AMedP-1.10 medical management of major incidents and mass casualties

What it is

What AMedP-1.10 covers

AMedP-1.10 is a NATO Allied Medical Publication (AMedP) that sets out shared medical principles for planning for and managing a Major Incident or a Mass Casualty (MASCAL) situation. In the document's own terms, a Major Incident is "a critical incident where the number, severity, or type of medical cases to treat, or its location, requires extraordinary resources and procedures", and a MASCAL situation is a Major Incident that overwhelms the available medical capability even with extraordinary measures in use. Edition B, Version 1 was promulgated in October 2021 and superseded Edition A, Version 1 on receipt. Nations' agreement to use the publication is recorded in STANAG 2879, which is how AMedP-1.10 acquires force: the STANAG is the agreement, and this publication is the specification it covers.

Who it addresses, and how it binds

AMedP-1.10 is written for military medical and health service personnel, and for the commanders who carry overall responsibility for a Major Incident/MASCAL response, within the armed forces of nations that use STANAG 2879. It does not name a supplier, manufacturer or notified body as an addressee. As with any NATO standardization agreement, ratification and implementation are separate steps, and a nation can ratify with reservations to specific paragraphs, as several nations did for this edition at the time of promulgation. The document describes no separate contract mechanism that carries it to a private company; where a company's work touches AMedP-1.10, it is because a national military customer's own doctrine, or a contract built on top of it, calls for something the publication describes.

How the document is organised

Chapter 1 states the aim, defines Major Incident and MASCAL, and makes clear that providing adequate medical and military capability is a matter of national responsibility, and that managing the response is a commander's responsibility requiring a coordinated, multi-agency effort that can include civilian resources. Chapter 2 works through what preparatory planning has to cover: assessing hazards and risk, including CBRN hazards specific to an area of operations; identifying available resources, agencies and evacuation assets; defining responsibilities and a command and control structure; and putting communication arrangements in place. It requires all military personnel to hold first-aid training and personnel who may deploy on operations to hold military acute trauma care training, and it requires units to exercise and review their Major Incident/MASCAL plans regularly. It sets out the organisational functions and coordination roles a response is expected to establish under the overall responsibility of the on-scene commander, and it addresses the categorisation (triage) of casualties for treatment priority, a subject it works through in its own detail. It covers the additional considerations that apply when an incident occurs under chemical, biological, radiological or nuclear conditions, principles for prioritising medical evacuation by casualty severity and available transport, and the medical and general supply provisioning a Major Incident/MASCAL situation demands, since normal re-supply is often too slow. Annex A lists the related NATO documents the publication draws on, and Annex B is a glossary of abbreviations.

What it does not cover

AMedP-1.10 sets out principles and organisational requirements; the more detailed clinical and technical procedures for CBRN casualty handling, aeromedical evacuation, and the wider medical support doctrine it sits under are covered in the separate publications listed in Annex A, not repeated here. The document's own record of reservations includes two scope limits the United Kingdom noted at promulgation: that it "does not provide comprehensive guidance for MASCAL scenarios of a significant scale", and that it "does not fully align with CBRN Major Incident guidelines" - both recommending NATO develop the doctrine further rather than disputing what exists. It names no certification, accreditation or third-party assessment scheme, and no organisation is certified or assessed against it: nations confirm their own readiness through the training, exercises and after-action review the document itself calls for, not through an external audit.

Standards it references

AMedP-1.10 sits under STANAG 2879, its cover, and under the wider STANAG 2228 (Allied Joint Doctrine for Medical Support). It cites STANAG 2122 as the source of the requirement that all military personnel hold first-aid training, and STANAG 2544 for military acute trauma care training. For CBRN casualty handling it points to STANAG 2461 and STANAG 2358, and for aeromedical evacuation to STANAG 2087 and STANAG 3204, stating plainly that "the agreements of STANAG 2087 and STANAG 3204 apply". Annex A also names STANAG 2542 (Allied Joint Medical Planning Doctrine), STANAG 2546 (Allied Joint Medical Doctrine for Medical Evacuation) and STANAG 7179 (fire and emergency services response), alongside MC 0326/4, ACO DIR 83-1 and ACO DIR 80-25, which are outside our catalogue and are named here rather than linked. Most of these are pointed to as further reading; STANAG 2122 and the aeromedical evacuation pair are the exceptions, invoked in more directive terms.

Standards it references

• STANAG 2122Binds
• STANAG 2087Binds
• STANAG 3204Binds
• STANAG 2228Background
• STANAG 2544Background
• AMedP-8.12Background
• AMedP-7.1Background
• STANAG 2461Background
• STANAG 2358Background
• AAMedP-1.5Background
• AMedP-8.15Background
• AMedP-7.2Background
• STANAG 2542Background
• AJMedP-1Background
• STANAG 2546Background
• AJMedP-2Background
• AAMedP-1.1Background
• STANAG 7179Background