores to establish a treatment center will be ready to move at short notice. They will join the medical convoy in their vehicle(s). All doctors taking part in rescue action must stay in touch with CMO/FMO (on cell-phone, land line or on channel 8 on Motorola radio). CMO & FMO contact details are given in Annex B to Chapter 3: Medical Contact Person. MANAGEMENT OF THE MASCAL SITUATION The medical management of the situation is carried out in five phases. % Phase | - Immediate action 2. Phase I - Treatment 3. Phase Ill - Evacuation 4. PhaselV. ~~ Management of Fatalities 5. PhaseV = ~— Wrap Up Phase | (Immediate Action) The FMO after reporting to JOC starts managing the response operations from there. He is in contact with CMO, who is screening development of the situation. Following the METHANE message, the nearest Level 1 facility sends medical team as a first response. If applicable, Lebanese Red Cross medical team with paramedics may also be involved in the rescue action. if there is MASCAL situation at hand the first medical officer on site acts as Primary Triage Officer (PTO). He will evaluate the situation and report to JOC/FMO, and once the incident site is declared safe to move in, will start Triage and providing of First Aid. ‘The Aero Medical Evacuation Team (AMET) shall be activated by FMO and put at the notice to move in 15 minutes. Road ambulances from series of closest designated medical facilities will be put on very short notice to move (5 minutes). After receiving the warning of MASCAL situation, one or more Forward Medical Teams (FMT - one doctor, one nurse and one paramedic who is also the ambulance driver) will be mobilized by FMO and deployed by the nearest UNIFIL medical facilities (Level 1 and/or Level 2). All medical personnel will wear bright orange color vests and blue helmets with their functional title printed on them. ‘After arrival at the scene the most senior medical doctor automatically becomes Medical Director (MD). FMT under the command of MD shall set up First Aid Post (FAP) and will 37UN CONFIDENTIAL eee Continue Triage as well as initial treatment of casualties. The words ‘MEDICAL DIRECTOR’ ‘must be boldly printed on the front and back of the bright orange vest and on the safety helmet will identify the Medical Director. MD will communicate with FMO who in turn will immediately inform CMO about the situation and undertaken measures. The duties of Medical Director would involve the following: 1. Would be overall in charge for overseeing medical support at the site of Mascal disaster, 2. Would be responsible for setup of First Aid Post in coordination with Engineers. 3. Would direct all operations at Triage center keeping FMO informed through available mode of communication. 4. Will ensure observation of all security instructions of the Incident Site Manager (Chief Security/MASO/Field Marshal). 5. Will coordinate with the Lebanese Red Cross and/or Civil Defence who arrive on the scene. 6. Will nominate: Regulator- preferably a Paramedic Loading Officer- Preferably a driver ili. Parking Officer 7. Return of FMTs at the end of the operations. 8. Post operation briefing to CMO/FMO After declaring mass casualty situation CMO/FMO will alert all sectors and neighboring Level 1 and Level 2 medical facilities, as well as Level 3-4 host nation hospitals in order to be on stand-by and be ready to send additional resources and receive casualties. Depending on the needs a certain number of road ambulances and helicopters will be sent at once. Upon receiving information from MD, the CMO/FMO will send out the medical convoy from UNFIL HQ. They will go along with the medical stores earmarked for establishing the treatment center. If necessary, doctors, nurses and paramedics will be drawn from the other TCC medical outfits to provide CASEVAC by road and air, as well as reinforce the treatment center at the incident site. Phase Il: TREATMENT The triage center is the location where patients can receive advanced trauma and life support and where all casualties are selected, depending on their medical condition. The appointed doctors will examine victims as they arrive and separate them according to the severity of their injuries into four priority groups Priority 1: (RED: Immediate) requiring immediate resuscitation and urgent surgery. 38UN CONFIDENTIAL a Priority 2: (YELLOW: Urgent) requiring early surgery and possible resuscitation. Priority 3: (GREEN: Delayed or Hold) Do notneed resuscitation or surgery. Can be returned to duty after medical intervention. Priority 4: (BLACK: Deceased) Having minimal chance of surviving or who are dead on arrival. b. Triage center has entry and exit points. One officer will register all who arrive at the treatment center, and another will register all exiting as well as those declared dead. Register officers will be appointed by MD from available support personnel on the ground. Nurses will direct them to the appropriate quarters for medical attention while the other doctors provide appropriate treatment and advanced trauma life support to the injured as. required, c. Registration would include: Name, rank (where applicable), Date of birth ID number (where) applicable, Section or branch or battalion (where applicable), Time of arrival, serial number (It will be an integrated function where the military and civilian staff registers people indiscriminately meaning that there will not be a separate register for military and civilian. This is to avoid any waste of time in admitting the patients.) d. The exit register will contain the same information as does the entry register except time of exit. Additionally it will contain color code on patient e.g. green, yellow, red or black and mode of exit e.g. walking, stretcher. e. All injured with the same priority for evacuation shall be placed in separate and well marked and defined areas. Depending on attached color code selection tags injured will be referred later to designated UNIFIL medical facilities (Level 1, 2, Level 3/4 host country hospitals, to staff counselor or to morgue). 6. Phase Ill: EVACUATIONS a. Medical Director (MD) is also responsible for proper evacuation process. He appoints from the available personnel Regulator (Casualty Clearing Officer), Loading officer and Parking officer. Regulator will be directing the process of clearing the scene from casualties by ordering them to be transported to other medical or non-medical facilities according to attached color priority tags. He is appointed from personnel available on the scene preferably paramedic. Regulator is located inside or just next to the First Aid Post. He will i. Know where the medical facilities are and what their capacities and capabilities are; 39UN CONFIDENTIAL ee _ follow up on this matter as casualties are being sent to these facilities. ji, As casualties received initial treatment and are ready for transportation, direct them to appropriate medical facilities using available transportation assets in close coordination with the ambulance loading officer. lil, Keep an exact record of the destination and time of departure for every casualty that leaves the scene to be transported. iv. Coordinate with MD so to be kept aware of incoming casualties. Loading officer will be organizing the loading of all ambulances at the scene before they depart with the casualties to other locations. He will: i. Be constantly aware of the available ambulances and helicopters or other transportation means and their capacity on the scene. Will work with coordination of parking officer. ii. Organize and direct the loading of casualties. ili, Keep exact record of every casualty that is loaded into a helicopter or ambulance noting ambulance identification and time of departure. Parking officer will be organizing the ambulance loading and parking areas. He is elected from available personnel on the scene and is located next to the ambulance holding area. He will: i. Organize ambulance holding/parking area Know availability of ambulances at the scene and inform Loading officer. Check knowledge and brief ambulance crews about directions to selected medical facilities. iv, On request of loading officer send appropriate ambulances from holding area to the loading point. v. _ Keep an exact record of every ambulance that passes through. b. There will be two forms of transportations: 1. Transportation with medical escort will have a doctor and a nurse on board of the ambulance or helicopter. 2. Transportation without medical escort will be with a nurse/paramedic on board of the ambulance or helicopter. ¢. Helicopters, if possible and depending on availability of helipads, will also be used for the evacuation of patients from the accident site. Improvised helipads may be created. However, the current practice indicates that transportation by air will be carried out only from permanent helipads located near Level 1 / Level 2 medical facilities in UNIFIL military units. d. All P1 casualties will bypass the designated hospitals. They will go directly to the supporting level 3-4 hospitals in Saida, Beirut and if necessary in Haifa by helicopter and if their medical Condition permits by road in ambulances with medical escort. 40UN CONFIDENTIAL OOOO e. AllP2 cases should be evacuated for the treatment to the nearest UNIFIL Level 2 Hospitals. f. All P3 casualties will be evacuated to Level 1 medical clinics. The moderately injured will remain under observation at for at least 24 hours. g. The designated UNIFIL Hospitals are: 1. Chinese Level 2 Hospital in the Sector East. 2. UNIFIL level 1+ Hospital in Naqoura in the Sector West. The hospitals must give its maximum capacity in case of Mass Casualty. If necessary both hospitals may be used regardless of the accident location. h. All casualties labeled as P4 will be kept at the location until all P1, P2, P3 cases are evacuated. Only then the remains of deceased will be collected and transported to the morgue. i. The doctors at the triage center will stabilize severely injured (P1) to allow at least 30 minutes for transportation to the designated hospital. j. Local hospitals at equivalent Level 2 may also be used as supporting hospitals. For example the Bint Jbel private hospital, Marjayoun Hospital, Tyr Government Hospital, Nabatiyeh Government and Jabel Amel Hospital in Tyr. List of available hospitals in Lebanon is included in Annex D to Chapter 5. k. Once patients arrive at the designated hospitals, the emergency teams present will quickly evaluate, and provide the necessary care. CMO or his designated is responsible for maintaining communication with designated Level 2/Level 3-4 hospitals and if necessary make decide on transfer to other supporting hospital in and out of Lebanon. |. Allsevere burn cases will go directly to Jtaoui hospital in Beirut. CMO or his designate will alert: 1. Hospital medical director of the arrival of burn cases to the hospital (number, name, age, ID, type of burns, and working diagnosis if available) via his cellular telephone. 2. Mr. Bishara of UNIFIL House, Beirut (03-73-09-72) to coordinate with Mr. George Kettaneh (03-34-59-69) Lebanese Red Cross (L-RC). UNIFIL Ops duty officer to alert the SURB. m. The helicopters will land at the Rafik Hariri International Airport-Beirut (RHIA-Beirut). n. Mr. Geries Bishara working with the SURB will coordinate with the L-RC ambulance and will ensure their prompt arrival at the RHIA-Beirut to receive burn victims) ©. The Chief Aviation Officer (CAVO)/Military Air Safety Officer (MASO) team will ensure aUN CONFIDENTIAL ee necessary clearance and airport authority preparedness to receive helicopter. p. The Aero Medical Evacuation Team (AMET) on the helicopter will disembark with the patient(s) along with the emergency equipment for life support and will accompany patient(s) to Jtaoui Hospital National Burn Center. AMET doctor will hand over patient(s) to the attending physician at the center. 9. The helicopter will wait for the team to return and MOVCON Beirut will have a vehicle ready at the Jtaoui Hospital Burn Center to transport the AMET to the airport again. The helicopter will return to Naqoura immediately with the AMET. The Agusta-Bell helicopter can transport maximum two stretcher cases at a time. Immediate care patients (P1) will have priority. If required MI-8 helicopter which has greater capacity (up to 8 casualties) may be used, 4. Phase IV - Management of Fatalities a. Chief Hygiene Officer (CHO) with the hygiene and general service teams arrives at the scene and takes care of the deceased (P4). b. Remains Collection Point : i. CHO will collect body bags from the medical stock and will assure their availability at the scene. CHO will count the dead. The CHO assisted by the hospital hygiene team will supervise the 10 general servicemen to bag and respectfully move the bodies to the designated location. ji, CTO will provide three trucks for transportation of the remains to the designated cold room in Naqoura or if necessary to external morgues in Lebanon. The military police will provide escort for the movements of the remains at all times and will remain on guard until transportation to their respective home countries. c. Immediate Counseling support Victims with minor injuries (P3) not in need of further medical treatment will receive counseling at the scene and will be sent home after having passed through the Staff Counselor's tent. Should the victim require medication, the Staff Counselor will refer appropriately. 5. PHASE V: WRAP UP a. At the end of the fourth phase when all casualties have been moved out to appropriate locations and the medicals teams to the hospital, the engineering team will close down the treatment center. They will pack all equipment and supplies into the medical stock-holding container. The CTO personnel will move the container to the medical warehouse in Naqoura. The medical equipment technician will work with the engineering team to ensure ‘that they pack all equipment properly that they include all parts. 42UN CONFIDENTIAL ee b. Immediately, the Medical Director with Triage Officer, Chief Hygiene Officer, Regulator (casualty clearing officer) and the Staff Counselor will fall back to the CMO/FMO in the Medical Section for post-incident debriefing. c. Atthe medical ware-house, the pharmacist will sort out the container and will refill all used up items and have the container ready for use. d. The medical equipment technician will service all emergency equipment and will have them ready for use. e. The head nurse will ensure sterilization of all recyclable emergency instruments. The head nurse will submit them to the FMSO to pack in the container ready for use. f. Within 24 hours, Chief Medical Officer or his designated will prepare a medical account report for the Force Commander through the Chief Integrated Support Services and the Director of Mission Support. D. ADDITIONAL NOTES AND COMMENTS 1. Layout of Triage center is presented in Annex C to Chapter 5. 2. All Level 1 SMOs and Level 2 COs will ensure that all FMTs are equipped with set of Triage tags as a part of equipment needed in case of MASCAL. Sets should be kept in the ambulances. 3. Hammoud Hospital in Saida is the primary supporting level 3 hospital. Upon receiving the alert of the accident, the chief medical officer or his designated immediately, will inform the hospital to standby to receive accident victims. CMO or his designated will relay information via VHF radio channel 40 and cellular telephone numbers: Dr. Fhailey 03-67-58-35, Dr. Nasser Hammoud 03-31-73-18 and Ms. Lulu 03-4942-63, 43UN CONFIDENTIAL ee CHAPTER 6 PROCEDURES IN THE EVENT OF DEATH, SERIOUS INJURY OR ILLNESS CONTENT: A. Reports from Unit Commander 8. Procedures In The Event Of Death in Lebanon €. Procedures In The Event Of Death in Cyprus D. Procedures In The Event Of Death of Civilian Staff Annexes: Annex A to Chapter 6: Death Certificate Annex B to Chapter 6: Request for Autopsy for UNIFIL Personnel Annex C to Chapter 6: Request for Embalming Service of UNIFIL Personnel Annex D to Chapter 6: Request for Mortician Services ‘A. REPORTS FROM UNIT COMMANDER In the event of death, serious injury or illness or permanent disability of a member of UNIFIL, the Unit Commander will immediately notify UNIFIL HQ-CMPO (1) and UNIFIL OPS (JOC), giving the following information on the deceased or injured individual(s): Service Number UN ID Number Rank Full name (Last, First, Middle in that order - on TTY the last name should be in brackets) Sex Nationality Next of kin (Name, relationship and address) On duty (Yes or No) ). Local Time 10. Place 11. Casualty type 12. Casualty cause oy eene ~~~ UNIFILJ1 CMPO will immediately notify UN HQ New York by cable ("NOTICAS"), B. PROCEDURES IN THE EVENT OF DEATH IN LEBANON 1. The Unit's Medical Officer after confirming the death shall alert the CMO immediately and shall issue @ Death Certificate (Annex A to Chapter 6 ), stating the time and probable cause of death immediately. 2. The Medical Officer confirming the death shall, also issue a short Medical Report containing history of the case during full tour of duty and other important medical information and report of external examination of the remains. 44UN CONFIDENTIAL ee 3. The unit shall transport the remains to the morgue in UNIFIL Level 1+ Hospital in Nagoura or Level 2 at 7-2 or to Hammoud Hospital Saida along with: a. Death certificate b. The deceased's UN ID-card (Blue card) . Medical report (case summary) d. Medical report of the external “Examination of the Remains” e. Anescort that will guard the remains. 4, In the event of death in Nagoura camp UNIFIL hospital, the CO or the medical officer in attendance shall immediately, inform the CMO, J1 CMPO or DCMPO, the Ops Room Duty Officer and FHQ MP-Duty Officer. The team will follow all procedures stated in Para. 1, 2, and 3 above. 5, The CMO shall notify the designate Hospital accordingly of the arrival of the remains to the hospital. 6. The Contingent shall request for MP Coy escort to transport the remains to the mortuary. 7. The Medical Section would arrange respectful handling and correct preparation of the remains (autopsy and or embalmment if requested by CMO). 8, Normally an autopsy shall be performed only if considered necessary from the medical or legal point of view. In view of possible religious or other implications the prior approval of the Contingent Commander to the CMO shall be required. 9. The designated mortician upon instructions of the CMO would collect the remains from the hospital and is responsible for the transportation arrangements for the remains thereafter. 10. The CMO shall make and send by fax /a written request for the following: a. Request for Autopsy (Annex B to Chapter 6) if necessary b. Request for Embalming (Annex C to Chapter 6) if necessary 11. The J1 CMPO (or CCPO) in a co-ordination meeting shall decide on all practical arrangements, (See SOP Volume 4 Part 2 Section 4) 12, The CMO shall provide assistance in the preparation of the body by contacting in writing (Annex D to Chapter 6), the designated Mortician (Bejjani Mortuary service, Beirut Phone: 03221262) about collecting and preparing the remains for transportation to the deceased home country. 13. No human organ can be given away for transplantation or research purposes. The same will be in accordance with the legislation of the country to which the deceased belongs. 14. In case of death caused by disease or after injury where the Patient has been hospitalized (on admission), the hospital in attendance must forward to the CMO immediately, a full 45UN CONFIDENTIAL EEE medical report on the case together with the death certificate. 15. The CMO must receive a copy of all medical documents on the deceased, including the embalming certificate and autopsy protocol if there is one) 16. The CMO shall file the medical documents mentioned above. 17. The CMO shall send a copy each of all medical documents on the deceased to the Medical Director UN HQ New York, through the DMS. 18. The CMO shall send a copy of the autopsy protocol to: FC Contingent Commander of the deceased J1CMPO MP Coy aese 19. The CAO (Travel Officer) is responsible for all arrangements concerning transportation of the remains to the deceased’s home country. The Contingent Commander will seek permission for the repatriation of the remains from the FC and DMS through the CMO and the CMPO. C. PROCEDURES IN THE EVENT OF DEATH IN CYPRUS 1. Paragraphs A and B 8, 11, 15 to 19 apply. 2. The Contingent Commander shall request all border-crossing formalities with MOVCON, UNIFIL HQ in coordination with the UNFICYP HQ for the transportation of the remains to the appropriate location. 3. Infrastructure available at UNFICYP for embalming and autopsy, as per their SOPs, will be utilized for this purpose. 4. The CMO UNIFIL shall send, through the DMS, to UNFICYP HQ a request for these Procedures including transport to and from the Hospital concerned and to the Airport when needed. 5. The Embassy of the country concerned (of the deceased) can be used for the formalities. D. PROCEDURES IN THE EVENT OF DEATH OF CIVILIAN STAFF All the necessary measures in case of death of civilian staff are outlined in UN HQ Administrative Instruction ST/Al/2000/14. 46UN CONFIDENTIAL EEE, CHAPTER 7 MEDICAL REFERRAL CONTENT: A. — Introduction B. Authori Responsibility D. Civilian International Staff jlian Local Staff ANNEXES: Annex A to Chapter 7: Request for Referral Annex B to Chapter 7: Flowchart of Procedure ‘A. INTRODUCTION 1. The purpose of this Directive is to lay down the responsibilities and proper procedures for referral of UNIFIL military personnel to civilian hospitals. While referrals may be made on non-urgent as well as on emergency basis, certain common rules apply with regard to the rights of the personnel as well as to procedures. 2. Reference outside the mission area as a rule is not considered if not part of a medical repatriation. UNIFIL mission area in the context of medical coverage is defined as the limited and specific area of Lebanon. Cyprus and Israel may be considered in special situations on approval of the head of the mission. 3. While coverage of required medical examinations as well as other medical services including hospitalisation is provided by the United Nations to UNIFIL military personnel, the injury or illness must have occurred while in the mission area either performing official duties or taking authorized time off. The illness is also to be attributable to conditions and hazards peculiar to the area of assignment. Coverage of costs attributable to chronic disease previously known to the staff member or contingent before reassignment to UNIFIL (pre-existing medical conditions) will not necessarily be provided by UN means or at UN costs. 4. UN will reimburse costs for further treatment in the home country, after a claim to UN HQ New York. Such reimbursement will only be considered if the costs are directly attributable to the service with UNIFIL. B. AUTHORITY 1. Authorisation to refer any military personnel to civilian hospitals is given only by the Chief Medical Officer-UNIFIL on behalf of the Director of Mission support. Before acceptance of the suggested referral, each case shall be evaluated on its own merit. a7UN CONFIDENTIAL Eee 2. No military personnel are authorized to make any payment for treatment, medicines or supplies without prior authorization of the CMO. Such unauthorised payments will not be reimbursed. 3. Instead the hospital shall send the original invoice labelled with the proper name and UNIFIL ID Number of the soldier to the CMO-UNIFIL for approval and authorization for payment to the hospital. C. RESPONSIBILITY 1. The Battalion’s Senior Medical Officers and the Commanding Officers of UNIFIL Hospitals are responsible for initiating referrals of patients that would need specialist's evaluation and care. The office of the CMO (Force Medical officer and /or Medical Officer (Ops) will assist in the practical referral arrangements once the referral is authorized by the CMO. The CMO shall assign a referral number to the request for treatment and payment form and shall send it directly to the receiving hospital. Following this procedure, the patient can be sent to the civilian hospital directly from the battalion (Unit). Please note that for urgent matters prior verbal agreement of the CMO is required. 2. The special form of reference note must be used. No personnel shall be dispatched to a civilian hospital without the approval of CMO (see Annex A to Chapter 7). This form has to be accompanied by a copy of the UNIFILID card 3. A payment statement, declaring the responsibility, is combined on the same sheet (Annex A to Chapter 7). 4. If an emergency turns up outside the AO, the injured or sick personnel must be transferred quickly to the nearest acceptable hospital and the CMO must be contacted immediately for prompt assistance to the patient and declaration of payment to the respective hospital. In Beirut, Rafik Hariri University Hospital at Beer Hassan or Hotel Dieu de France at Achrafieh are advisable. Otherwise the Hammoud Hospital in Saida is another possibility. 5. Flowchart of the procedure in at Annex B to Chapter 7. D. CIVILIAN INTERNATIONAL STAFF 1. Civilian International Staff Members are e covering most of their medical expenses. itled to subscribe to a group insurance plan, 2. The DMS may authorise payment for expenses not covered by the insurance plans, 3. The patient shall pay for all outpatient medical expenses and will request reimbursement from their medical insurance. This includes medical care. The same applies for the care of the dependents. 48UN CONFIDENTIAL Se Hospitalization expenses for both staff members and their dependants shall be sent directly to the insurance company by the hospital for payment. Staff member is responsible for informing their insurance company when hospitalized and must request the insurance company to send in letter of undertaking to the hospital. Medical treatment Civilian International Staff members are entitled to have basic medical care from all military medical facilities of UNIFIL. They are free to consult doctors/hospitals of their ‘own choice, however, with a referral letter from the CMO. b. The staff members shall buy prescribed medicines on their own expenses. Civilian International Staff Members can use UNIFIL L2 Hospital in Naqoura. The hospital provides primary, emergency and secondary health care to all civilian Staff Members. Sick leave ‘A medical certificate from a medical practitioner is required when the sick leave continues for more than 3 consecutive days. After more than 7 days of uncertified sick leave, the certificate is required from the first. day. The staff member is responsible for producing the certificate. The certificate should be sent to CCPO for registration and for certification by the CMO Sick leave report from UNIFIL Hospital should be sent directly to CMO for authorisation before being sent to CCPO for registration CIVILIAN LOCAL STAFF Medical expenses All Local Staff members holding a contract of three months or more automatically participate in the UN Medical Insurance Plan (MIP). The spouse and the children of the staff member can be enrolled in the MIP on a voluntary basis. MIP covers reasonable and customary medical expenses up to a percentage of 70-100 % depending on the type of treatment, up to a maximum of US $ 20,200/year and US $ 2,500 for dental treatment. MIP is outsourced and covered by GMS Insurance Company. Claims are to be screened by CMO to determine if the expenses are reasonable and customary for the area. 49UN CONFIDENTIAL ———————— 2. Medical treatment a. Local Staff members are entitled to have basic medical care from all military medical facilities of UNIFIL; they are free to consult doctors/hospitals of their own choice, however with a referral letter from the CMO b. Local Staff members can also use UNIFIL L2 Hospital Naqoura. The hospital provides primary, emergency and secondary health care to all civilian Staff Members. ©. Sick Leave: The same applies as for Civilian International Staff. 50UN CONFIDENTIAL Ce EEE EEE CHAPTER 8 REPATRIATION CONTENT: A. _ Repatriation on Medical Ground B. Processes of Repatriations C. Actions by Contingent ANNEXES: Annex Ato Chapter 8: Request for Repatriation Annex B to Chapter 8: Flowchart ‘A. REPATRIATIONS ON MEDICAL GROUND a. Repatriation is only allowed on genuine medical grounds b. Repatriation on medical grounds before the completion of a full tour of duty will normally be at UNIFIL expenses. This applies when the patient: |. Is unlikely to be fit for duty within 30 days and/or expected medical treatment is longer than 30 days. Il. Requires treatment, which is not available in the mission area c. The UN bears the expenses for repatriations in case of disease or disability due to UN service and not for pre existing conditions. B. PROCESSES OF REPATRIATIONS See flowchart in annex B to Chapter 8 C. ACTIONS BY CONTINGENT 1. The repatriation request should be prepared and submitted as soon it becomes clear that conditions outlined in Paragraph A above (points (1) and (2) are fulfilled. One does not have ‘to wait for 30 days and then ask for repatriation. It will take minimum 04 working days for processing the documents for the FC. The papers are then forwarded to Medical Support Division UN HQ, NY. 2. Contingents have to fill out the form in Annex A to Chapter 8. 3, The Senior Medical Officer (SMO) will complete part | of the repatriation form. He has to take care that there is no diagnoses on the form. A medical case summary has to be added in a separate sealed envelope as “medical in confidence” addressed to the CMO. The signature has to be followed by the name and telephone number of the SMO along with a stamp impression. 51UN CONFIDENTIAL ee 4. Part It will be completed by the Contingent Commander with the signature followed by the ame and the original paper shall be handed over to the CMO/FMO (NOT by fax or email). The contingent seal stamp shall be affixed. 5. All the details are to be filled up clearly. Incomplete forms with information lacking will be returned back and the responsibility of delay is of the SMO of the contingent. 6. Adequate time should be foreseen for fixing up the date of repatriation by national rotation flights 7. UN will bear the expenses for repatriation on medical grounds only if the patient is repatriated after the adequate approvals. 8. The urgency of grounds of repatriation holds priority over the procedures and the CMO is the final authority for such decision. 52UN CONFIDENTIAL ea aa SS OO CHAPTER 9 DENTAL CARE DENTAL SERVICES. 1. UNIFIL Civilian international and local Staff Members must arrange for their normal dental care through their own dentists prior to assignment with UNIFIL. 2. UNIFIL military dental care ‘a. Unit that have a Dental Chair with dentist in his Level 1 facility can use this for his own troops Other units can go to the Level 2 medical facilities in their respective Sector If some special treatment is needed that can’t be provided by UNIFIL, and approved by CMO, the patient can always be referred to civilian hospitals in Lebanon (see UNIFIL SOP “Medical Referral”) d. Prosthesis is not prescribed except in emergency. fe. The respective SMO/MO or the Battalion are responsible for providing dental health education to their troops on a regular basis as part of the personal health maintenance pack. The CO-UNIFIL hospital is responsible for dental health education for the HQ staff. f. Each soldier is responsible for maintaining daily dental hygiene by regular brushing with fluoride containing toothpaste and brush. It is recommended that toothbrushes be to be replaced every 4 months. & Military staff members/MPs/OGL in need of dental care for an acute symptom, would present to the UNIFIL-Hospital for referral to Level 2 hospital Sector or to a civil dentist after authorization of the CMO. While waiting for the appointment with the dentist, the doctors would provide palliative treatment as indicated and as needed. h. Amonthly report from each unit should be submitted to CMO prior to the 3rd day of the following month (see Chapter 10) 53UN CONFIDENTIAL ——— CHAPTER 10 MEDICAL REPORTING ‘A. Report to be submitted by all Units B. _L2 Hospital reports C. Urgent Medical Report ANNEXES: — Annex Ato Chapter 10 : Form for Vaccination and Immunization Report Annex B to Chapter 10 Form for Medical Staff Aid 1A Report Annex C to Chapter 10 Form for Medical Staff Aid 18 Report Annex D to Chapter 10 : Form for Medical Staff Aid 2 Report ‘Annex E1to Chapter 10 _: Form for Medical Staff Aid 3A Report ‘Annex E2to Chapter 10: Form for Medical Staff Aid 3B Report ‘Annex Fito Chapter10 _—_: Form for Weekly Report Annex F2toChapter10 —_—_: Form for Weekly Report with Comments Annex G1 to Chapter 10: Form for Daily Report Annex G2toChapter10 _: Form for Daily Report with Comments A. REPORTS TO BE SUBMITTED BY ALL UNITS The SMO of each battalion and each independent minor unit is responsible for the periodic reports on medical activities within the unit. All reports are to be sent to the Medical Section HQ NAQOURA to FMO at unifil-force- medoffr@un.org with a copy to CMO (bojenko@un.org), Medical Planner (unifil-medoffr- plan@un.org), Medical (Ops) at unifil-mo-ops@un.org and Administrative assistant at sayaha@un.org. 1. Report on vaccination and immunisation a. This report has to be sent no later than two weeks after completion of rotation. b. Submitted on form as in Annex A to Chapter10. 2. Medical Staff Aid 1A (MSA 1A) a. The MSA 1A is to be used for serious accidents or diseases that warrant admissions to hospital. b. Sent by the L2 hospitals ©. Submitted on form as in Annex B to Chapter10 . 3. Medical Staff Aid 18 (MSA 18} a. The MSA 18 contains detailed information on each individual casualty b, To be sent by the L1 Hospitals ¢. Submitted on form as in Annex C to Chapteri0. 54UN CONFIDENTIAL — 4, Medical Staff Aid 2 (Deployment Report} a. The "Medical Staff Aid 2" contains detailed information on each Medical Facility in the mission area. b. The MSA 2 should be submitted quarterly NLT the 3rd day of the reporting month (Jan-Apr-Jul-Oct) c. Submitted on form as in Annex D to Chapter10. 5. Medical Staff Aid 3A and 3B a. The MSA 3A and 3B should be submitted monthly NLT the 3rd day of the next month b. Submitted on form as in Annex E1 and E2 to Chapter10. 6. Weekly report a, Should be send every Monday before 1300 Hr b. Scope: Monday 0000 Hr till Sunday 2359 Hr c. Submitted on form as in Annex F to Chapter10 B. L2 HOSPITAL REPORTS 1. In addition to the above mentioned reports, the L2 hospitals need to send the daily report. 2. This report contains detailed information about the admitted patients in these facilities. Should be send to CMO & FMO every day before 0700 Hr by email Scope: daily from 2000 Hr tll 2000 Hr Submitted on form as in Annex G to Chapter10 C. URGENT MEDICAL REPORT specific incidents that have resulted in or are likely to result in significant casualties or other incidents of a medical nature which are likely to attract higher staff, public, political or media attention (such as assassination, mass casualties, outbreak of infectious diseases, food and water poisoning, treatment of peacekeeper outside of UNIFIL medical facility, etc) have to be reported to the CMO immediately as Urgent Medical Reports (by phone or by Fax). 55UN CONFIDENTIAL aS CHAPTER 11 MEDICAL RECORDS General Medical Records 1g of Medical Documents mo A. GENERAL Medical documents include medical records, medical reports, X-ray films, ECG records, laboratory lists, etc. All medical documents are confidential therefore only medical personnel shall handle them, B. MEDICAL RECORDS 1. Medical Records for all patients shall be in English. 2. The medical records shall contain: Reason for the visit Symptoms Examinations, tests ete. Diagnosis Treatment Recommendations mp eaoge 3. For hospitalized patients, notes must be made every day and a case history must be written for the period of hospitalization at the Level 2 Hospitals. Final medical reports are to be sent to the CMO, FMO and to the SMO of the respective contingent by the Level 2 Hospitals. C. FILING OF MEDICAL DOCUMENTS 1. UN Military Staff a. At the unit level, the medical records shall be kept for as long as the staff member remains in the unit. Upon retum of the soldiers to his/her home country, a copy of the medical documents shall be sent at the request of appropriate national authority, b. Level 2 Hospitals shall keep the medical documents for one year. After which the hospital CO shall hand over all inactive files to the CMO’s registry, Medical Section, UNIFIL HQ, now located at the hospital premises. Storage boxes are available from Procurement Section, 56UN CONFIDENTIAL aE 3. 1 UNIFILHQ. The documents must be classified by contingents; each box clearly marked with the name of the contingent (e.g. INDBATT) and the period covered (e.g. January 2010 - January 2011). In each box, all documents must be in alphabetical order and the box should contain an index also in alphabetical order. A copy of the index must be sent to the CMO. ‘At the CMO’s registry, Medical Section, UNIFIL HQ, the documents would be kept for an additional four years, after which they would be sent to the respective home countries. Civilian Patients One year after their definitive departure from the mission, the medical records for international and national civilian staff would be scanned onto the CMO's G-drive. It is advisable that civilian patients take copies of their records with them along with any x-ray films, All hard copies after scanning will remain in the registry for another 4 years after which they will be disposed by shredding. LUNIFIL Local Staff and Civilian International Staff he medical records should be kept in the unit's medical files for as long as UN employs the staff member in that unit. D. CMO a de 2. 3 4, MO is responsible for keeping files indefinitely (as long as UNIFIL exists) on the following jocuments: . Medical reports Index on Medical records on all hospitalized military personnel. Deaths (complete medical record and postmortem examination). |. Repatriations on medical grounds. 87UN CONFIDENTIAL es CHAPTER 12 HEALTH CARE TO NON-UN CIVILIANS ON HUMANITARIAN GROUNDS CONTENT: A. — General B. _ Hospitalization in UNIFIL Level 2 Hospital C. Blood Donation Annex A to chapter 12: Medical Waiver of Liability A. GENERAL 1 FC's DIRECTIVE 2010/08 provides guidance on health care to non-UN civilians within UNIFIL camps 2. Medical services to UNIFIL personnel always has priority. 3. Although UNIFIL medical services have the primary task to provide UNIFIL personnel with the medical care required, UNIFIL also has the mandate to extend its assistance to help ensure humanitarian access to civilian populations. 4. In the context of the prevailing security situation (ic. alert status yellow, incidence level low), non-emergency medical care to non-UN civilians may be provided inside UNIFIL camps. Medical advice and prescription may be given, but preferably, no medicines should be dispensed except for the first day.. COE clinics may offer humanitarian services to the local population at their discretion and cost. 5. UNTFIL medical services are not to replace Lebanese health care but rather to support the infrastructure of the local Lebanese health care system and to support its further development. Such services must therefore be coordinated between UNIFIL Headquarters, the respective contingent Commander, Lebanese health services and other UN agencies/non governmental Organizations (NGOs) offering services in the area of responsibility. 6. _ With the deterioration of the security situation (i.e. a change in the alert status to red), UNIFIL medical facilities will only be allowed to provide emergency medical assistance inside UNIFIL Camps. 7. A Medical Waiver of Liability (See Annex A to chapter 12) to be signed by the patient may be used for certain medical interventions releasing the UN from any liabilities in connection with the provision of such medical care. 8. The following procedures will apply: 58UN CONFIDENTIAL = (a) (b) UNIFIL Hospital (Naqoura) (i) The entry of non-UN civilians to the Force Headquarters in Naqoura shall be guided by the “Standing Orders for the Naqoura Camp and Nagoura Extension Camp” dated Aug 2009, (ii) Non UN civilian patient, accompanied by not more than one escort, shall have pedestrian access at the Hospital gate for identification and screening, The patient will be escorted to and from the medical facility. (ii) Before escorting the patient to the UNIFIL Hospital, the sentry at the hospital will establish a clear communication with the hospital reception during working hours and Duty Medical Officer after working hours. Sentry post at the hospital gate will be provided with the name and contact details of the DMO by the hospital (iv) In cases of emergency medical care, after stabilization, the patient should be transferred to the nearest civilian hospital preferably in a civilian ambulance from the Lebanese Red Cross/ Civil Defence. (v) Patients with chronic diseases must be referred to local civilian hospitals. (vi) Nurses and medical assistants are not allowed to treat civilian patients unless authorised. TCC Medical Facilities: (i) The entry of non-UN civilian to the camps shall be guided by the applicable force protection regulations. (ii) Humanitarian medical services provided to the local population will be done at the discretion and cost of TCCs. (iii)AIl the general principles and procedures outlined in the FC Directive 2010/08 will be observed while rendering medical services to non UN civilians. 59UN CONFIDENTIAL eee B. Hospitalisation in Level 2 hospitals No civilian, non-UN, patient will be transferred from a hospital outside the AO to a UNIFIL Hospital 1, The final decision to admit a civilian patient to Level 2 hospitals in case of an emergency has to be approved by the CMO. 2. The following procedures are to be observed: a Emergencies The requesting unit (military or civilian) must give the following information to CO of the Level 2/UNIFIL Hospital: 1) Has UNIFIL in any way been involved in the accident? 2) Description of injuries, the present condition of the patient and treatment initiated 3) Identity (Name, sex and if possible age) and domicile of patient. 4) IsaMEDEVAC requested? 5) Alternative destinations to Level 2 hospital considering political/religious and geographical factors: i. Hospitals in Tyre ii, Tibnin Hospital iii, Marjayoun Hospital iv. Beirut Hospitals vy. Hospital in Saida. The CO of the Level 2/UNIFIL Hospital must in co-operation with CMO make an evaluation based on the information provided by the requesting unit: 1). Can the patient be treated in Level 2 hospital? 2) __Isthe professional knowledge available sufficient? 3) Are the facilities available sufficient? 4) Can the treatment be finished or can the patient be transferred to a civilian hospital promptly? CMO will inform FC, DFC or DMS and suggest the course of action: 1) Transfer of patient to Level 2 hospital 2) ‘Transfer of patient to a civilian hospital in Tyte/Marjayoun/Tibnin 3) Transport by Lebanese Red Cross or 4) Transport by UNIFIL ambulance or 5) Transport by UNIFIL helicopter (MEDEVAC). 60UN CONFIDENTIAL i In an event that a non-UN civilian has to be transported by UN vehicle, the necessary waiver form must be completed. The transporting of non-UN civilian by UNIFIL Helicopter will be guided by the provisions as set out in the SOP on Casualty and Medical Evacuation (CASEVAC/MEDEVAC) approved on 20 Jul 2010. b. __ Elective requests (non urgent) 1) The requesting unit (military or civilian) must give the following information to CMO in writing. i) Identity (Name, sex and birth-datefage) and domicile of the patient ii) Diagnosis, requested treatment, reason — why exactly in UNIFIL Hospital. iii) Has the patient previously been treated in UNIFIL Hospital’? 2) CO of the Level 2 Hospital must, if the patient is considered for admission to Level 2 hospital, obtain permission from CMO. 3) After considering the possibilities for treatment in Level 2 hospital and possible political/religious and economical aspects, CMO may decide if the patient should be admitted to the hospital 4) Tfany doubts exist concerning the political/religious aspects, the decision should be made by FC/DFC/DMS. C. BLOOD DONATION 1. Requests may come from civilian hospitals to UNIFIL. 2. The CMO-UNIFIL may approve blood donation from UNIFIL blood bank to the civilian hospital, if the patient is in serious danger. 3. Donor may not be bled in UNIFIL premises, 61UN CONFIDENTIAL —————— CHAPTER 13 HYGIENE DIRECTIVES AND VETERINARIAN MEDICINE A. Field Hygiene Service in UNIFIL B. Chief Hygiene officer and Hygiene Team C. Hygiene Report D. Hygiene Instructions E. __ Veterinary service in UNIFIL dogs A. Field Hygiene Service in UNIFIL 1. Permanent hygiene service is to be carried out by SMO (MO) and hygiene officer (WO, NCO) appointed in each battalion and unit. They are responsible for continuous supervision of the following hygiene tasks: a. Food and water hygiene b. Camp hygiene - including personnel, accommodation and environmental hygiene c. Insect and rodent control d. Disinfection €. Destruction of contagious material f. Immediate notification to the Chief Hygiene Officer (CHO) in case of gastrointestinal diseases and food poisoning. 2. The advice, control and inspections are to be carried out by the Hygiene Team headed by CHO. 3. The Hygiene Team will inspect all the units at a regular interval as per the UN guidelines 4. Every unit in the mission must be inspected at least once in four months. If the result is unsatisfactory, a re-inspection will be held within two months. Chief Hygiene Officer and the Hygiene Team 1. CHO, with the Hygiene Team is also responsible, within means and capabilities, for: a. Screening veterinary care to the UNIFIL dogs (see Para €) Control of stray animals c. Support to CMO in matters especially concerning epidemics, food borne diseases and parasitic diseases. 2. Water samples should also be taken from the wells and the Water Treatment Plants and brought to the laboratory of UNIFIL Level 2 Hospital for examination. 62UN CONFIDENTIAL ee Hygiene Reports The CHO is responsible for all hygiene reports. All reports shall be sent to the CMO- UNIFIL. The reports shall contain detailed account of the hygiene situation in the inspected unit. The CHO shall make a front letter with the most important observations and recommendations for the future Hygiene Instructions “UNIFIL Field Hygiene Instructions" shall be used as a guideline and a handbook for the hygiene work in UNIFIL. CHO is responsible for the updating of the "Instructions". Veterinary service to UNIFIL dogs CHO and the Hygiene Team shall monitor the veterinary care given to the UNIFIL dogs by their contingent veterinarian. The dog handlers shall be instructed in First Aid, de-worming, control of ectopara food and water intake and the rabies vaccination. Compulsory vaccinations once a year against the following diseases are to be given: a. Rabies b. Distemper c. Infectious canine hepatitis, HCC 4. e. Parvovirus enteritis Leptospirosis ‘The dog handler and the CHO shall keep records of every dog that has been treated. The CHO will, when necessary, issue health certificates for the UNIFIL dogs. 4. Nuisance of Stray dogs and cats within UNIFIL Camps See “Force Commander's Directive no-06/2004”. Stray animals should be handled carefully under the supervision of the CHO. See also: Guideline for Pest Control in Peace Keeping Mission. 63UN CONFIDENTIAL —— Q. DATES - The effective date of this SOP is as per the date of signature. - The latest date this SOP shall be reviewed in Jan2012, after this date the SOP shall be considered out of date and pending review. R. CONTACT The Chief Medical Officer or his designated representative shall be the contact for any queries related to the issuance of 5. History This SOP was finalised on 6 Jan 2010. T. 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Has 2 | functioning Operating Theatres and 5 ICU beds Sector EAST CHINMEDCOY | UN Posn 7-2 Marjayoun 20 general beds. Has 1 functioning Operating Theatre and 5 ICU beds 69nnex to Chapter 4 : Medi UNIFIL Referral Hospitals ‘Ser no Referral Hospitals Point Of Contact 1 Rafik Hariri University Hospital, Beirut | Dr Masri Bilal, Chief Operation officer [ 03592943(M) 2 Hotel Dieu-De France Hospital, Beirut | Or Zoghbi 03750909(M) 3 Hammoud Hospital, Saida Dr George Fhaily 03675835(M) 4 Rambam Health Center, Haifa, Israel__| Dr Yaron Bar-El, Dy Director 972-50-20662170 5 Bejjani Mortuary Services in Beirut 03221262 70Annex A to Chapter 5 : Mass Casualty Response METHANE MESSAGE METHANE Critical Message The message format to be used is known as the METHANE Critical Message Structure format. M —_ Mycall ign /name / appointment | E Exact location (grid reference) *f Type of incident 4 Hazards, present and potential A Access and egress N Number and severity of casualties E Emergency services present & required Speed is of the essence, this means that even if not all data are known or established, the troops should be sending this message as soon as possible. What is important is the number and severity of casualties. 71Annex 8 to Chapter Casualty Responss 9-LINE MESSAGE ‘9-LINE Message provides the information needed to request CASEVAC. TEMPLATE | Explanatory notes a 1. Exact pick-up location 2: 2. Radio freq and cal 2-123.50 3A 3. Number of patients by prior 3-AL B A+ no. of urgent non-surgical: evac within 2hrs B2 < B+ no. of urgent surgical (inc trauma: immediate evac D2 D needed) E C+ no. of priority (evac within 4hrs) D+ no. of routine (evac within 24hrs) | E+ no. of convenience (evac whenever possible) 4 4. Special equipment needed (eg. ventilator, extrication | 4—Nil equipment) SL 5. Number of patients by type: 5-3 A L+ no. of stretcher cases (='litter’) Az A+ no. of walking cases (=/ambulatory’) 6 N Security at pick-up site: 6-E P E x ‘onfirmed Danger in the area (use caution) currently engaged in a dangerous situation 7. 7. Marking of pick-up point (smoke, panels, etc) 7—Red smoke BA 8. Patient's status (number not required) B-A B A-UNIFIL military D c | B-UNIFIL civilian D C—Non-UNIFIL military D—Non-UNIFIL civilian 9 9. NBC contamination | 9- Nit N= Nuclear/radiological B = Biological C= Chemical nRnex Mass ity Response Lay-out of the tria; inter 2BAnn fer 5 : Mass Casuall HOSPITALS IN LEBANON NO NAME PHONE NUMBER. LOCATION 1_| Hotel Dieu De France (01-615300/01 - 422970 Beirut 2 | American University Hospital 01-374374/01-350000 Beirut 3_| Trad. Hospital 01-369494 Beirut 4 | Roum Hospital 01-587700 Beirut 5_| Alsitawi Lebanon Hospital 01-577177/577277 Beirut 6 | Al-Makased Hospital (01-636000 Beirut 7_| Barbir Hospital (01-630000/652955 Beirut 8 | Hospital Du Sacre Coeur 05-455485 Beirut 9 | Rizk Hospital (01-328800 Beirut 10 | Middle East Hospital (01-805572/809555 Beirut ail 11 | Lebanese Red Cross Emergency 140 Beirut Mr George Kettaneh Tel & Fax : 05-925009 12 | Abou-jaoude Hospital (04-7160000 Beirut 13 | Hammoud Hospital 7066. Ext 1943 Saida Lulu : 03-494263 14 | Dalla Hospital Saida 15 | Libib Medical Center (07-720333 Saida 16 | Jabal Amel Hospital (07-740198/07-740343 Tyre 17 | Hiram Hospital (007-343710 Tyre 18 | Najem Hospital 07-344423 Tyre 19 | Dentist-Malek Bazzi 07-742083/03-810860 Tyre 20 | Dr. Bassam Chalhoub-ENT 03-866639 Tyre 21 | Dr. Tanal Fardoun Ophtalmologist 07-740764/03241877 Jaba-Amel 22 | UNIFIL Hospital 5227/5228 Nagoura 23 | Baba Hospital 05-920755/921380/923606 | Hazmieh 24 | Jesus Heaart Hospital 05-456293/453500 Hazmieh 25 | Bahman Hospital 01 & 03-544000 Haret Hriek 26 | Notre Dame Du Liban Hospital 09-835350/228668 Jounieh 27 | Canadian Hospital (01-511487/487825 ‘Sin El Fil 28 | Hayek Hospital 01-481788/499203 Horch Tabet 29 | St.Charles Hospital (05-451100 Fayadieh 30 | Nabatiye Government Hospital 07-766999/766777 Nabatiye 31_| South Health Center 07-720111/730959 South Lebanon 32_| Dentist-Tony Choufani (03-302097 Rmeich 33 | Islamic Health Society (07-450100/03-820305 Bint sbeil 74Inthe event of Des 45 In UNITED NATIONS INTERIM FORCE IN LEBANON NATIONS UNIES FORCE INTERIMAIRE AU LIBAN UN RESTRICTED DEATH CERTIFICATE 1D Card No| Rank Family Name First Name Unit Date of birth Religion Date of death e of death Probable Cause of death: Name and address of next of ki Date & Signature of SMO Date & Signature of MO Distribution Hammoud Hospital (2) Escort 2) Unt (2) HQUNIFILPets (2) ewoia) MORTICAAN 752x B to Chapter 6 : Prog in the event of Deatt 1s Injury tt UNITED NATIONS NATIONS UNIES INTERIM FORCE IN LEBANON: P FORCE INTERIMAIRE AU LIBAN eae uN REF #: CMO/AU. To: Hammoud Hospital Date... saida From: The Chief Medical Officer UNIFIL Subject: REQUEST FOR AUTOPSY FOR UNIFIL PERSONNEL Patient Name: UNIFIL ID No: NATIONALITY/CONTINGENT: Date of Birth: Date of death: | hereby request your assistance to carry out autopsy on the above named deceased member of UNIFIL. A death certificate has been issued by: According to the United Nations regulations, a UN Medical Doctor and a UN Military Police Officer should be present at the time of autopsy; therefore we would be grateful if you could please inform LUNIFIL Chief Medical Officer as soon as possible the date and time scheduled for the autopsy to take place. ‘The CMO can be contacted as follows: ~ Faxt 01-827-546 - E-mail address: bojenko@un.org = Phone: 01-92-6777 - Mobile: 7091 56 54 The protocol of post mortem examination report (written in English) is to be sent to the Chief Medical Officer of UNIFIL as follows: The Chief Medical Officer UNIFIL P.O Box 7476 Beirut. Lebanon. Please send all charges in respect of this autopsy to the CMO, UNIFIL as above. Thank you most sincerely for your co-operation. 76Annex C to Chapter 6 : Procedures in the event of Serious ness UNITEDNATIONS INTERIM FORCE IN LEBANON : NATIONS UNIES FORCE INTERIMAIRE AU LIBAN CONFIDENTIAL REF.#: CMO/EMB/_ To: Hammoud Hospital Date: Saida From: The Chief Medical Officer UNIFIL Subject: REQUEST FOR EMBALMING SERVICE OF UNIFIL PERSONNEL Patient Name: UNIFIL ID No: Date of Birth: I hereby request your assistance to perform respectful embalming / posthumous service of the above named deceased member of UNIFIL. ‘Once the embalming is completed, the Mortician will collect and prepare the body for transportation to his/her home country. All procedures are to be in accordance with National/religious regulations of the deceased. A death certificate has been issued by: Contact for organs reasons ‘According to UNIFIL regulations, all payment for your service will be done after sending invoice to: The Chief Administrative Officer UNIFIL P.O. Box 7476 Beirut. Lebanon ‘Thank you most sincerely for your co-operation, which is greatly appreciated. 7Annex D to Chapter 6 : Procedures in the event of Deat ju UNITEDNATIONS tat NATIONS UNIES INTERIM FORCE IN LEBANON @ FORCE INTERIMAIRE AU LIBAN To: XXX Date: Beirut From: UNIFIL Chief Medical Officer Subject: Request for Mortician Services Patient Name . UNIFIL ID No: Date of Birth: Nationality: Date of Death: ‘We would be grateful if in accordance with UNIFIL Contract No. respectful posthumous / mortuary services could be provided in respect of the abov named deceased member of UNIFIL. (Collection and storage of the corpse, arrangement and co-operation with the Hospital performing the embalmment/autopsy, preparation for public viewing/burial and preparation for transportation to home country according to International regulations (embalming), crating the coffin, delivery to the Airport, reports and provision of all necessary documentations. A death certificate, a copy of which is attached, has been issued by: Your invoice for the above services should be sent to: The Chief Administrative Officer UNIFIL P.O Box 7476 Beirut ‘We thank you for your kind attention to this request. 78Annex A to Chapter 7: Medical Referral ct UNITED NATIONS age NATIONS UNIES INTERIM FORCE IN LEBANON ios FORCE INTERIMAIRE AU LIBAN REFERRAL REFH SMO/ (the total No.)/ (the year)/ To: Dr. Sergiusz Bojenko Dates / | CMO, Medical HO, UNIFIL From: (the name) The Senior Medical Officer Battalion: Location: UNIFIL Subject: Request for Medical Treatment for UNIFIL Uni Personnel Patient Name: UNIFIL ID No: Nationality: Date of Birth: Date of Arrival UNIFIL: Date of illness: We would be grateful if you would please arrange the following treatment/tests for the above- named Patient: Fresh/Review: Case summary: ‘Treatment/Tests Requested: ‘The SMO can be contacted as follows: Tel: Mobile Fax: Lotus mail: SMO SIGNATURE WITH STAMP: 79OWN [evdsoH pnowweH E-7 UoR2as [e>1PaN ~ SSI uoRASTURUpE Bups9]3u oy a[qissod dau ysaxpreO 9) 394) :UNJpI) STV.LIdSOH £ THAT OL TANNOSWAd AUV.LITIN AO TVARAATA Jenayou [es1paw :Z sxdeyp o4 g xouuy‘Annex A to Chapter 8 : Medical Repatriation sit UNITED NATIONS & 3 NATIONS UNIES INTERIM FORCE IN LEBANON x “a FORCE INTERIMAIRE AU LIBAN vn CONFIDENTIAL REQUEST FOR REPATRIATION BEFORE THE END OF JUR OF DUTY FOR MEDICAL REASONS PART I:(To be completed by Contingent Medical Officer) To: Commander... smmnnnenee Contingent Rank: - First Name Family Name: Dos. : UNIFIL 1D Number: Service Number: . Date of Arrival in UNIFIL a: Itis recommended that the above-mentioned, who Is suffering from: 2 Which Occurred as follows: How (in case of accident/injury). Where: When: Should be repatriated as soon as possible for the following reasons (Delete as necessary): a. Hes unlikely to be fit for full duties within thirty days, b. He requires treatment, which is not available in the Mission Area. 2. tis considered that a ‘The Patient should travel as a lying/sitting case, b. —_Anescort is/is not necessary. 3 Repatriation requested. 4, The Patient should travel as a sitting/lying case. 5. A Medical escort is/is not required for the following reasons: From (Station)... snseumenet9 (Station). Date:. Signed: SMO 81© pemratese® rein blame ma oF Werte HERA ITU Deh aN laste bai 1 “Becatn 9061 gM Hake ole maepene tate 8 oe HSE Re IPA i bres wy 7 PamritinS mateahial a iiins pe uma locbpiest® = SAR RTE com a ey TTT err 0 ti we Mn A Fh tm epee at ete me one 1 (ETSI taHO-a8 a ean 26 TT WE ELA ee " : BR as S| f 7 os jt a Pra irate ae a fetes iPARTII (To be completed by Contingent Commander) To: Chief Medical Officer, HQ UNIFIL, Nagoura 6. Permission is requested for the above-mentioned to be repatriated. 7. Hearrived in UNIFIL on (Date) 8, Relevant medical documents are attached under “Medical in Confidence” 9, Thenext routine ight on shether it's commercial fight: 10. ESCOM’S RANK enone UNIFILID NO% esesnsnnnnN@met 11, Theescort wil/will nat return to the Mission Area, Date. . Signed! Contingent Commander PART Ill (To be completed by the Chief Medical Officer, UNIFIL - Chairperson of the Medical Board) To: 1+ Chief Military Personnel Officer UNIFIL HO (Delete as necessary) 12, Repatriation is recommended. 13, Repatriation is not recommended For the following reasons: 14, The Patient should travel as a sitting/Iying case. 15, A Medical escort is/is not required for the following reasons: Date: wii Signed: PART IV (To be completed by J1-Chief (CMPO)) 16, The repatriation of: Is/is not recommended for approval. 17. Expenses of repatriation are to be borne by UNIFIL/His/Her National Government. Reason’ Date: snsinmnennnnnnnnrinen Signed! 83PART (To be completed by FC) 16. | agree/do not agree that the expenses of the repatriation of ‘Should be borne by UNIFIL/His/Her home Government, J1-Chief (CMPO) Date Signed: Fc PART VI (To be completed by DMS) 17. Repatriation at UN expense approved vide authorization of Medical Director, UN Headquarters. Fax No. Date: (attached) Date: Signed: pms ce ccPO Travel Officer 84ougann ‘OHA uo11995 |e1PaIN — SSI aauassa au Jo st paads :9u GNNOUD TVIIGAW NO NO uonenjeday je21paw +g 49}deY) 0} g xouUYPORT. ATION To be submitted after each rotation. This concerns unit: Pl k appropriate column) Are your troops inoculated against? Yes No Comments ‘Annex A to Chapter 10: Medical Reporting IMMUNIZATI Polio Diphtheria Tetanus Yellow Fever Cholera (bacillary) ‘Typhoid (bacillary) (Salmonellosis) ‘Typhus (tropical) Paratyphoid (Salmonellosis A/8) Hepatitis (epidemic) Are all troops screened by X-ray Are all troops blood-typed (A,B, O and Rhesus systems): Are all troops HIV-tested Wve your troops received malaria Prophylaxis before leaving your home country: Have your t initial briefing concerning matters of hygiene, first aid, venereal disease: Are your dogs inoculated against ral Do you have sufficient resources to carry out daily hygiene control. of: Water Food Garbage Latrines Insects Rodents3 spuncm jo 990 vo pena ‘asnas es9p0H1 "MT Ss=u/nlo Jo M302 dood WewiAANREGO MeN AMAL wy oN vonaun¥@pI NN: ON INN, sant (Msusupp) | sthn 2 Asn 40 AAAS a 800 ‘wey | nouvisaina | sowamn | ons | ave avn | wis :quaprouy jo ou, sayeq Sunuoday quaprouy jo 930 1 ON Moday, aaiva Jssayio [] aseasia TINT? UONSSHAL [_ ]swuappoy ajiyaa [] sau [ ] uodeam :LNJGIONI 40 asNv> SON SVOILON 0} aaua1ajoy VT atv 44¥is T91d3W NNDISEASE / nAURY TPs: REMARKS DISEASE /iMIURY Weapon wcene |) vaneipeere |] vena den TD Dine) Othe (| “AREA OF NIOY Weeanet( ) fee 1] Wore (7 wayrave morethanone — | abeomen (J Saemal {] Exes £} srenaectee SEVERTTY Wwe] Wodeaie[ | Sere beat ‘30H | Sacwntedrom | EvomteaTo | Te Ten Types ornare tee tee own (Check one Chee) z neice (Granta vance a ed ing aera Ly Otberua eons io} neue Ly Waterers a wots nn 2 Wekcoper_] Reeivingarca TD ambulance '[) UNoRers 1 Chan andVeide { } Oertanateane {| Were 7 Tecooter—() Fea WreareaR [ ] Uwambsoree {TUMOR ] Chtlan andi { JOthertandMears | [ ) Waerests tT) 3 Welcomer (1 Fosaivigarcrt [ 1 nambslace CT UNOMes |) Can andVenice [| Omertana Means (3 Waererite * acai Leet Laer Se athe vest ae vel, Sand Leveld re fornon UN Fay raed ol fhe Manon Asa Pa RUBS om ‘cf eb, UNF Fla Hosa PREVENTIVE MEASURES TAKEN Toes Gre Ove choice Desrinions hereon ro ‘Vecanaions ne Prat wethode ¥e Tai Aces eof eat bats Vor] ROD 88@ MEDICAL STAFF AID 18—Page 2 NAME Medical Facies | Main Treatment Given ‘evelcl edialinpetse —Yrrin_ Blood Trastson Feerrinta BS AS antibeis, Resprtoy suspen, | es Fate, Mes, east Sree ea Tenet) Parana, urs, oot, non | feety | ants gen and Boot ofthe stow) vow INCIDENT STE evEL Wa? lever ‘OUTCOME OF CASUALTY / DISEASED DIAGNOSIS SECONDARY DINGNOSS| 1S (avaiable) Tay ery ore ‘uteome Discharge with Full Recovery (J Dacharge with Permanent Dsabity [1° Medevacto level atzcity Repatrte Home ti Dente rr Repatriation tohome land on medical ground isrecommended. —[ Weath Occurred ‘Case of Death PrimaryCouse Secondary (if appicable) am Marem Bone Yes/No tached Post mortem report) 89@ Anns 10 tir ee as roel li baced a ; 1 juve twats {1 wniz@li ledals 2 | eauewenr noe 11 coelll re. 7 | Sener Teng me Tipo = ame ae, = ner ens Nara Fa laweisel aris nmaas any =a neameruRe ; 3 ae morn i Sere oe Ee] seaiaty ae aa Z Brae aoa = mame ee ep acae 7 a Nae is can nae ace ie Spaaieg jae oa 7 Feeou tees ase ae i risaie coe Tine waned 3 verso... lWasnal een Taeui ae rn ea rere 21 Ophthalmology Psychologist, = is Taare 23 Pathologist ‘Technician, Hygiene a nanan ferent 25 Psychiatry Technician, Laboratory. a Fe feces eked +r ae Tehace or aa ane Tea = oor Tae Soe o fea ees Sariaaae 90z Total personnel Total personnel General Ward (Low den 3 BED CAPACITY dependency) JEL tat Oaperisey) 3 ‘lation Other 35 Ventilator Respirator Type: 36 Matlin monitor Type: 7 HIGH DEPENDENCY | Defibrilator Type 38 [Syringe pump Type: 39 other: Type ry ‘Anaesthesla machine Type [a SURGERY Surgical ables Type: a2 ‘Surgical teams MEDIC STAPE AD 2 ome 4a Biochemistry Sedli 44 Blood cross match Speciy sped 45 Haematology Specify Speci 46 HIV tests neem Spec 47 LABORATORY Malaria testing pect 5 48 Microbiology pect Speal 49 Microscopy pedty 5 50 Rapid tests pect Spec Ss. Urinanalysis pec 3 BLOOD STOCK ey be 3 AS A S 81000 BANK Ax a 35 87 Ad 913 Oe ae 37 Blood refrigerator ‘Temperature monitor 58 Hepatitis test 59 HIV tests 60 VOIR test 61 @ X Ray: Extremities a Ray: Head os X-Ray: Columnna a Ray: Pelvis 65 RADIOLOGY X-Ray: Chest o Ray: Contrast Spealy: a Scan 6 IMR Scan 70 Ultrasound 7 Other: 72 Dental Chair Speaiy 73 ABT [Dental x-Ray Sp 74 | ne 75 Hygiene inspection Speciy 76 Water Quality Control Specty FrT| PREVENTIVE meorcine | Water Quality or 78 Veterinary service Specify 79 Other: Specify: 20 Dispensary at Peary Medical Store 2 33 “Ambulance ‘With emergency equipment a4 pec ee ‘Ambulance 4x4 With emergeney equipment 85 “Ambulance tracked With emergency equipment 86 ‘APC Ambulance With emergency equipment 92nex EL ter ti ssc | ware wow racuaicomncext ase94INJURIES DISEASES NON INFECTIOUS DISEASES INFECTIOUS [GYNECOLOGY SEXUALLY [TRANSMITED INFECTIONS ‘MISSION [ UNIFIL FACILTY/CONTINGENT. POPULATION ‘OUTPATIENT, weapons / mines road traffic sport/ recreational (Other (specify) Cardiovascular pulmonary Gastrointestinal Urogenital Musculo-skeletol Neurological eye ENT skin Tumor / Neoplasm ‘Other ispecity) ‘Upper respiratory tract infection Pulm Tuberculosis Gostroenterts uns Gestroentertis (spect) Hepatitis (A/B/C) Dengue fever ‘Meningitis ‘Malaria verified Malaria presumptive “Ameobiasis Giardiasisfelmints peti Scabies ‘Others (Specify) Gonorrhoea ‘Syphilis HIV/AIDS (thers (Speci Vaginitis Pelvic inflammation Pregnancy (Others (Specify) ‘Accidental 1 F2 to Chapter REPORT MONTH/YEAR, DATE EVACUATIONTO inpamient_|_unracury | omen | peanPOISOINIGS, NaC. aires d snake (Others (Spec ili Excactions (thers Routine examinations vaccinations 96UNITED NATIONS INTERIM FORCE IN LEBANON UNIT NAME: ... To: Chief Medical Officer UNIFIL, HQ Naqoura (fax 5546) From: Subject: Senior Medical Officer / CO, Annex FI to Chapter 10: Medical Reportin NATIONS UNIES FORCE INTERIMAIRE AU LIBAN Date: No. of pages: 120 (Rank & Name, Signature) Weekly Medical Report dd mm yy - dd mm yy (week ww/yyyy) PATIENT NUMBERS NUMBERS OF OUT PATIENTS MEDICAL TREATMENT UN CIVILIANS: OUT PATIENTS UN UNIFORMED: >| UNIFIL: i i MALE FEMALE: -+[ UNTSO/OGL: Ls: ‘Non-UN MILITARY: NUMBERS OF IN PATIENTS MEDICAL TREATMENT 97UN CIVILIANS: [>| UNIFIL: IN PATIENTS: UN UNIFORMED: ;—> UNTSO/OGL: “+f Mp: MALE: FEMALE: Non-UN MILITARY: NUMBERS OF PATIENTS DENTAL TREATMENT/ TREATMENTS GIVEN UN CIVILIANS: UNIFIL: DENTAL PATIENTS: UN UNIFORMED: UNTSO/OGL: MALE: FEMALE: MP: Non-UN MILITARY: FILLINGS: DENTAL TREATMENTS: ROOT FILLINGS: PROVISIONAL FILLINGS: EXTRACTIONS: TARTAR REMOVAL ‘CONSULTATION MEDICATION: 98UN MEDICAL IN-CONFIDENCE NUMBERS OF PATIENTS CASEVAC/MEDEVAC PATIENTS ‘MISSIONS Incident site toL-1 | Incident site tol-2 | L-1toL-2 L2toL3 3 # CASEVAC by road | if N/A N/A # CASEVAC by helicopter N/A N/A # MEDEVAC by road N/A N/A # MEDEVAC by helicopter N/A N/A NUMBER OF PATIENTS REFERRED TO L-2 HOSPITAL UN CIVILIANS: > UNFFIL: PATIENTS REFERRED: UN UNIFORMED |+[ UNTSO/OGL: t 4 MALE: | [FEMALE: LMP: Non-UN MILITARY: NUMBER OF PATIENTS REFFERED TO L-3 HOSPITAL (SAIDA) 99p| UN CIVILIANS: (> UNIFIL: PATIENTS TO L3: ~ >| UN UNIFORMED: »[ UNTSO/OGL: MALE: FEMALE: LMP: | Non-UN MILITARY: NUMBER OF PATIENTS DISCHARGED FROM YOUR HOSPITAL UN CIVILIANS: > UNIFIL: DISCHARGED PATIENTS: A pLUN UNIFORMED: _|—/*{ UNTSO/OGL: MALE: FEMALE: Les > Non-UN MILITARY: NUMBER OF PATIENTS DISCHARGED FROM YOUR HOSPITAL p> UN CIVILIANS: p>] UNIFIL: DISCHARGED PATIENTS: p UN UNIFORMED: +{ UNTSO/OGL: MALE: FEMALE: (MP. > Non-UN MILITARY: 100ACTIVITY REPORT Humanitarian aid activities DATE | ACTIVITY DETAILS/REMARKS Veterinarian’s activities DATE ACTIVITY. DETAILS/REMARKS Hygiene activities DATE ACTIVITY | DETAILS/REMARKS 101Number of f laboratory analyses Biochemistry Blood cross match Hematology HIV tests Malaria testing Microbiology Microscopy Rapid tests Urine analysis, ‘other: [a B. Number of X-ray or medical imag es produced X-Ray: Extremities [DcRay: Head X-Ray: Columna X-Ray: Pelvis X-Ray: Chest X-Ray: Contrast T Scan MRI Sean, Ultrasound Other: | Inspection DATE By who INSPECTION / BRIEF SUMMARY 102Logistic activities DATE ‘ACTIVITY Miscellaneous activities DATE ACTIVITY SITUATION Medical Personnel situation and problems al Supplies or Equipment problems ‘Ambulance situation and problems ‘Type Number | Problems Operational SOFT SKIN ‘SOFT SKIN w/Emergency equipment 103‘ARMOURED ‘ARMOURED w/Emergency equipment Specific questions towards HQ UNIFIL ‘SMO’s or CO’s general appreciation PLANNING NEXT WEEK General activities, including medical support missions DATE ACTIVITY 104Humanitarian medical assistance to non-UN civilians DATE ‘ACTIVITY (MOBILE CLINIC, HOUSE CALL....)and LOCATION Change of position? YES/NO [NEW POSN: DATE NEW POSN : 105UN MEDICAL IN-CONFIDENCE emer UNITED NATIONS HENATIONS UNIES UNIT NAME: Date: No. of pages: 120 To: Chief Medical Officer UNIFIL, HQ Nagoura (fax 5546) From: Senior Medical Officer / CO, ... (Rank & Name, Signature) Subject: ‘Weekly Medical Report dd mm yy - dd mm yy (week ww/yyyy) PATIENT NUMBERS NUMBERS OF OUT PATIENTS MEDICAL TREATMENT UN CIVILIANS: (> UNIFIL: OUT PATIENTS: UN UNIFORMED: UNTSO/OGL: MALE: FEMALE: —>MP: Non-UN MILITARY: NUMBERS OF IN PATIENTS MEDICAL TREATMENT 106UN CIVILIANS: > [UNIFIL IN PATIENTS: UN UNIFORMED: + UNTSO/OGL: f : MALE FEMALE: MP: 107 Non-UN MILITARY:NUMBERS OF PATIENTS DENTAL TREATMENT/ TREATMENTS GIVEN UN MEDICAL IN-CONFIDENCE UN CIVILIANS: UNIFIL: DENTAL PATIENTS: co UN UNIFORMED: UNTSO/OGL: MALE: FEMALE: MP: Non-UN MILITARY: FILLINGS DENTAL TREATMENTS: Reg PROVISIONAL FILLINGS: TARTAR REMOVAL: (CONSULTATION MEDICATION: NUMBERS OF PATIENTS CASEVAC/MEDEVAC PATIENTS MISSIONS Incident site to L-1 | incident site to L-2 L-itoL2 L3 L2toL3 # CASEVAC by road N/A N/A +# CASEVAC by helicopter N/A N/A #MEDEVAC by road N/A N/A # MEDEVAC by helicopter N/A N/A 108UN MEDICAL IN-CONFIDENCE NUMBER OF PATIENTS REFERRED TO L-2 HOSPITAL UNIFIL: PATIENTS REFERRED: |} p{UN UNIFORMED: |}-~-* UNTSO/OGL: L 1 — MALE: FEMALE: aed ¥ Non-UN MILITARY: NUMBER OF PATIENTS REFFERED TO L-3 HOSPITAL (SAIDA) [UN CIVILIANS: —>[UNIFIL: PATIENTSTOL3: »[UN UNIFORMED: »[ UNTSO/OGL MALE: | [FEMALE aN >| Non-UN MILITARY: NUMBER OF PATIENTS DISCHARGED FROM YOUR HOSPITAL »{ UN CIVILIANS: (| UNIFIL DISCHARGED PATIENTS: |) »{ UN UNIFORMED: UNTSO/OGL: { 1 —— MALE: FEMALE: | ‘| Non-UN MILITARY: 109ACTIVITY REPORT Humanitarian aid activities DATE ACTIVITY DETAILS/REMARKS Veterinarian’ activities DATE ACTIVITY, DETAILS/REMARKS Hygiene activities DATE ACTIVITY DETAILS/REMARKS 110Number of laboratory analyses Biochemistry Blood cross match Hematology HIV tests Malaria testing Microbiology Microscopy Rapid tests Urine analysis Other: | a. 8 Number of X-ray or medical images produced DeRay: Extremities Ray: Head Ray: Column X Ray: Pelvis X-Ray: Chest Ray: Contrast CTsean MRI Scan Ultrasound | > Other: Inspection DATE Bywho | INSPECTION / BRIEF SUMMARY 1a.Logistic activities DATE ACTIVITY Miscellaneous activities DATE ACTIVITY, SITUATION Medical Personnel situation and problems Ambulance situation and problems Type Number | Problems Operational ‘SOFT SKIN | SOFT SKIN w/Emergency equipment ‘ARMOURED 112ARMOURED w/Emergency equipment Specific questions towards HQ UNIFIL Important unsolved questions or problems already reported SMO’s' or CO’s general appreciation PLANNING NEXT WEEK General activities, including medical support missions [DATE ACTIVITY * gwo = senior medical officer who is him/herself a medical doctor 113Humanitarian medical assistance to non-UN civilians DATE ACTIVITY (MOBILE CLINIC, HOUSE CALL,...Jand LOCATION: Change of position? YES / NO NEW POSN : DATE NEW POSN : Free text 114VTEstr _ z i T Seva SISONDVid | NOISSIWGV 40 31a ON GITgINN AIN3ONIINOD FAWN | ON's (san vz 1sv1) SI9NVHISIG ~ ] 7 z 7 NOILWSTIvildsOH | —NOILIGNOD NOIssIWaVv JO qorssd AN | 7SISONDOud i 1G JORLvG | IsvITIO7MIN ON Gi | IN3ONILNOD AVN | ONS T WoL ‘URIIAID aseueqaT ~f uy asaueqay eas 12907 levoneusayuy jouuosied NN yoooe eve Taupe ery say pe we; uy) | (oo0e Te Aep shojneady Je soueUWSy Oy Joysuesy sqyesd ‘sSsTeIsSIG ‘SUO|Ssiuipe MON ‘TOUTEUOy TWwaaaw AVGTeses parmmuipe ji] a [als ‘Save SISONSVIG| NOISSIWGV3O3Iva| ONGIWSINN| INJONIINODAnnex A to Chapter 12: Medical Waiver of Liability GENERAL RELEASE FROM LIABILITY ON ACCOUNT OF PROVISION BY UN OF MEDICAL CARE Medical Waiver of Liability) |, the Undersigned, hereby recognize that all medical care that may be provided to me by the UN is solely for my own convenience and benefit, and may take place in areas or under conditions of special risk. In consideration of receiving such medical care, | hereby: |. Assume all risks and liabilities in connection with the provision of such medical care; . Recognize that neither the United Nations nor any its officials, agents, servants and employees is liable for any loss, damage, injury or death that may be sustained by me during or as a result of the provision of such medical care; Agree, for myself as well as for my dependents , heirs and estate, to hold harmless the United Nations and all its officials, employees and agents from any claim of action on account of any such loss, damage, injury or death; Agree, for myself as well as for my dependents, heirs and estate, that in the event that | sustain any loss, damage, injury or death during or as a result of the provision of medical care for which the United Nations otherwise may be found to be liable, such liability, if any, shall be subject to the terms of paragraphs 8 and 9 of General Assembly resolution 52/247 of 17 July 1998, whether or not the medical care is provided in the context of peacekeeping operations and whether or not such terms are otherwise directly applicable by virtue of that resolution. Patient Witness Date a7