Military reference books and manuals (2009-2023, Volume 6)

FM 90-8

language-qualified, or has an interpreter attached and

available, documents and materials should be forwarded

immediately to higher headquarters where qualified personnel

can conduct interrogations and/or examinations.

(14)

Planning, supervising, and coordinating with the S3 to

ensure all reconnaissance, surveillance, target acquisition

(RSTA) devices maintain as complete coverage of the area of

operation as possible.

(15)

Coordinating with the S3 to ensure the reconnaissance and

surveillance plan and the limited visibility plan are adjusted

as needed by the tactical situation.

(16)

Supervising and controlling the operation of the scout

platoon in the execution of intelligence missions.

(17)

Originating requests and screening requests from staff

elements and subordinate units for air reconnaissance.

(18)

Analyzing air photos and imagery-analysis reports received

from brigade.

(19)

Supervising the destruction of classified materials in

accordance with the unit’s classified document destruction

plan.

I-5. Operations and training officer (S3).

a. The S3 prepares the operations estimate and recommends to the

commander actions to be taken. The estimates, predictions, and

information supplied by the S2 drive the tactical plan.

The S3 and the S2 work in close coordination if they are to

successfully support the mission. More specifically, the S3

accomplishes the following major tasks:

(1)_{Receives and sends initial unit or attachment dispositions.}

(2)_{Monitors the tactical situation.}

(3) Analyzes, interprets, and recommends courses of action.

(4)_{Interacts and coordinates with other staffs.}

(5)_{Maintains communications.}

(6)_{Prepares for future operations.}

(7)_{Supervises training.}

I-6. Logistics officer (S4).

a. The S4 is responsible for advising the commander on all logistical

matters. He determines supply and other service support

requirements. The S4 prepares the logistical estimate and

logistical administrative plans.

I-3

90-8

The S4 accomplishes the following tasks:

(1)

Maintains equipment readiness reports.

(2)

Monitors support of units or attachments.

(3)

Monitors the tactical situation.

(4)

Supervises use of transportation assets.

(5)

Prepares for future operations.

Supply operations in support of counterguerrilla forces involve

much use of pre-positioned caches and the urgency to resupply

units in action.

I-7. Civil-military operations officer (S5).

a. The role of the S5 is a major one in the inevitable interaction

between counterguerrilla forces and the civilian population. The

S5 prepares civil affairs estimates and portions of the operation

orders. All operations have civil affairs value, and the S5 ensures

that this value supports the overall COIN goals.

To do this, the S5:

(1)

Advises, assists, and makes recommendations that relate to

civil affairs.

(2) Makes recommendations to ensure operations are consistent

with overall COIN goals.

(3)

Coordinates and implements the civil affairs tasks of the

unit.

I-8. Fire support officer (FSO).

a. The FSO is responsible for the planning, coordination, and

request of fire support for the battalion. He ensures that fire

support is in consonance with any firepower restrictions and

adheres to the principle of “minimum essential force.”

To accomplish this, the FSO:

(1)

Establishes and maintains communication.

(2)

Manages fire support coordination reports and information.

(3)

Plans and coordinates employment of battalion fire support

assets.

(4)

Coordinates all fire support on surface targets.

(5) Processes planned fire support requests.

(6) Monitors immediate fire support requests.

(7) Performs target analysis.

I-4

90-8

APPENDIX J

Combined Operations

J-1. General.

If and when US forces are deployed to a host country to assist in a

counterinsurgency conflict, tactical operations will probably be joint

in nature, and it is likely that US forces will be working with, or in

support of, the military and paramilitary forces of the host country.

J-2. Nature of Combined Operations.

Combined operations require prior written agreement as to

authority, jurisdiction, and procedural and organizational

matters. The legal basis for combined operations is usually a

treaty or operational agreement between the US and the host

country.

US forces must plan to coordinate and work with the military or

paramilitary forces. Commanders and staffs must be prepared to

establish workable arrangements rapidly, once introduced into a

host country, if not done prior to deployment. Every situation will

be unique and will depend upon the extent of involvement of

US forces and the nature of the operations.

Planning for factors that must be taken into consideration will

benefit combined operations. Chief considerations are:

(1) Command and control.

(2) Intelligence.

(3) Operational procedures.

(4) Combat service support.

J-3. Command and Control.

Establish:

Organization of the combined force.

Overall command of the force.

Roles and/or missions of the combined force.

Procedure for exchange of liaison officers with language

capability or interpreter support, and determine the level of

exchange.

Understanding of differences, capabilities, and personal charac-

teristics of host country military leaders.

J-1

FM 90-8

J-4. Intelligence.

Establish procedures for:

Dissemination of military intelligence and use of intelligence

assets by partners.

Coordination of intelligence operations.

Sharing of high-tech intelligence capabilities.

J-5. Operational Procedures.

Establish plans and procedures for:

a. SOPs that ensure effective cooperation.

b. Assignment of responsibility for certain operations based on

special capabilities of the force.

Determining difference in tactics, techniques, and procedures.

Determining difference in equipment, radios, and maps.

Detailed planning and rehearsals.

Determining allied unit recognition.

Rear operations coordination, planning, and responsibilities.

h. Use of combat support assets.

J-6. Combat Service Support.

Establish plans for:

Exchange of liaison officers.

Coordinating support from local resources and facilities.

Determining equipment and ammunition compatibility.

d. Support in a tactical emergency.

J-2

FM 90-8

Index

advisory assistance, H-16

attack

Army assistance, H-16

deliberate,

3-27

tactical assistance, H-16

hasty, 3-27

aerial search operations, 3-20

helicopters, 5-7

aerospace reconnaissance and

base commander, 3-30

surveillance, 6-13

responsibilities of, 3-30

air assault forces, 3-20, 3-22, 5-3

base defense

airborne forces, 5-3

ambushes, 3-33

construction of, E-18

air cavalry, 5-7

forces (BDF), 3-32, E-18

aircraft support, 3-38

fundamentals of, 3-31, E-15

in depth, 3-32

air transportation, 7-5

offensive action, 3-33

Air-Land Battle, 1-7

passive, 3-31

doctrine, 1-8, 1-9

preparations, 3-33, E-17, E-19, E-20, E-22

air movement, 3-44

security, 3-32

use of host and third country forces, 3-35

ambushes, 3-32

bases

area, see area ambush

brigade or division support, see brigade support

attack fundamentals, C-2

base

base defense, 3-33

operational support, see operational support

deliberate, C-1

bases

execution of, C-5

patrol, see patrol bases

fire discipline, C-6

tactical uses of, E-1

force size and deployment, C-3, C-7

formations, see formations, ambush

battle-in-depth,

1-8

hasty, C-1

border operations, 3-44

night, 3-24

control methods, 3-46

objective rallying point, C-6

sanctuaries, 3-47

planning of, C-3

waterline, 3-47

point, C-1

purpose of, C-1, C-22

brigade support base

techniques, C-6, C-21, see also spider hole

base commander, E-16

ambush, demolition ambush, and special

base defense force, E-18

ambush

defense of, E-15, E-17

defense positions, E-19

antitank platoons and companies, 6-8

defensive construction, E-18

area ambush, C-1, C-18

operational concepts, E-14

baited trap, C-20

organization of, E-13

multiple point, C-18

permanent, E-12

armor, 5-6

training exercises, E-22

built-up area searches, 3-19, G-9, G-11

armor and cavalry movement, 3-41

armored cavalry, 5-6

checkpoints, 3-18

Army assistance, H-16

civil affairs

artillery and mortar support, 3-38

civic action programs, H-11

Index-1

FM 90-8

civic assistance, H-11

conflicts

operational scope, H-12

conventional, 1-1, 5-8

planning, H-13

counterinsurgency, 1-1

US role in, H-13

consolidation campaigns

civil police, H-14

control of, 3-14

development and completion phases, 3-14

civilian population protection

offensive phase, 3-14

by civil police, H-14

preparatory phase, 3-14

by host nation’s military

forces, H-15

convoy security, G-13

by paramilitary forces, H-15

strong, G-13

weak, G-14

civilians, relocation of, 3-45

cordon and search operations, see searches,

close air support, 6-12

built-up areas

combat

counterguerrilla forces

operations, 3-10

flexibility of, 3-8

patrols, 3-34, D-1, D-8, D-15

mobility of, 3-8

service support, 7-1

patience, 3-9

support, 6-1

reserves, 3-9

combat aviation companies, 5-8

counterguerrilla operations, 1-5, 1-6, 3-1, 3-4

combat electronic warfare intelligence

(CEWI),

economic factors, 4-4

6-16

effects of weather and terrain on, 3-4, 4-3, 4-6

in conventional conflicts, 4-1

combat forces

in rear areas, 4-1

air assault, 3-20, 3-22, 5-3

in urban areas, B-2

airborne, 5-3

political considerations, 3-5, 4-3

air cavalry, 5-7

principles of, 3-6

armor, 5-6

psychological factors, 4-4

armored cavalry, 5-6

purpose of, 3-2

attack helicopter, 5-7

sociological factors, 4-3

aviation companies, 5-8

tactical, see tactical counterguerrilla

composition of, 5-1

operations

mechanized infantry, 5-5

time available for, 4-7

US, in COIN operations, 1-6

troops available for, 4-7

use of, 5-2

counterinsurgency

mission, 1-4

combined operations

operations, 1-5

combat service support, J-2

operating principles, 3-6

command and control, J-1

strategy, 1-5

intelligence, J-2

target groups, 1-4

nature of, J-1

operational procedures, J-2

counterintelligence, H-15

communications

defensive operations, 3-29

during movements, 3-38

against guerrilla offensive, 3-36

lines of, 3-35

base, see base defense

patrol bases, E-8

security (COMSEC), 1-10

deliberate

ambush, C-1

communications intercept (COMINT), 6-17

attack, 3-27

communications security (COMSEC), 1-10

demolition ambush, C-22

Index-2

FM 90-8

dismounted patrols

Geneva Conventions, 3-45

basic movements, D-14

ground transportation, 7-5

linear movement, D-15

guerrilla tactics in urban areas, B-2

division support base, see brigade support

base

guerrillas

base camps, 2-8

electronic combat (EC), 6-14

capabilities, 3-3, 4-5

C³CM, 6-14

limitations, 3-3

EW, 6-14

logistical support, 2-7, 4-5

SEAD, 6-14

objectives, 4-2

engineers, 6-7

popular support, 2-6, 4-2

exploitation, 3-28

strengths, 2-4

force, 3-28

threats, 4-1

type of forces, 4-7

weaknesses, 2-5

field artillery

units, 6-9

guerrilla warfare, 1-4, 2-1, 3-31

use of in convoy security, G-13

environmental considerations, 2-2

political, sociological and economic

considera-

fire support units, 6-7

tions, 2-3

flame expedients

principles, 2-10

flame mine, F-2

tactics, 2-8

fougasse, F-2

fuel, F-2

hasty

M202 rocket, F-2

ambush, C-1

attack, 3-27

force

exploitation, 3-28

helicopters, 5-7

minimum essential, 3-48, B-3

herbicides, F-2

use of, 3-8

hiding holes

forces

air hole, A-3

air assault, 3-20, 3-22, 5-3

bamboo hole, A-2

airborne, 5-3

water entrance hole, A-3

base defense, 3-32, E-18

host nation forces, H-15

civil police, H-14

host nation, H-15

house searches, G-11

paramilitary, H-15, see also combat forces,

human intelligence (HUMINT), 4-6, 6-6, 6-16

counterguerrilla forces, and guerillas’

formations, ambush

imagery intelligence (IMINT), 4-6, 6-16

area, see area ambush

internal defense and development (IDAD), H-1

box, C-17

L-formation, C-7

insurgency

line, C-9

activities, 3-16

T-formation, C-11

aims and goals, 2-1

triangle, C-14

development of, 1-3

V-formation, C-13

organization, 1-3

Z-formation, C-10

prerequisites,

1-2

foreign internal defense (FID)

intelligence officer, duties of, H-2, I-1

US activities in, 1-6

intelligence sources

US assistance in, 1-6

combat electronic warfare intelligence (CEWI),

US role in, 3-1

6-16

Index-3

FM 90-8

communications intercept (COMINT), 6-17

operational support bases, 7-1

host country intelligence organizations, H-1

commander, E-10

human intelligence (HUMINT), 4-6, 6-6, 6-16

defense of, E-9

imagery intelligence (IMINT), 4-6, 6-16

infiltration of, E-10

local population, H-1, H-3

location, 7-2

military intelligence (MI), 6-7, 6-16

purpose of, E-9

signal intelligence (SIGINT), 4-6, 6-16

reserves, E-11

work priorities, E-11

international law, 4-4

operations

aerial search, 3-20

large-unit operations, 3-25

combat, 3-10

law of land warfare, 4-4

combined, see combined operations

counterguerrilla, see counterguerrilla

Mao Tse-Tung, 2-10

operations

counterinsurgency,

1-5

mechanized infantry, 5-5

large-unit, 3-25

METT-T, 1-9

military, see military operations

planning considerations, 3-2

offensive, 3-16

police-type, 3-16

military intelligence, 6-7, 6-16

psychological, see psychological operations

military operations

reaction force, 3-34

along borders, 3-46

security (OPSEC), 1-10

purpose of, 1-8

small-unit, 3-22

special air, see special air operations

military police, 6-18

strike campaigns, 3-11

mortar platoons, 6-8

subsurface, see subsurface operations

tactical counterguerilla, see tactical counter

motor movement, 3-39

guerrilla operations

motorized patrols, D-9

tactical, see tactical operations

actions of at danger areas, D-12

urban, see urban operations

movement of, D-10

movement

paramilitary forces, H-15

by air, 3-44

patrol bases

by foot, 3-43

communications, E-8

by motor, 3-39

defense of, see base defense

by rail, 3-41

departure, E-9

of armor and cavalry, 3-41

occupation and operation of, E-3

over water and rivers, 3-42

planning, E-1, E-9

security during, 3-37, 3-40

security measures, E-3, E-7

movement to contact, 3-26

site selection, E-2

patrolling

naval gunfire support

defensive, 3-29

in conventional conflicts, 6-10

offensive, 3-29

in counterinsurgency, 6-10

saturation, 3-23

night ambush, 3-24

patrols, 3-22, 3-23

nontactical transportation, 7-4

combat, 3-34, D-1, D-8, D-15

dismounted see dismounted patrols

motorized, see motorized patrols

objective rallying point, C-6

operation order, D-5

offensive operations, 3-16

planning, D-2

Index-4

FM 90-8

reconnaissance and surveillance, 3-34, D-1,

communication (COMSEC), 1-10

D-7, D-15

convoy, G-13

time schedule, D-4

during movements, 3-37, 3-40

warning order, D-3

operations (OPSEC), 1-10

poke-type operations, 3-16

service support, combat, 7-1

medical, 7-3

point ambush, C-1

maintenance, 7-5

property searches, 3-17

personnel and administration, 7-6

supply, 7-4

psychological operations, 3-1, 6-5, 6-15, H-8

concept, H-7

transportation, see transportation

unit messes, 7-4, see also operational support

organization, H-7

bases

pursuit, 3-28

signal intelligence (SIGINT), 4-6, 6-16

purpose of, 3-28

signal units, 6-19

rail movement, 3-41

small-unit operations, 3-22

rear battle

smoke

defensive techniques, 4-9

sources, F-1

offensive techniques, 4-9

use of, F-1

reaction force operations, 3-34

special air operations,

reconnaissance and surveillance, 3-45

aerospace surveillance and reconnaissance,

aerospace, 6-13

6-13

in force, 3-26

airlift,

6-13

LRSU mission, 6-6

electronic combat (EC), 6-14

patrols, 3-34, D-1, D-7, D-15

psychological operations, 6-15

units, 6-2

weather operations, 6-15

techniques, 6-2

special ambush, C-22

reserves, 3-39

spider hole ambush, C-21

relocation of civilians, 3-45

staff functions

riot control, 3-21

adjutant (S1), I-1

agents, F-2

civil-military operations officer, I-4

executive officer (XO), I-1

roadblocks, 3-18

fire support officer (FSO), I-4

intelligence officer (S2), I-1

saturation patrolling, 3-23

logistics officer (S4), I-3

operations and training officer, I-3

search teams, G-10

strike campaigns

search techniques, G-5

concepts, 3-11

searches

missions, 3-11

aerial, 3-20

operations, 3-11

of built-up areas, 3-19, G-9, G-11

organization, 3-10

of houses, G-11

targets, 3-10

of individuals, 3-18, G-7

of property, 3-17

subsurface operations

of tunnels, A-10, G-12

base areas, A-5

of vehicles, 3-18

base camps, A-5

bunkers, A-6

security, 3-9

hiding holes, see hiding holes

base, 3-32, E-3, E-7

tunnels, see tunnel systems

Index-5

FM 90-8

support

tactics

aircraft, 3-38

conventional warfare, 1-4, 3-25

artillery and mortar, 3-38

guerrilla warfare, 2-8

close air, 6-12

training, 1-8, E-22

support bases, see brigade support base

transportation

support units

air, 7-5

engineers, 6-7

ground, 7-5

fire support, 6-7

nontactical, 7-4

military intelligence, 6-7, 6-16

tactical, 7-4

military police, 6-18

tunnel systems

reconnaissance and surveillance, 6-2

access and escape routes, A-4

signal, 6-19

construction methods, A-8

destruction of, A-12

tactical

detection of, A-9

assistance, H-16

search of, A-10

intelligence, 3-6

special equipment, A-11

situation, 3-7

tactical counterguerrilla operations, 3-1, 3-2, 3-5

Uniform Code of Military Justice, 4-4

contraction, G-3

urban operations

encirclement, G-1

counterguerrilla, B-2

hammer and anvil, G-4

government activities, 3-49

wedge, G-4

guerrilla tactics, B-2

tactical operations

in cities and towns, B-1

air, 6-11

subversive activities, 3-49

counterguerrilla, see tactical counterguernlla

operations

vehicle searches, 3-18

in urban areas, 3-49

tactical transportation, 7-4

water and river movement, 3-42

Index-6

90-8

References

Required Publications

Required publications are sources which users must read in order to

understand and use FM 90-8.

Field manual (FM)

100-20

Low Intensity Conflict

Related Publications

Related publications are sources of additional information. Users do

not have to read them to understand FM 90-8.

Army regulation (AR)

310-25

Dictionary of United States Army Terms

310-50

Catalog of Abbreviations and Brevity Codes

Field manual (FM)

1-100

Combat Aviation Operations

3-10

Employment of Chemical Agents

3-12

Operational Aspects of Radiological Defense

3-50

Deliberate Smoke Operations

5-100

Engineer Combat Operations

6-20

Fire Support in Combined Arms Operations

7-8

The Infantry Platoon and Squad (Infantry, Airborne,

Air Assault, Ranger)

7-10

The Infantry Rifle Company (Infantry, Airborne, Air

Assault, Ranger)

7-20

The Infantry Battalion

(Infantry, Airborne, Air

Assault )

7-30

Infantry, Airborne, and Air Assault Brigade Opera-

tions

17-47

Air Cavalry Combat Brigade (ACCB)

17-50

Attack Helicopter Operations

17-95

Cavalry

References-1

90-8

19-1

Military Police Support for the AirLand Battle

19-4

Military Police Team, Squad, Platoon Combat Operations

19-15

Civil Disturbances

19-40

Enemy Prisoners of War, Civilian Internees, and

Detained Persons

21-75

Combat Skills of the Soldier

24-1

Combat Communications

29-2

Organizational Maintenance Operations

29-23

Direct Support Maintenance Operations

(Non-

divisional)

29-30-1

Division Maintenance Battalion

29-51

Division Supply and Field Service Operations

30-5

Combat Intelligence

31-11

Doctrine for Amphibious Operations

31-12

Army Forces in Amphibious Operations

33-1

Psychological Operations: US Army Doctrine, Combat

Electronic Warfare and Intelligence

34-1

Intelligence and Electronic Warfare Operations

34-10

Military Intelligence Battalion (Combat Electronic

Warfare Intelligence Division)

41-10

Civil Affairs Operation

44-1

US Army Air Defense Artillery Employment

44-3

Air Defense Artillery Employment: Chaparral/Vulcan

44-18

Air Defense Artillery Employment: Stinger

55-2

Division Transportation Operations

71-1

Tank and Mechanized Infantry Company Team

71-2

The Tank and Mechanized Infantry Battalion Task

Force

71-3

Armored and Mechanized Brigade Operations

90-4

Airmobile Operations

90-10

Military Operations on Urbanized Terrain (MOUT)

90-10-1

An Infantryman’s Guide to Urban Combat

References-2

FMI 4-02.46

Field Manual Interim

Headquarters

Department of the Army

No. 4-02.46

Washington, DC, 8 November 2007

MEDICAL SUPPORT TO

DETAINEE OPERATIONS

Contents

Page

PREFACE

Chapter 1

OVERVIEW OF MEDICAL SUPPORT TO DETAINEE OPERATIONS

1-1

Section I — Detainee Status Defined

1-1

Enemy Combatant

1-1

Retained Personnel

1-2

Civilian Internees

1-2

Other Detainees

1-2

Section II — Law of Land Warfare and the Geneva Conventions

1-2

Law of Land Warfare

1-2

Sources of the Law of Land Warfare

1-3

Geneva Conventions

1-3

Section III — Ethical Considerations for the Medical Treatment of

Detainees

1-9

Responsibilities of Health Care Personnel

1-9

Informed Refusal

1-16

Chapter 2

HEALTH CARE PERSONNEL ROLES AND FUNCTIONS

2-1

Section I — Roles and Functions

2-1

Health Care Personnel

2-1

Technical Supervision

2-2

Relationships

2-5

DISTRIBUTION RESTRICTION: Distribution restricted to the DOD and DOD contractors only to

protect technical or operational information from automatic dissemination under the International

Exchange Program or by other means. This determination was made on 8 November 2007. Other

requests for this document must be referred to the Commander, US Army Medical Department

Center and School, ATTN: MCCS-FCD, 1400 East Grayson Street, Suite 221, Fort Sam Houston, TX

78234-5052.

DESTRUCTION NOTICE: Destroy by any method that will prevent disclosure of contents or reconstruction of the

document.

8 November 2007

Contents

Page

Theater Internment Facility

2-5

Section II — Nongovernmental Organizations

2-5

International Organizations

2-5

International Committee of the Red Cross

2-6

Health Care Personnel Contact with Nongovernmental Organizations

2-7

Chapter 3

MEDICAL GUIDELINES FOR DETAINEE OPERATIONS

3-1

Section I — General Considerations

3-1

Cultural Considerations

3-1

Linguist Requirements

3-3

Security Considerations

3-4

Use of Restraints

3-7

Section II — Prior to Transfer to An Internment Facility

3-8

Medical Screening

3-8

Emergency Medical Treatment

3-8

Medical Evacuation

3-9

Field Sanitation and Personal Hygiene Considerations

3-9

Administrative Processing

3-9

Section III — At the Internment Facility

3-10

Medical Screening

3-10

Documentation of Existing Medical Conditions or Injuries

3-14

Monitoring

3-15

Routine Medical Care

3-19

Hunger Strikes

3-22

Section IV — Detainee Outprocessing

3-23

Outprocessing Procedures

3-23

Detainee Release Process

3-23

Section V — Medical Logistics

3-23

Formulary

3-23

Supply/Resupply

3-24

Medical Equipment

3-24

Section VI — Detainee Decedent Affairs

3-24

Secretary of Defense Policy

3-24

Detainee Death Notification Process

3-25

Detainee Declaration of Death

3-25

Burial, Record of Interment, and Cremation

3-26

Chapter 4

FUNCTIONAL SPECIALTIES

4-1

Section I — Nursing Support to Detainee Operations

4-1

Facility Inprocessing

4-1

Care in the Detention Compound

4-1

Inpatient/Facility Nursing Care

4-2

Section II — Nutrition Care

4-3

Nutritional Requirements

4-3

Entrance Nutrition Screening

4-3

Monthly Detainee Weight Tracking

4-3

Cultural Considerations

4-4

FMI 4-02.46

8 November 2007

Contents

Page

Detainee Menu

4-4

Detainee Feeding Operations

4-5

Therapeutic Diets

4-5

Clinical Dietetics

4-6

Section III — Eye Care

4-6

Detainee Screening

4-6

Emergency Services

4-7

Cataract Surgery

4-7

Eye Trauma and Specific Eye Disease

4-7

Diabetes Clinic

4-8

Section IV — Ear and Hearing Care

4-8

Section V — Behavioral Health Services

4-9

Behavioral Health Evaluations and Treatment

4-9

Suicide Prevention

4-9

Section VI — Preventive Medicine

4-13

Potable Water

4-13

Pest Management Services

4-14

Food Sanitation

4-15

Environmental Sanitation

4-15

Control of Communicable Diseases

4-16

Guideline Listing

4-16

Section VII — Pharmacy Services

4-17

Responsibilities

4-17

Inspection and Disposition of Prescription Files and Records

4-21

Section VIII — Dental Care

4-21

Dental Resources Within the Theater

4-21

Concerns and Issues Dealing Specifically with Detainee Dental Operations .. 4-21

Examinations

4-21

Treatment Screening Procedures

4-22

Section IX — Veterinary Services

4-24

Appendix A

MEDICAL CODE OF CONDUCT IN DETAINEE OPERATIONS

A-1

Section I — Definition of Terms

A-1

Section II — Rules for Appropriate Interaction Between Health Care

Personnel and Detainees

A-2

Restrictions/Limitations

A-2

Unauthorized Possession of Goods and Services

A-3

Unauthorized Disclosure of Information

A-4

Maintaining Custody and Control

A-4

Hostage Situations

A-5

Appendix B

DETAINEE BEHAVIORAL HEALTH CARE

B-1

Components

B-1

Appendix C

MEDICAL INPROCESSING SCREENING TOOLS

C-1

Physical Examination

C-1

Behavioral Health Inprocessing Screening

C-1

Quality Assurance Screen

C-1

8 November 2007

FMI 4-02.46

iii

Contents

Page

Appendix D

PREVENTIVE MEDICINE INSPECTION CHECKLIST

D-1

Appendix E

PLANNING CHECKLIST FOR MEDICAL SUPPORT TO DETAINEE

OPERATIONS

E-1

General Considerations

E-1

Training

E-4

Command, Control, Communications, Computers, and Intelligence

E-5

Preventive Medicine

E-6

Medical Treatment

E-7

Hospitalization

E-9

Nutrition Care

E-10

Dental Services

E-11

Behavioral Health, Neuropsychiatric Care, and Stress Control

E-11

Medical Evacuation and Medical Regulating

E-11

Medical Logistics

E-12

Veterinary Services

E-12

Medical Laboratory

E-13

Chemical, Biological, Radiological, and Nuclear Environment

E-13

Appendix F

SAMPLE EXTRACT MISSION ESSENTIAL TASK LIST WITH

COLLECTIVE TASKS

F-1

Appendix G

LINGUIST SUPPORT

G-1

Linguist Categories

G-1

Sources of Linguists

G-1

Appendix H

IMMUNIZATIONS

H-1

Military Vaccine Agency

H-1

Responsibilities

H-1

Special Detainee Immunization Policy Considerations

H-2

Detainee Immunization Records

H-2

GLOSSARY

Glossary-1

REFERENCES

References-1

FMI 4-02.46

8 November 2007

Contents

Figures

Figure 1-1. Sample compassionate release request

1-8

Figure 2-1. Technical supervision

2-4

Figure 3-1. Sample Department of the Army Form 2664-R, Weight Register

3-12

Figure 3-2. Sample daily disposition log

3-17

Figure 3-3. Example medication tracking matrix

3-17

Figure 3-4. Sample medication issue register

3-18

Figure C-1. Inprocessing overprint for Standard Form 600

C-2

Figure C-2. Sample behavioral health screening tool

C-5

Figure C-3. Quality assurance checklist tool

C-6

Tables

Table B-1. Continuum of health care standards and expected practices

B-1

Table B-2. Staff training standards and expected practices

B-2

Table B-3. Humane treatment of detainees standards and expected practices

B-2

Table B-4. Services by level

B-3

Table B-5. Performance improvement standards and expected practices

B-4

Table B-6. Cross-cultural clinical considerations

B-5

Table D-1. Sample internment facility inspection checklist

D-1

Table E-1. Evaluation of available public health services

E-2

Table E-2. Evaluation checklist for a host nation medical treatment facility

E-3

Table F-1. Sample mission essential task list

F-1

8 November 2007

FMI 4-02.46

Preface

This field manual interim (FMI) establishes guidelines for medical support to detainee operations (DO) as part

of the Army Health System (AHS) in the theater. It discusses command structure and staff operations

necessary to provide medical support to detainees.

This FMI is designed for use by commanders and their staffs in the planning and execution of providing

medical support to detainees. Field Manual Interim 4-02.46 is not a stand-alone manual and must be used in

combination with other publications. These publications are noted throughout the manual and a consolidated

listing is provided in the references.

This publication applies to the Active Army, the Army National Guard/Army National Guard of the United

States, and the United States Army Reserve, unless otherwise stated.

Users of this publication are encouraged to submit comments and recommendations to improve the publication.

Comments should include the page, paragraph, and lines of the text where the change is recommended and

a rationale for the recommended change. The proponent for this publication is the United States (US) Army

Medical Department Center and School (USAMEDDC&S). Comments and recommendations should be

forwarded directly to the Commander, USAMEDDC&S, ATTN: MCCS-FCD-L, 1400 East Grayson

Street, Fort Sam Houston, Texas

78234-5052 or send electronic suggestions to e-mail address:

medicaldoctrine@amedd.army.mil.

Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men.

Use of trade or brand names in this publication is for illustrative purposes only and does not imply endorsement

by the Department of Defense (DOD).

The Army Medical Department (AMEDD) is in a transitional phase with terminology. This publication uses the

most current terminology; however, other Field Manual (FM) 4-02-series and FM 8-series may use older

terminology. Changes in terminology are a result of adopting the terminology currently used in joint and/or

North Atlantic Treaty Organization

(NATO) and American, British, Canadian, and Australian Armies

publication arenas. Therefore, the following terms are synonymous—

• Medical logistics (MEDLOG) is now the Army term but health service logistics and combat

health logistics were previously used.

• Roles of care is now the Army term but echelons of care and levels of care were previously

used.

FMI 4-02.46

8 November 2007

Chapter 1

Overview of Medical Support to Detainee Operations

It is DOD policy that the US military services will comply with the principles, spirit,

and intent of the international law of war, both customary and codified, to include the

Geneva Conventions. As such, captured or detained personnel shall be accorded an

appropriate legal status under international law and conventions. Personnel in US

custody shall receive health care consistent with the standard of health care that

applies for US military personnel in the same geographic area. For additional

information refer to Department of Defense Directives (DODDs) 2310.01E, 2311.01E,

Army Regulation (AR) 40-400, AR 190-8, FM 3-19.40, FMs 4-02- and 8-10-series,

and FM 27-10.

SECTION I — DETAINEE STATUS DEFINED

1-1. It is essential for all health care personnel involved in the care of personnel in US custody to

understand that the differences between categories of captured, retained, or detained personnel should not

affect health care treatment.

ENEMY COMBATANT

1-2. The term enemy combatants is used for personnel engaged in hostilities against the US or its

multinational partners during an armed conflict. This term includes both lawful combatants who are

engaging in hostilities on behalf of a party to the conflict and unlawful combatants, such as spies,

saboteurs, or civilians who are engaging in or supporting, hostilities against the US or multinational

partners on behalf of a party to the conflict or on behalf of another party such as a terrorist organization.

For purposes of the war on terrorism, the term enemy combatant means an individual who was part of or

supporting terrorist forces that are engaging in hostilities against the US or multinational partners.

Lawful enemy combatants include enemy prisoners of war (EPW) who are members of the

regular armed forces of a State party to the conflict; militia, volunteer corps, and organized

resistance movements belonging to a State party to the conflict, which are under responsible

command. These individuals wear a fixed distinctive sign recognizable at a distance, carry their

arms openly, and abide by the laws of war. Members of regular armed forces who profess

allegiance to a government or an authority not recognized by the detaining power are also

referred to as enemy combatants. They are entitled to EPW status upon capture and are entitled

to combatant immunity for their lawful pre-capture warlike acts. They may be prosecuted,

however, for violations of the law of war. If so prosecuted, they still retain their status as

prisoners of war (POW).

An unlawful enemy combatant is a person who is not entitled to treatment either as a peaceful

civilian or as an EPW by reason of the fact that the person has engaged in hostile conduct

without meeting the qualifications established by Article 4 of the Geneva Convention Relative

to the Treatment of Prisoners of War, 12 August 1949 (GPW). Unlawful enemy combatants

may include spies, saboteurs, or civilians who are participating in hostilities or who otherwise

engage in unauthorized attacks or other combatant acts. Unlawful enemy combatants are not

entitled to EPW status and may be prosecuted under the domestic law of the captor. This may

include those individuals or entities designated according to references Comprehensive List of

8 November 2007

FMI 4-02.46

1-1

Chapter 1

Terrorist Groups Identified Under Executive Order and Terrorist Groups Identified Under

Executive Order, as identified in applicable Executive Orders approved by the Secretary of

Defense (SECDEF).

RETAINED PERSONNEL

1-3. Enemy personnel who are within any of the categories below are eligible to be certified as retained

personnel (RP). See paragraph 1-19 for additional information.

Health care personnel exclusively engaged in the—

Search for, collection, transport, or treatment of the wounded or sick.

Prevention of disease.

Staff administration of medical units and establishments exclusively.

Chaplains attached to enemy armed forces.

Staff of national Red Cross societies and other voluntary aid societies duly recognized and

authorized by their governments. The staff of such societies must be subject to military laws

and regulations.

CIVILIAN INTERNEES

1-4. A civilian internee is a person that is interned during armed conflict or occupation for security

reasons or for protection or because he has committed an offense against the detaining power. This term is

used to refer to persons interned and protected in accordance with the Geneva Convention Relative to the

Protection of Civilian Persons in Time of War, 12 August 1949 (GC).

OTHER DETAINEES

1-5. Persons in the custody of the US Armed Forces that have not been classified as an EPW (Article 4,

GPW), a RP (Article 33, GPW), or civilian internee (Article 78, GC), shall be treated as an EPW until a

legal status is ascertained by competent authority.

1-6. It is possible that other detainees may be designated additional classifications according to the

policies promulgated by The President or the DOD. Such additional classifications do not impact the

planning and execution of DOs governed by this publication. Instead, these additional classifications

impact issues such as possible criminal charges for engaging in unprivileged military activities.

SECTION II — LAW OF LAND WARFARE AND THE GENEVA CONVENTIONS

LAW OF LAND WARFARE

1-7. The conduct of armed hostilities on land and sea is regulated by the Law of Land Warfare. This

body of law is inspired by the desire to diminish the evils of war by—

Protecting both combatants and noncombatants from unnecessary suffering.

Safeguarding certain fundamental human rights of persons that fall into the hands of the enemy,

particularly POWs, the wounded and sick, and civilians.

Facilitating the restoration of peace.

1-8. The Law of Land Warfare places limits on the exercise of a belligerent’s power in the interest of

furthering that desire (diminishing the evils of war) and it requires that belligerents—

Refrain from employing any kind or degree of violence that is not actually necessary for military

purposes.

Conduct hostilities with regard for the principles of humanity.

1-2

FMI 4-02.46

8 November 2007

Overview of Medical Support to Detainee Operations

SOURCES OF THE LAW OF LAND WARFARE

1-9. The Law of Land Warfare is derived from two principal sources—

Lawmaking treaties or conventions (such as The Hague and Geneva Conventions).

Custom (practices which by common consent and long-established uniform adherence have

taken on the force of law).

1-10. Under the US Constitution, treaties constitute part of the Supreme Law of the Land and, thus, must

be observed by both military and civilian personnel. The unwritten or customary Law of Land Warfare is

also part of the US law. It is binding upon the US, citizens of the US, and other persons serving this

country. For additional information on the Law of Land Warfare, refer to Department of the Army

Pamphlet (DA Pam) 27-1 and FM 27-10.

GENEVA CONVENTIONS

1-11. The US is a party to numerous conventions and treaties pertinent to warfare on land. Collectively,

these treaties are often referred to as The Hague and Geneva Conventions. Whereas The Hague

Conventions concern the methods and means of warfare, the Geneva Conventions concern the victims of

war or armed conflict. The Geneva Conventions are four separate international treaties, signed in 1949.

The Conventions are very detailed and contain many provisions, which are tied directly to the medical

mission. These Conventions are entitled—

Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed

Forces in the Field (GWS).

Geneva Convention for the Amelioration of the Condition of Wounded, Sick, and Shipwrecked

Members of Armed Forces at Sea.

Geneva Convention Relative to the Treatment of Prisoners of War.

Geneva Convention Relative to the Protection of Civilian Persons in Time of War.

PROTECTION OF THE SICK AND WOUNDED

1-12. The essential and dominant idea of the GWS is that the Soldier who has been wounded or is sick,

and for that reason is out of the fight, is from that moment protected.

Protection and Care

1-13. Article 12 of the GWS imposes several specific obligations regarding the protection and care of the

wounded and sick.

The first paragraph of Article 12, GWS, states “Members of the armed forces and other persons

mentioned in the following Article, who are wounded or sick, shall be respected and protected

in all circumstances.”

The word respect means “to spare, not to attack,” and protect means “to come to someone’s

defense, to lend help and support.” These words make it unlawful to attack, kill, ill-treat, or

in any way harm a fallen and unarmed enemy soldier. At the same time, these words

impose an obligation to come to his aid and give him such care as his condition requires.

This obligation is applicable in all circumstances. The wounded and sick are to be

respected just as much when they have fallen into the hands of the enemy as when they are

with their own army or in no man’s land, as well as when they have fallen into the hands of

the enemy.

Combatants, as well as noncombatants, are required to respect the wounded. The obligation

also applies to civilians; Article 18, GWS, specifically states:

“The civilian population shall

respect those wounded and sick, and in particular abstain from offering them violence.”

The GWS does not define what “wounded or sick” means, nor has there ever been any

definition of the degree of severity of a wound or a sickness entitling the wounded or sick

combatant to respect. Any definition would necessarily be restrictive in character and

8 November 2007

FMI 4-02.46

1-3

Chapter 1

would thereby open the door to misinterpretation and abuse. The meaning of the words

“wounded and sick” is thus a matter of common sense and good faith. It is the act of falling

or lying down of arms because of a wound or sickness that constitutes a claim to protection.

Only the soldier who is himself seeking to kill may be killed.

The benefits afforded the wounded and sick extend not only to members of the armed

forces, but to other categories of persons as well, classes of whom are specified in Article

13, GWS. Even though a wounded person is not in one of the categories enumerated in the

Article, we must still respect and protect that person. There is a universal principle which

says that any wounded or sick person is entitled to respect and humane treatment and the

care that his condition requires. Wounded and sick civilians have the benefit of the

safeguards of the GC.

The second paragraph of Article 12, GWS, provides that the wounded and sick “...shall be

treated humanely and cared for by the party to the conflict in whose power they may be, without

any adverse distinction founded on sex, race, nationality, religion, political opinions, or other

similar criteria

”

All adverse distinctions are prohibited. Nothing can justify a belligerent in making any

adverse distinction between wounded or sick that require his attention, whether they be

friend or foe. Both are on equal footing in the matter of their claims to protection, respect,

and care. The foregoing is not intended to prohibit concessions, particularly with respect to

food, clothing, and shelter, which take into account the different national habits and

backg2rounds of the wounded and sick.

The wounded and sick shall not be made the subjects of biological, scientific, or medical

experiments of any kind that are not justified on medical grounds and dictated by a desire to

improve their condition.

The wounded and sick shall not willfully be left without medical assistance nor shall

conditions exposing them to contagion or infection be created.

The only reasons that can justify priority in the order of treatment are reasons of medical

urgency.

Article 12, GWS, provides that if we must abandon wounded or sick, we have a moral

obligation to,

“as far as military considerations permit,” leave medical supplies and

personnel to assist in their care. This provision is in no way bound up with the absolute

obligation imposed by paragraph 2 of Article 12 to care for the wounded. A belligerent can

never refuse to care for enemy wounded on the pretext that his adversary has abandoned

them without medical personnel and equipment.

Enemy Wounded and Sick

1-14. The protections accorded the wounded and sick apply to friend and foe alike without distinction.

Certain provisions of the GWS, however, specifically concern enemy wounded and sick. There are also

provisions in the GPW which, because they apply to POWs generally, also apply to enemy wounded or

sick.

Article 14 of the GWS states that persons who are wounded and then captured have the status of

POWs. However, that wounded soldier is also a person who needs treatment. Therefore, a

wounded soldier who falls into the hands of an enemy who is a Party to the GWS and the GPW,

such as the US, will enjoy protection under both Conventions until his recovery.

Article 16 of the GWS requires the recording and forwarding of information regarding enemy

wounded, sick, or dead. See AR 190-8 for disposition of an EPW after hospital care.

When intelligence indicates that large numbers of EPWs may result from an operation, medical

units may require reinforcement to support the anticipated additional EPW patient workload.

Procedures for estimating the medical workload involved in the treatment and care of EPW

patients are described in FM 8-55.

1-4

FMI 4-02.46

8 November 2007

Overview of Medical Support to Detainee Operations

Search for and Collection of Casualties

1-15. Article 15 of the GWS imposes a duty on combatants to search for and collect the dead, wounded,

and sick as soon as circumstances permit. It is left to the tactical commander to judge what is possible and

to decide to commit his medical personnel to this effort. If circumstances permit, an armistice or

suspension of fire should be arranged to permit this effort.

Assistance for the Civilian Population

1-16. Article 18, GWS, addresses the civilian population. It allows a belligerent to ask civilians to collect

and care for wounded or sick of whatever nationality. This provision does not relieve the military

authorities of their responsibility to give both physical and moral care to the wounded and sick. The GWS

also reminds the civilian population that they must respect the wounded and sick, and in particular, must

not injure them.

Enemy Civilian Wounded and Sick

1-17. Certain provisions of the GC are relevant to the medical mission.

Article 16 of the GC provides that enemy civilians who are “wounded and sick, as well as the

infirm, and expectant mothers shall be the object of particular protection and respect.” The

Article also requires that, “as far as military considerations allow, each Party to the conflict shall

facilitate the steps taken to search for the killed and wounded (civilians), to assist...other persons

exposed to grave danger, and to protect them against pillage and ill-treatment

(emphasis

added).”

The “protection and respect” to which wounded and sick enemy civilians are entitled is the

same as that accorded to wounded and sick enemy military personnel.

While Article 15 of the GWS requires Parties to a conflict to search for and collect the dead,

wounded, and sick members of the armed forces, Article 16 of the GC states that the Parties

must “facilitate the steps taken” in regard to civilians. This recognizes the fact that saving

civilians is the responsibility of the civilian authorities rather than of the military. The

military is not required to provide injured civilians with health care in a combat zone (CZ).

However, if we start providing treatment, we are bound by the provisions of the GWS.

Provisions for treating civilians (enemy or friendly) will be addressed in division, corps,

and theater regulations.

In occupied territories, the Occupying Power must accord the inhabitants numerous protections

as required by the GC. The provisions relevant to medical care include the—

Requirement to bring in medical supplies for the population if the resources of the occupied

territory are inadequate.

Prohibition on requisitioning medical supplies unless the requirements of the civilian

population have been taken into account.

Duty of ensuring and maintaining, with the cooperation of national and local authorities, the

medical and hospital establishments and services, public health, and hygiene in the

occupied territory.

Prohibition on requisitioning civilian hospitals on other than a temporary basis and then

only in cases of urgent necessity for the care of military wounded and sick and after suitable

arrangements have been made for the civilian patients.

Requirement to provide adequate medical treatment to detained persons.

Requirement to provide adequate health care in internment camps.

PROTECTION AND IDENTIFICATION OF MEDICAL PERSONNEL

1-18. Article 24 of the GWS provides special protection for “Medical personnel exclusively engaged in the

search for, or the collection, transport or treatment of the wounded or sick, or in the prevention of disease,

staff exclusively engaged in the administration of medical units and establishments...(emphasis added).”

8 November 2007

FMI 4-02.46

1-5

Chapter 1

Article 25 provides limited protection for “Members of the armed forces specially trained for employment,

should the need arise, as hospital orderlies, nurses or auxiliary stretcher-bearers, in the search for or the

collection, transport or treatment of the wounded and sick...if they are carrying out these duties at the time

when they come into contact with the enemy or fall into his hands (emphasis added).”

1-19. There are two separate and distinct forms of protection.

The first is protection from intentional attack if medical personnel are identifiable as such by an

enemy in a combat environment. Normally this is facilitated by medical personnel wearing an

armband bearing the distinctive emblem (a Red Cross or Red Crescent on a white backg2round),

or by their employment in a medical unit, establishment, or vehicle (including medical aircraft

and hospital ships) that displays the distinctive emblem. Persons protected by Article 25 may

wear an armband bearing a miniature distinctive emblem only while executing medical duties.

The second protection provided by the GWS pertains to health care personnel who fall into the

hands of the enemy. Article 24 personnel are entitled to RP status. They are not deemed to be

POWs, but otherwise benefit from the protections of the GPW. They are authorized to carry out

medical duties only, and as stated in Article 28, “shall be retained only in so far as the state of

health...and the number of prisoners of war require.” Article 25 personnel are POWs, but shall

be employed to perform medical duties in so far as the need arises. They may be required to

perform other duties or labor, and may be held until a general repatriation of POWs is

accomplished upon the cessation of hostilities.

1977 PROTOCOLS TO THE GENEVA CONVENTIONS

1-20. Additional Protocols to the Geneva Conventions have been ratified by some of our allies and

potential adversaries. The US representative to the diplomatic conference signed these amendments, but

they have not been officially ratified by our government.

MEDICAL REPATRIATION

1-21. The Geneva Conventions provide for the repatriation of—

Retained medical personnel once they are no longer needed to provide medical care to members

of their own forces (Article 28 and 30, GWS).

Seriously wounded and sick POWs.

1-22. Parties to the conflict are bound to send back to their own country, regardless of number or rank,

seriously wounded and seriously sick POWs, after having cared for them until they are fit to travel. No

sick or injured POW may be repatriated against his will during hostilities (Article 109, GPW).

1-23. The following shall be directly repatriated (Article 110, GPW):

Incurably wounded and sick whose mental or physical fitness seem to have been gravely

diminished.

Wounded and sick who, according to medical opinion, are not likely to recover within one year,

whose condition requires treatment, and whose mental or physical fitness seems to have been

gravely diminished.

Wounded and sick who have recovered, but whose mental or physical fitness seems to have

been gravely and permanently diminished.

1-24. The following may be accommodated in a neutral country (Article 110, GPW):

Wounded and sick whose recovery may be expected within one year of the date of the wound or

the beginning of the illness, if treatment in a neutral country might increase prospects of a more

certain and speedy recovery.

Prisoners of war whose mental or physical health, according to medical opinion, is seriously

threatened by continued captivity.

1-25. The conditions which POWs accommodated in a neutral country must fulfill in order to permit their

repatriation will be fixed, and will likewise their status, by agreement between the Powers concerned. In

1-6

FMI 4-02.46

8 November 2007

Overview of Medical Support to Detainee Operations

general, POWs who have been accommodated in a neutral country and who belong to the following

categories, should be repatriated:

Those whose state of health has deteriorated so as to fulfill the conditions laid down for direct

repatriation.

Those whose mental or physical powers remain, even after treatment, considerably impaired.

1-26. Upon the outbreak of hostilities, Mixed Medical Commissions will be appointed to examine sick and

wounded POWs and to make all appropriate decisions regarding them (Article 112, GPW). However,

POWs, who in the opinion of the medical authorities of the Detaining Power, are manifestly seriously

injured or seriously sick, may be repatriated without having been examined by a Mixed Medical

Commission.

1-27. Submit and track compassionate release candidates (elderly detainees 65 years or older, complex or

chronic medical problems, terminal or end-stage conditions, problems that cannot be treated within the

theater medical system, and problems that require constant supervision or that restrict movement and/or

personal care) to avoid inappropriate transfers or on-going difficulty within the facility. Compassionate

release requests must be submitted to the higher command governing DO via secret internet protocol router

network

(SIPRNET). All requests must be cleared through military intelligence

(MI) and higher

headquarters (HQ) before the request is submitted to the commander, detainee operations (CDO). Refer to

Figure 1-1 for a sample compassionate release request.

8 November 2007

FMI 4-02.46

1-7

Chapter 1

DEPARTMENT OF THE ARMY

XXX COMBAT SUPPORT HOSPITAL

APO XXXXX

XXXX-XX-XX-XX

19 February 2005

MEMORANDUM THRU Detainee Operations Medical Director

MEMORANDUM FOR Commander, Detainee Operations

SUBJECT: Detainee’s Name Here (internment serial number [ISN] # 123456)

1. The above mentioned detainee is a 71-year-old male currently detained at the XXX Theater Internment

Facility. In addition to his advanced age, he has high blood pressure, recurrent chest pain, chronic

dizziness, anxiety, and arthritis. He is on multiple medications to control these problems, but continues to

come to sick call for problems related to dizziness, arthritis, and disorientation. He cannot walk around the

compound without becoming short of breath, having chest pain, and becoming dizzy. As a result, he has

an increased likelihood of having a fall resulting in hip fracture or a significant cardiac event (such as heart

attack or even sudden death). If he survives after a fall or heart attack, he would most likely require long-

term hospitalization or outpatient medical care. Therefore, I petition for the accelerated review of his case

and consideration for compassionate release.

2. If this detainee receives approval for a medical release, our civil-military operations (CMO) liaison can

assist and contact his family in order to arrange transfer to their custody, as required.

3. Point of contact for this memorandum is the undersigned at (123) 456-7890.

JOHN C. BROWN

Colonel, MC

Commanding

Military Intelligence

CONCUR/NONCONCUR

Staff Judge Advocate

CONCUR/NONCONCUR

The release of internee 123456 is APPROVED/DISAPPROVED

SAMUEL S. SMITH

Brigadier General, USA

Commander, Detainee Operations

Figure 1-1. Sample compassionate release request

1-8

FMI 4-02.46

8 November 2007

Overview of Medical Support to Detainee Operations

SECTION III — ETHICAL CONSIDERATIONS FOR THE MEDICAL TREATMENT

OF DETAINEES

RESPONSIBILITIES OF HEALTH CARE PERSONNEL

1-28. Health care personnel are well trained in and guided by the ethics of their professional calling. This

training and ethical principles, coupled with the requirements of international law as it pertains to the

treatment of EPWs, detainees, and civilians during conflict, will ensure the ethical treatment of all sick and

wounded personnel. Refer to Appendix A for additional information on the medical code of conduct in

detainee operations.

1-29. Health care personnel (particularly physicians) perform their duties consistent with the following

principles: health care personnel—

Have a duty in all matters affecting the physical and behavioral health (BH) of detainees to

perform, encourage, and support, directly and indirectly, actions to uphold the humane treatment

of detainees. See Appendix B for additional information on detainee BH care. They must

ensure that no individual in the custody or under the physical control of the DOD, regardless of

nationality or physical location, shall be subject to cruel, inhuman, or degrading treatment or

punishment, according to and as defined in US law.

Charged with the medical care of detainees have a duty to protect detainees’ physical and

behavioral health and provide appropriate treatment for disease. To the extent practicable,

treatment of detainees should be guided by professional judgments and standards similar to

those applied to personnel of the US Armed Forces.

Will not be involved in any professional provider-patient treatment relationship with detainees

the purpose of which is not solely to evaluate, protect, or improve their physical and behavioral

health.

Whether or not in a professional provider-patient treatment relationship, will not apply their

knowledge and skills in a manner that is not in consonance with applicable law or the standards

set forth in DODD 2310.01E.

Will not certify or participate in the certification of, the fitness of detainees for any form of

treatment or punishment that is not in consonance with applicable law or participate in any way

in the administration of any such treatment or punishment.

Will not participate in any procedure for applying physical restraints to the person of a detainee

unless such a procedure is determined to be necessary for the protection of the physical or

behavioral health or the safety of the detainee or necessary for the protection of other detainees

or those treating, guarding, or otherwise interacting with them. Such restraints, if used, shall be

applied in a safe and professional manner.

1-30. Health care personnel engaged in a professional provider-patient treatment relationship with

detainees will not participate in detainee-related activities for purposes other than health care. Such health

care personnel will not actively solicit information from detainees for other than medical purposes. Health

care personnel engaged in nontreatment activities

(such as forensic psychology, behavioral science

consultation

[BSC], forensic pathology, or similar disciplines) will not engage in any professional

provider-patient treatment relationship with detainees (except in emergency circumstances in which no

other health care providers can respond adequately to save life or prevent permanent impairment).

During the initial screening of detainees any preexisting medical conditions, wounds, fractures,

and bruises should be noted. Documentation of these injuries/conditions provides a baseline for

each detainee which facilitates the identification of injuries which may have occurred in the

theater internment facility (TIF).

Detainees who report for routine sick call should be visually examined to determine if any

unusual or suspicious injuries are apparent. If present, the health care provider should determine

from the detainee how the injuries occurred. Any injuries which cannot be explained or for

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Chapter 1

which the detainee is providing evasive responses should be noted in the medical record and

reported to the chain of command, technical medical channels, and US Army Criminal

Investigation Command (USACIDC).

Health care personnel may enter the holding areas of the facility for a variety of reasons. These

can include, but are not limited to, conducting sanitary inspections, providing emergency

medical treatment (EMT), and dispensing medications. When in the holding areas of the

facility, health care personnel must be observant. Should they observe anything suspicious

which might indicate that detainees are being mistreated, they should report these suspicions

immediately to the chain of command. Should they observe a detainee being mistreated, they

should take immediate action to stop the abuse and then report the incident.

1-31. Detained personnel must have access to the same standard of medical care as the US and

multinational forces to include respect for their dignity and privacy. In general, the security of detainees’

medical records and confidentiality of medical information will be managed the same way as for the US

and multinational forces. During DO, the patient administrator (PAD), the Criminal Investigation Division

(CID), the International Committee of the Red Cross (ICRC), and medical chain of command can have

access to detainee medical records besides the treating health care personnel.

1-32. Health care personnel shall safeguard patient confidences and privacy within the constraints of the

law. Under US and international law and applicable medical practice standards, there is no absolute

confidentiality of medical information for any person. Detainees shall not be given cause to have incorrect

expectations of privacy or confidentiality regarding their medical records and communications. However,

whenever patient-specific medical information concerning detainees is disclosed for purposes other than

treatment, health care personnel shall record the details of such disclosure, including the specific

information disclosed, the person to whom it was disclosed, the purpose of the disclosure, and the name of

the medical unit commander (or other designated senior medical officer) approving the disclosure. Similar

to legal standards applicable to US citizens, permissible purposes include preventing harm to any person,

maintaining public health and order in TIFs, and any lawful law enforcement, intelligence, or national

security-related activity.

1-33. In any case in which the medical unit commander (or other designated senior medical officer)

suspects that the medical information to be disclosed may be misused, he should seek a senior command

determination that the use of the information will be consistent with the applicable standards.

1-34. The information disclosed to a physician during the course of the relationship between physician and

patient is confidential to the greatest possible degree. The patient should feel free to make a full disclosure

of information to the physician in order that the physician may most effectively provide needed services.

The patient should be able to make this disclosure with the knowledge that the physician will respect the

confidential nature of the communication. The physician should not reveal confidential communications or

information without the express consent of the patient, unless required to do so by law. The obligation to

safeguard patient confidences is subject to certain exceptions, which are ethically and legally justified

because of overriding social considerations. Where a patient threatens to inflict serious bodily harm to

another person or to himself and there is a reasonable probability that the patient may carry out the threat,

the physician should take reasonable precautions for the protection of the intended victim, including

notification of law enforcement authorities.

1-35. Patient consent for the release of medical records is not required. The medical treatment facility

(MTF) commander or commander’s designee, usually the PAD, determines what information is appropriate

for release. Only that specific medical information or medical record required to satisfy the terms of a

legitimate request will be authorized for disclosure.

1-36. Because the chain of command is ultimately responsible for the care and treatment of detainees, the

internment facility chain of command requires some medical information. For example, detainees

suspected of having infectious diseases such as tuberculosis (TB) should be separated from other detainees.

Guards and other personnel who come into contact with such patients should be informed about their

health risks and how to mitigate those risks.

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Overview of Medical Support to Detainee Operations

1-37. Releasable medical information on internees includes that which is necessary to supervise the

general state of health, nutrition, and cleanliness of internees and to detect contagious diseases. Such

information should be used to provide health care; to ensure health and safety of internees, Soldiers,

employees, or others at the facility; and to ensure the administration and maintenance of the safety,

security, and good order of the facility.

1-38. For additional information on medical ethics refer to the Textbooks of Military Medicine: Military

Medical Ethics, Volumes I and II, and The Emergency War Surgery Handbook. Both of these publications

are available electronically at: http://www.bordeninstitute.army.mil./.

PROHIBITED ACTS

1-39. The GPW describes acts that are prohibited under the Conventions and specifies that all detainees

will receive humane treatment.

Prohibited acts include killing, torture, medical/scientific experimentation, physical mutilation,

removal of tissues/organs for transplantation, and causing serious injury, pain, and suffering.

Torture can take many guises in wartime situations. Historically, it has been used to extract

tactical information from an uncooperative EPW. However, it has also been applied for the

sake of punishment and/or to inflict pain and suffering. Regardless of the rationale, the

torture of EPWs is prohibited. Health care personnel, who administer drugs to facilitate

interrogation or advise interrogators on the ability of an individual to withstand torture, can

be considered complicit in that torture.

Under current DOD policy, health care personnel cannot certify a detainee for torture but

they can provide consultation to interrogators so long as they are not also detainee treatment

providers.

Medical care will be provided with the consent of the detainee. To the extent practicable,

standards and procedures for obtaining consent will be consistent with those applicable to

consent from other patients. Standard exceptions for lifesaving emergency medical care

provided to a patient incapable of providing consent or for care necessary to protect public

health, such as to prevent the spread of communicable diseases, will apply.

The Detaining Power is prohibited from conducting medical and scientific experimentation

on detained personnel. This prohibition arose from the experiences in World War II. Since

the prisoner is in the custody of the Detaining Power, any consent to the experiment is

suspect as the prisoner may feel coerced to provide consent. This prohibition does not

extend to the introduction of new treatment regimens and/or pharmaceuticals when there is

a substantiated medical necessity and withholding the treatment would be detrimental to the

health of the detainee.

Due to the nature of warfare, numerous combatants/noncombatants will sustain injuries that

require amputation of the unsalvageable limb to save life. Amputation which is based on a

medical necessity and conforms to existing standards of health care is not considered

physical mutilation and therefore not prohibited. Refer to paragraph 3-81 pertaining to

documenting serious injuries and paragraph 3-85 pertaining to medical photography.

With advances in medical science, transplantation of organs in peacetime has become an

accepted method of treatment for certain conditions. However, during wartime with the

exception of blood and skin grafts, transplantation of organs is prohibited. Although the

recipient’s health benefits from the transplant, the donor’s health status does not. As with

the discussion of consent for medical experimentation, the consent of a donor in custody of

the Detaining Power is suspect as he may feel coerced into providing consent by his status.

Additionally, the transplantation of organs/tissue from cadavers is also prohibited as the

practice could lead to allegations that donors were permitted to die in order to harvest their

organs. Protocol I, which supplements the GWS for the protection of war victims, permit

the exception of blood and skin grafts but provides stringent controls. Tissues obtained

must be used for medical purposes, not research or experimentation. The tissue donor must

voluntarily consent to the procedure and records must be maintained.

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Chapter 1

One ethical issue may confront surgeons on the battlefield that does not have a clear answer.

Protocol I reiterates the right of an individual to refuse to undergo a surgical procedure, even if

that procedure would be lifesaving and falls within existing medical standards. A surgeon may

feel that he is not ethically bound by a refusal in the case of a minor or of an individual whose

judgment is impaired by injury or illness. Documenting the issue, whether it is the patient’s

refusal (in writing if at all possible) or the surgeon’s decision is an essential step in ensuring that

allegations of abuse are not forthcoming.

ASSISTANCE PROVIDED TO INTERROGATION TEAMS

1-40. Under the provisions of the Geneva Conventions, health care personnel are prohibited from engaging

in acts that are considered harmful to the enemy. Therefore, health care personnel providing direct patient

care for detainees will not provide assistance to detainee interrogation teams. However, health care

personnel must also consider the welfare of their patients. If a detainee has a medical condition which

could deteriorate during interrogation and result in a health crisis for the detainee, the health care provider

should inform the interrogation team of existing medical limitations. For example, a detainee who is a

diabetic may have dietary restrictions and requirements, as well as a need to take medications on a

scheduled basis.

1-41. Health care personnel charged with any form of assistance with the interrogation process, to include

interpretation, of medical records and information will not be involved in any aspect of detainee health

care. Health care providers charged with the care of detainees should not engage in any activities that

jeopardize their protected status under the Geneva Conventions. Health care providers charged with the

care of detainees should not be actively involved in interrogation, advise interrogators how to conduct

interrogations, or interpret individual medical records/medical data for the purposes of interrogation or

intelligence gathering. Health care providers who are asked to perform duties they feel are unethical

should ask to be recused. Requests for recusal should first go to the health care provider’s commander and

chain of command. If the chain of command is unable to resolve the situation, providers should engage the

technical chain by contacting the detainee operations medical director (DOMD) or command surgeon. If

these avenues are unfruitful, health care providers may contact their specialty consultants or the Inspector

General (IG).

1-42. As a matter of personnel management policy, except as provided in this paragraph, health care

personnel’s support of DO is limited only to providing services in a professional provider-patient treatment

relationship in approved clinical settings, conducting disease prevention and other approved public health

activities, advising proper command authorities regarding the health status of detainees, and providing

direct support for these activities. Health care personnel will not be used to supervise, conduct, or direct

interrogations. Health care personnel assigned as, or providing direct support to, behavioral science

consultation teams (BSCT), consistent with Armed Forces Medical Examiner personnel, are the only

authorized exceptions to this paragraph. The Assistant Secretary of Defense for Health Affairs (ASD[HA]),

or designee, must approve any other exceptions to this paragraph. Behavioral science consultants—

Are authorized to make psychological assessments of the character, personality, social

interactions, and other behavioral characteristics of detainees, including interrogation subjects

and, based on such assessments, advise authorized personnel performing lawful interrogations

and other lawful DO, including intelligence activities and law enforcement. They employ their

professional training not in a provider-patient relationship, but in relation to a person who is the

subject of a lawful governmental inquiry, assessment, investigation, interrogation, adjudication,

or other proper action. Requirements in this instruction applicable to behavioral science

consultants are also applicable to other health care personnel providing direct support to

behavioral science consultants.

May provide advice concerning interrogations of detainees when the interrogations are fully in

consonance with applicable law and properly issued interrogation instructions are available.

May observe, but shall not conduct or direct, interrogations.

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Overview of Medical Support to Detainee Operations

May provide training in listening and communications techniques as well as skills needed to

interpret results of studies and assessments concerning safe and effective interrogation methods

and potential effects of cultural and ethnic characteristics of subjects of interrogation.

May advise command authorities on the detention facility environment, organization and

functions, ways to improve DO, and compliance with applicable standards concerning DO.

May advise command authorities responsible for determinations of release, continued detention

of detainees, or assessments concerning the likelihood that a detainee will, if released, engage in

terrorist, illegal, combatant, or similar activities against the interests of the US.

Will not support interrogations that are not conducted according to applicable law.

Will not use or facilitate directly or indirectly the use of physical or behavioral health

information regarding any detainee in a manner that would result in inhumane treatment or not

be in consonance with applicable law.

Ensure that detainees do not obtain the mistaken impression that health care personnel engaged

in clinical care of detainees are also assisting in interrogations. Behavioral science consultants

will not allow themselves to be identified to detainees as health care providers. Behavioral

science consultants will not provide medical care for staff or detainees (except in emergency

circumstances in which no other health care providers can respond adequately to save life or

prevent permanent impairment).

Will not provide training in first aid, sanitation, or other health matters. Absent compelling

circumstances requiring an exception to the rule, health care personnel will not within a three-

year period serve in the same location both in a clinical function position and as a behavioral

science consultant.

Will not provide medical screening (which is a health care function) to detainees nor act as

medical monitors during interrogation.

May consult at any time with the psychology or other applicable specialty consultants

designated by The Surgeon General concerned for this purpose regarding the roles and

responsibilities of behavioral science consultants and procedures for reporting instances of

suspected noncompliance with standards applicable to DO.

As a matter of professional personnel management, physicians are not ordinarily assigned duties

as behavioral science consultants, but may be so assigned, with the approval of the ASD(HA) in

circumstances when qualified psychologists are unable or unavailable to meet critical mission

needs.

1-43. A psychologist, who is the behavioral science consultant, is assigned to DO. This person assists

interrogators and the detention staff with interrogations and the management of detainees within the facility

and is not assigned a mission of patient care. The medical treatment team should not consult with the

BSCT on issues of treatment. Behavioral science consultation team members will not have access to

medical records or any information about a detainee’s medical treatment except as needed to maintain safe,

legal, and ethical interrogations. For example, it may be helpful to advise the BSCT that a detainee has

diabetes and should not be provided certain types of food during interrogation. The BSCT will not provide

treatment, except in emergency, and will inform the medical treatment staff of any medical issues needing

attention.

REPORTING OF SUSPECTED ABUSE AND/OR TORTURE

1-44. Any health care personnel who in the course of a treatment relationship or in any other way observes

or suspects a possible violation of applicable standards, including those prescribed in ASD(HA) Policy

Memorandum 05-006, and DODD 2310.01E for the protection of detainees will report those circumstances

to the chain of command. Health care personnel who believe such a report has not been acted upon

properly should also report the circumstances to the medical program leadership, including the DOMD or

military department specialty consultant. Officials in the medical program leadership may inform the joint

staff surgeon or the command surgeon concerned, who then may seek senior command review of the

circumstances presented. Other reporting mechanisms, such as the IG, CID, or staff judge advocate (SJA),

may also be used.

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Chapter 1

1-45. Health care personnel involved in clinical practice activities will make a written record of all reports

of suspected or alleged violations in a reportable incident log maintained by the medical unit commander or

other designated senior medical officer.

INVESTIGATION

1-46. While all medical staff members are responsible for immediately identifying and reporting potential

and actual cases of abuse or assault to CID and to the applicable MTF commander and higher HQ, no

further investigation is warranted beyond that necessary to render appropriate treatment, except in the case

of rape or sexual assault, where health care personnel will collect and process rape kits, as set forth below.

It is the role of CID and/or the military police (MPs) to investigate the allegation and collect evidence such

as photographs.

DOCUMENTATION

1-47. For the purposes of this policy, a medical examination is a physical examination that evaluates and

documents medical injury and/or trauma and reviews a detainee’s overall health. The examination includes

the documentation of findings and may include photographs or radiographs as needed for patient care

purposes only.

Procedures

1-48. When physical, sexual, or emotional abuse is alleged or suspected, the health care provider is

required to report the situation immediately to the MPs and the supporting CID.

1-49. A thorough medical examination will be performed by a licensed independent health care provider in

all cases of suspected physical or sexual abuse. If the patient is a female of childbearing age, a pregnancy

test will be performed. In cases of suspected rape or sexual assault, health care personnel will comply with

the standard procedures applied to US personnel for the collection, preservation, and processing of a “rape

kit” evidence.

1-50. All detainees alleging sexual abuse will be tested for sexually transmitted diseases (STDs), such as

chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV).

1-51. The medical report of the medical examination will read “alleged” or “suspected” abuse and the

detainee will be identified as the victim where indicated.

1-52. Cases of alleged sexual assault will follow procedures specified in the theater sexual assault policy.

1-53. Once required medical care has been rendered, the detainee will be released to the MPs or the CID,

who will return the detainee to an appropriate location.

1-54. Subsequent investigation of the alleged abuse, including identifying the perpetrator, is the

responsibility of the MPs and CID.

1-55. The MTF commander where a report of suspected or alleged detainee abuse originates will ensure

that a serious incident report (SIR) is submitted to its higher HQ, documenting each incident of alleged or

suspected abuse or assault. Abuse can involve physical harm, financial exploitation, emotional or verbal

abuse, neglect (including self-neglect), or abandonment. Abuse is by definition improper. Inflicting

physical harm against an active combatant is not abuse since causing harm to an enemy is by custom and

treaty considered a proper use of force.

Categories of Abuse

1-56. Physical Abuse: Slapping, hitting, bruising, beating, or any other intentional act that causes someone

physical pain, injury, or suffering. The use of painful physical restraints or the use of restraints for purely

punitive action rather than safety reasons may be considered abuse.

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Overview of Medical Support to Detainee Operations

1-57. Emotional Abuse: Threatening, humiliating, and causing emotional pain, distress, or anguish.

Emotional abuse can be verbal or nonverbal; it includes insults and threats of harm.

1-58. Sexual Abuse: Any sexual activity to which the individual does not consent or is incapable of

consenting. Any sexual activity between detainees and internment facility personnel is without question

abusive because it cannot be truly “consensual.” Nonconsensual sexual activity includes everything from

exhibitionism to inappropriate touching to sexual intercourse.

Tenets of Abuse Prevention

1-59. The four “Ps” of abuse prevention are:

Priorities—Has a command philosophy that places honor and dignity at the top of priorities be

established.

Policies—It is not good enough to tell everyone to do the right thing…put it in writing.

Procedures—Have systems in place that by nature reduce the potential for abuse.

Practices—Continuous exercise of a professional demeanor and conduct is required.

1-60. When dealing with detainees, Soldiers need to use their common sense and exercise good judgment.

Remember that if—

It looks wrong, then it probably is.

It is something that would enrage you if you saw a family member or another Soldier being

subjected to, then it is probably wrong.

You are confused and you do not know if it is right or wrong seek help and guidance.

RESPECT AND DIGNITY

1-61. Medical providers will treat all detainees with dignity and respect. They will be especially protected

against violence, insults, public curiosity, bodily injury, reprisal, sexual attack, or any form of indecent

assault. Thus, detainees will be examined in an environment appropriate for the preservation of individual

dignity and safety. Graduated levels of privacy will be used, appropriate to the type of examination. The

detainee will be asked only to expose as much body surface as medically necessary for a complete

examination. Every effort will made to provide an examiner of the same gender as the detainee.

RESPECT FOR PRIVACY

1-62. To the extent possible, informed consent will be obtained through an interpreter before performing

an examination of sensitive areas, such as the genital region or the female breast region. The MTF

commander responsible for providing health care to a detainee may authorize such examinations without

consent where the safety of the detainee and/or staff may be at risk. All attempts will be made to minimize

body exposure to the level medically appropriate for a thorough evaluation of the region at issue. This will

be done by giving the patient proper gowns and clothing and by conducting the examinations behind

curtains or walls and away from public view.

1-63. In order to ensure safety of detainees and medical staff, detainees will be examined in the presence

of designated security personnel. The medical staff will maximize the use of same-gender medical

examiners and security support. Examiners will position patients to minimize any exposure of private

regions of detainees to nonmedical personnel, consistent with security requirements.

BODY CAVITY SEARCHES

1-64. Cavity examinations and searches may conflict with the customs of some detainees. Therefore, in-

take and routine medical examinations will not include body cavity exams or inguinal (hernia) exams.

Body cavity examinations may be performed for valid medical reasons with the verbal consent of the

patient. Body cavity searches may only be performed when there is a reasonable belief that the detainee is

concealing an item that could present a security risk and must be authorized by the first general officer in

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Chapter 1

the chain of command. To the extent possible, body cavity examinations or searches will be conducted by

trained personnel of the same gender and with the utmost respect for the detainee’s dignity and privacy.

CONTRABAND

1-65. For the safety of the detainee population, the security personnel, internment/holding facility staff,

and the medical staff, any contraband found on a detainee during the course of a medical examination will

be turned over to appropriate security personnel.

INFORMED REFUSAL

DETAINEE

1-66. Detainees may refuse routine examinations or parts of physical examinations. Competent detainees

that do not consent, will be informed that this refusal may alter the type of detention environment in which

they live, particularly if there is a suspicion that they harbor potential communicable diseases. The MTF

commander responsible for providing health care to the detainee may authorize examination or treatment in

the absence of consent if it is deemed necessary to preserve the life, limb, or eyesight of the detainee or to

preserve the health or safety of other detainees or any other persons.

1-67. Involuntary treatment or intervention in an internment facility must be preceded by a thorough

medical and BH evaluation of the detainee and counseling concerning the risks of refusing consent. Such

treatment or intervention shall be carried out in a medically appropriate manner, under standards similar to

those applied to personnel of the US Armed Forces.

1-68. Detention facility procedures for dealing with cases in which involuntary treatment may be necessary

to prevent death or serious harm shall be developed with consideration of procedures established by Title

28, Code of Federal Regulations, Part 549.

MENTAL COMPETENCY FOR INFORMED REFUSAL

1-69. On occasion, severely impaired detainees will require medical examination. Unconscious or

psychotic individuals, under customary rules, may be examined without expressed verbal consent. Health

care personnel will use a two-person verification rule when dealing with impaired detainees. In order to

deem a detainee impaired and unable to give informed consent, two members of the medical staff must

agree that the detainee is, in fact, impaired and this is to be documented clearly on the examination report.

Preferably, one of the two individuals assessing competency will possess BH expertise.

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Chapter 2

Health Care Personnel Roles and Functions

Health care personnel provide all detainee health care to include inprocessing,

periodic, and outprocessing screening examinations, all routine and emergency

outpatient care, all dental and BH care, all inpatient care including critical care, all

detainee medical transfers, and public health. Refer to Appendix C for additional

information on medical inprocessing screening tools. Detainee health care personnel

will not provide or share detainee medical information with Joint Interrogation and

Debriefing Center intelligence or interrogator personnel. This prohibition applies to

all agencies conducting interrogations. Medical record information may be shared

with the CDO who has a responsibility for the welfare of all detainees. Detainee

health care personnel will not provide detainee security and custody or control under

any circumstances for even brief instances; nor will there ever be the perception that

health care personnel provide such functions (such as they will not carry handcuffs or

flex cuffs). Health care personnel when operating within a detainee collection point

(DCP), detainee holding area (DHA), or internment facility are under operational

control (OPCON) of the MP unit operating the DCP, DHA, or internment facility.

SECTION I — ROLES AND FUNCTIONS

HEALTH CARE PERSONNEL

DETAINEE OPERATIONS MEDICAL DIRECTOR

2-1. The Army Service component commander’s (ASCC) senior Army medical officer appoints a DOMD

to oversee and guide all elements of health care delivery to detainees within the theater. This ensures that a

comprehensive assessment of critical mission tasks is continuous, facilitates the rapid identification of

deficiencies, and enhances the timely resolution of health care delivery issues.

2-2. The DOMD is responsible for—

Advising the CDO on the health of the detainee population.

Providing guidance, in conjunction with the SJA, on the ethical and legal aspects of providing

health care to detainees.

Recommending task organization of medical resources to satisfy mission requirements.

Recommending policies concerning medical support to DO.

Developing, coordinating, and synchronizing health consultation services for detainees.

Evaluating and interpreting medical statistical data.

Recommending policies and determining requirements and priorities for medical logistics

(MEDLOG) operations in support of detainee health care. This includes blood and blood

products, medical supply/resupply, formulary development, medical equipment, medical

equipment maintenance and repair services, optometric support, and fabrication of single- and

multivision optical lens, and spectacle fabrication and repair.

Recommending medical evacuation policies and procedures and monitoring medical evacuation

support to detainees.

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Chapter 2

Recommending policies, protocols, and procedures pertaining to medical and dental treatment of

detainees. These policies, protocols, and procedures will provide the same standard of care

provided to US Forces in the same geographical area.

Ensuring medical records are maintained on each detainee as prescribed by AR 40-66 and AR

40-400.

Ensuring monthly weigh-ins are conducted and reported as required by regulation and

international law.

Planning for and implementing preventive medicine (PVNTMED) operations and facilitating

health risk communications

(to include PVNTMED programs and initiating PVNTMED

measures [PMM] to counter the health threat). Refer to Appendix D for additional information

on PVNTMED inspection checklist.

Planning for medical support to the detainee population. See Appendix E for additional

information on the planning checklist for medical support to detainee operations.

TECHNICAL SUPERVISION

TECHNICAL SUPERVISION DEFINED

2-3. Technical supervision is the authority, less than command, over certain clearly delineated technical

functions performed by units not in the chain of command. Technical supervision is governed by policies

and procedures that are established by regulation and restricted to prescribing detailed and specific

technical guidance to control the performance of those functions.

TECHNICAL SUPERVISION OF DETAINEE MEDICAL OPERATIONS

2-4. The DOMD is designated by the ASCC to exercise technical supervision of the medical aspects of

DO conducted throughout the joint operational area (JOA). Technical supervision is exercised across units

of assignment and levels of command and affects all health care personnel and units engaged in delivery of

health care to detainee populations (Figure 2-1). Technical supervision encompasses—

All medical services provided at DCPs and DHAs to include limited medical screening, EMT,

PMM (hygiene and sanitation), and medical evacuation of seriously injured or ill detainees

through medical channels.

Note. For those detainees evacuated through medical channels, the echelon commander or

supporting MP commander must provide guards/escorts as health care personnel cannot perform

guard functions.

Medical services provided in the TIF include—

Initial medical examinations.

Medical treatment (routine care, sick call, emergency services, hospitalization, and medical

consultation and specialty care requirements).

Medical evacuation.

Preventive medicine (to include medical surveillance, occupational and environmental

health

[OEH] surveillance, hygiene and sanitation standards and practices, pest

management activities, water potability inspections, and dining facility/services hygiene and

food preparation practices).

Dental services.

Veterinary service support (to include food safety, veterinary PVNTMED, animal health

care, and oversight of animal welfare, as required).

Neuropsychiatric (NP) treatment and stress prevention (as required) and BH support.

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Health Care Personnel Roles and Functions

Medical logistics

(to include medical supplies, pharmaceuticals, medical equipment and

medical equipment maintenance and repair, blood management, and optical lens

fabrication.)

Medical laboratory services for the clinical diagnosis of infectious diseases.

All medical services provided in US military MTFs that are not part of established internment

facilities. This can include EMT provided at battalion aid stations (BASs) and Role 2 MTFs

(medical companies), forward resuscitative surgery provided at forward surgical teams (FSTs) to

stabilize the detainee for further evacuation and hospitalization, and contract public health

services

All medical administrative matters such as the establishment and maintenance of medical

records, documentation of preexisting injuries (to include medical photography, if deemed

appropriate), restrictions on activities based on medical conditions (similar to medical profiles),

and documentation required for legal purposes (such as monthly height and weight records).

Procedural guides/standing operating procedures (SOPs) for reporting suspected detainee abuse

are developed and disseminated and health care personnel are trained on procedures and ethical

considerations.

Procedural guides/SOPs are developed that standardize credentialing of health care providers,

define the scope of practice of health care personnel, and establish scope of practice and

supervision of retained health care personnel.

Standards of health care throughout internment facilities within the JOA are established,

inspected, and enforced (the standards used are the same as the standard of health care provided

to US Forces in the same geographical area).

Procedures for identifying, reporting, and resolving of medical ethics and other legal issues are

established and disseminated.

Procedures are established for ensuring medical proficiencies/competencies, and providing

required training to resolve deficiencies. Programs of instruction are developed to ensure all

health care personnel engaged in health care delivery to detainees will have appropriate

orientation/training in culture, language (and/or language support), social, and religious beliefs

of the detainee population. Refer to Appendix F for additional information on a sample mission

essential task list with collective tasks.

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Chapter 2

MEDCOM

Theater

G2X

Division

Theater

BFSB

MED BDE

C&E

BDE

OMT

While inside the DHA, all personnel

(including members of the OMT, HCTs,

and medical elements) are OPCON to

Legend

the military police company.

HCT

Assigned

OPCON

Technical

Supervision

DHA

Figure 2-1. Technical supervision

HEALTH CARE PERSONNEL ORGANIC TO MILITARY POLICE UNITS

2-5. The internment/resettlement (I/R) battalion has organic health care personnel to provide a limited

Role 1 medical care capability and PVNTMED services within the internment facility. When a DOMD has

been designated within the JOA, these health care personnel are under the technical supervision of the

DOMD. The TIF health care personnel inprocess detainees and provide the initial medical examination.

They provide routine sick call services and EMT and coordinate with the supporting medical units for

Role 2 and above care. They maintain medical records to include the monthly weight register. When the

supporting medical unit is collocated with the TIF, their scope of practice, schedule, and duty assignments

are coordinated through the supporting medical unit.

HEALTH CARE PERSONNEL ORGANIC TO MANEUVER UNITS

2-6. Health care personnel organic to maneuver units may be required to provide EMT, area medical

support, and medical evacuation (if required) at the point of capture and to temporary concentrations of

detainees at DCPs and DHAs. In early-entry operations, the senior medical officer (brigade surgeon) will

serve as the DOMD until follow-on forces are deployed and a DOMD is designated for the JOA.

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Health Care Personnel Roles and Functions

RELATIONSHIPS

COMMANDER, DETAINEE OPERATIONS

2-7. The operational commander shall designate the commander of the senior MP HQ as the CDO with

OPCON of forces conducting DO. While the CDO exercises OPCON of all forces conducting DO,

technical supervision of medical assets remains in the medical channels to ensure medical guidelines and

standards are met.

JOINT INTERROGATION AND DEBRIEFING CENTER

2-8. The CDO is the approval authority for any detainee to be interrogated during an inpatient

hospitalization. Before making this decision the DOMD will be notified and the supporting SJA will

provide legal review for consideration by the CDO.

SECURITY PERSONNEL

2-9. Designated security personnel are solely responsible for detainee security, custody, and control. At

no time, when outside of the internment facility, will a detainee be without a designated security person as

overwatch.

Note. Designated security personnel are normally MP personnel but may be other military

occupational specialty (MOS) or area of concentration (AOC) Soldiers. Medical MOS/AOC

personnel will not serve as security personnel.

2-10. Security personnel do not provide health care to detainees. However, guard personnel may

administer first aid (self-aid/buddy aid) or enhanced first aid (combat lifesaver [CLS]) in an emergency

situation until health care personnel arrive.

THEATER INTERNMENT FACILITY

2-11. Key organizational elements in the TIF may be task organized and include a joint security group, a

joint interrogation group, a detainee hospital, a joint logistics group, and a joint internment operations

group. Special and personal staff considerations may include a joint visitor's bureau, a chaplain, the IG, the

SJA, public affairs office (PAO), a surgeon, a forensic psychologist, a forensic psychiatrist, a medical plans

and operations officer, an environmental health officer, and a provost marshal (PM) and/or security forces.

SECTION II — NONGOVERNMENTAL ORGANIZATIONS

INTERNATIONAL ORGANIZATIONS

2-12. International organizations (IOs) may request access to and/or information about detainees at any

phase of the operation. All requests for access or information should flow via the established chain of

command to the Office of the SECDEF (OSD).

2-13. There are three principal types of civilian organizations. They are—

International organizations. These are established by intergovernmental agreements and operate

at the international level (such as various United Nations [UN] organizations).

Nongovernmental organizations (NGOs). These are voluntary organizations that are not funded

by governments. They are primarily nonprofit organizations that are independent of

governments, IOs, or commercial interest. They are legally different from UN agencies and

other IOs in that they write their own charters and missions. Nongovernmental organizations

are increasingly numerous and sophisticated and can involve hundreds of people in any potential

conflict. They generally remain strongly independent from political control in order to preserve

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Chapter 2

their effectiveness. In many cases, their impartiality has been of great benefit, forming the only

available means of rebuilding relations when political dialog has broken down. They are often

highly professional in their field, extremely well motivated, and prepared to take physical risk in

appalling conditions. They may fall into the two following categories:

Mandated. A mandated NGO has been officially recognized by the lead IO in a crisis and is

authorized to work in the affected area.

Nonmandated. A nonmandated NGO has no official recognition or authorization and,

therefore, works as a private concern. These organizations could be subcontracted by IOs

or a mandated NGO. In other cases, they obtain funds from private enterprises and donors.

International humanitarian organizations. These are impartial, neutral, and independent

organizations whose mandate is to assist and protect victims of conflict. This group includes

organizations such as the ICRC and the Red Crescent Societies. They carefully guard their

neutrality and do not desire to be associated with or dependent upon the military for fear of

losing their special status in the international community that allows them to fulfill their mission.

Per DOD policy, generally the ICRC is the only international humanitarian organizations

authorized conditional access to detainees.

2-14. Media attention concerning detainees will likely be substantial. Commanders and staffs should

anticipate such attention and ensure that supporting PAO develops procedures, in advance, for dealing with

media requests for visits and information. Photographing, filming, and videotaping of detainees is strictly

controlled by DOD policy and ARs. The OSD is the sole release authority for photographs of detainees.

Advance public affairs plans for events such as detainee movement for transfer and/or release is prepared

and coordinated, with both the transferring and receiving geographic combatant commands (GCCs).

2-15. Requests for access to detainees by other government agencies (such as the Drug Enforcement

Agency [DEA]) outside the DOD are common. All of these requests should flow through the chain of

command to the appropriate approval authority. For various reasons, such visits may occur with little

advance notice. Established procedures will assist units in verifying visit approval and coordinating the

actual conduct of the visit.

INTERNATIONAL COMMITTEE OF THE RED CROSS

2-16. The ICRC is an independent agency whose activities include observing and reporting on conditions

in wartime detention camps and facilities. During visits, it attempts to register all prisoners, inspect

facilities, and conduct private interviews with detainees to discuss any problems concerning detainee

treatment or conditions; it also provides a means for detainees to contact their families. While the ICRC

has no enforcing authority and its reports are confidential, any public revelation regarding standards of

detainee treatment can have a substantial effect on international opinion.

2-17. The ICRC seeks to handle problems at the lowest level possible. When a team conducts an

inspection, it provides a briefing and sometimes a report to the local commander. Discrepancies and issues

are presented to the detaining authorities and follow-up visits are made to monitor compliance with

recommendations. The commander may not implement the recommendations based on either resource

constraints or his interpretation of applicable law. These constraints can make complete implementation of

ICRC recommendations either difficult or inappropriate. If recommendations are not implemented, the

ICRC may address the issue with higher authorities. The ICRC does not expect to receive, nor does the

DOD have a policy of providing, a written response to ICRC reports. However, DOD elements do attempt

to implement as many of the recommendations as practicable, given security and resource constraints.

2-18. The ICRC should serve as an early warning indicator of possible abuse. Commanders should be

alert to ICRC observations in their reports and take corrective actions as appropriate.

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Chapter 3

Medical Guidelines for Detainee Operations

Providing health care to a detainee population presents some unique challenges for

health care personnel. Normally, detainees cannot be evacuated out of their national

boundaries and must be escorted and guarded everywhere they go including the

latrine and showers. Detainees are not military recruits and therefore do not normally

have the advantages of being physically fit and having protective equipment (body

armor). This results in detainees having more serious injuries than seen in allied and

multinational forces. There may also be a secondary gain for a detainee in feigning

illness and he can do so without negative repercussions.

SECTION I — GENERAL CONSIDERATIONS

CULTURAL CONSIDERATIONS

3-1. All personnel participating in multinational operations normally receive, as part of their

predeployment activities an orientation, to the culture, languages, and religious beliefs prevalent in the area

of operations (AO). Health care personnel must ensure they understand the medical considerations

presented by these beliefs. Cultural or religious norms may affect a detainee’s compliance with a

prescribed medical regimen, may prohibit the use of blood and blood products, or may restrict the use of

certain food products, thereby affecting the detainee’s nutritional status.

GENERAL INTERACTION

3-2. Be sensitive to male-female interactions. Use a female provider and nurse for a female detainee

whenever possible. This allows the health care personnel to respect the detainee’s cultural and religious

beliefs, as well as protect against potential allegations of physical or sexual misconduct. Male detainees

will usually allow female providers to examine them, although some staunch believers may refuse even

minimal physical contact. However, the detainee may simply be hesitant if the complaint requires

observation and examination of the genitals. Usually an explanation of the examination and an

acknowledgment of the detainee’s modesty will suffice. The detainee will then allow the examination to

proceed. If the detainee continues to refuse, explanation of the ramifications of no examination and

documentation of his refusal and its consequences is essential. Each health care provider must determine

whether they will subsequently prescribe treatment even if a detainee refuses an examination.

MODESTY

3-3. Always keep modesty in mind when examining a detainee and allow for privacy whenever possible.

This is especially important in the case of examination of a “sensitive” body area. The use of curtains,

draping, and positioning are helpful in protecting a detainee’s modesty. Modesty must be balanced against

guard force security and detainee and medical staff safety. Refer to paragraphs 1-62 and 1-63 for

additional information.

RELIGIOUS REQUIREMENTS

3-4. Religious requirements can interfere with health care (such as fasting and prayer times). For

example, Muslims take time to pray up to six times daily and for longer periods on Fridays. Health care

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personnel must not interrupt prayer unless it is a medical requirement for immediate examination. If a

detainee is truly ill, he will usually disregard prayer time in favor of examination whenever it is available.

As in the US, there are many different preferences for following one’s religious beliefs. Whether or not a

detainee observes fasting requirements on a regular basis is an individual decision. Some fast regularly

and others fast only on chief religious holidays. Make contingency plans for handling medication

distribution and meals for a detainee observing a fast and anticipate delays during prayer times.

MEDICATIONS

3-5. In many countries/cultures, people can easily purchase medications from a pharmacy without a

prescription and the individual normally takes those medications however he desires. This leads to

requests for inappropriate medication prescribing, as well as the common mentality of using a pill or cream

to treat all problems. This also results in detainees refusing medications whenever they feel that the

condition is sufficiently treated or at any other random time of their choosing.

3-6. When captured, detainees will often bring their medications with them and they will expect to take

those medications in their normal way. For the individual’s safety, medications will be confiscated at the

time of capture and will be placed in a bag and identified with the detainees name and capture tag number.

Individual detainees will not normally retain medications on their person with the exception of emergency

inhalers (or other emergency medicines), creams, or lotions as specified by command policy.

SECONDARY GAIN

3-7. Always be aware of secondary gain issues. To avoid secondary gain, make every effort to practice

field medicine within the facility as much as possible. Detainees will try to obtain treatment at the hospital

facility and will repeatedly ask for it. They will also feel important when requiring transport in an

ambulance. This may occur because of the impression of better care, favorable environmental conditions

(depending upon the temperature and time of year), the possibility of better food, or most importantly, the

opportunity to gain intelligence about the facility, its personnel, and its operations.

3-8. Detainees may attempt to thwart interrogations by manipulating the medical system. Medical

treatment will never be given nor denied in relation to interrogations. Health care will never be offered as

incentive for participating nor denied for nonparticipation in the interrogation process. The medical staff

must be vigilant of manipulation attempts by both the detainees and interrogators with regard to treatment

requests and interrogations.

HEALTH CARE AND DRAMATICS

3-9. Health care in the facility can become the day’s entertainment. Usually care through the wire elicits

a crowd of interested or bored detainees who feel that they have something to contribute to the care of their

friends. For privacy issues, as well as detainee and provider safety, it is important to insist that only the

detainee come forward and that all the others remain a safe distance behind. Some detainees will markedly

overplay their symptoms or appear helpless.

“Blanket litters,” in which a detainee is carried forward in a

blanket due to the “inability” to walk or “severe” illness, are commonplace and should not influence the

provider’s examination or diagnosis. Having the detainee stand or sit upright and actively participate in the

examination helps the provider determine the true nature and extent of the illness. Avoid rewarding

dramatics whenever possible. Be concerned and compassionate, but not a pushover.

FAVORITISM

3-10. Do not play favorites and avoid making promises that you cannot keep. Perception is paramount in

many cultures. The perception of special treatment of some detainees in favor of others can lead to unrest

and feelings of inequality amongst the detainees, which can interfere with the trust relationship that must

sustain the health care provider’s interactions. A promise is essentially a contract and the provider

damages his credibility if promises are not kept or if the detainee expectations are not met, within reason.

(See paragraph 3-18 below for additional information on trust.)

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Medical Guidelines for Detainee Operations

LINGUIST REQUIREMENTS

MEDICAL CONSIDERATIONS

3-11. Linguists are a major priority. Obtaining an accurate medical history is paramount to detainee care,

both for documentation issues and for treatment plans. Use a trained linguist whenever possible. Even

better is a medical translator who knows the specific medical terminology that providers commonly use.

Most times, trained linguists are in high demand and are hard to acquire.

3-12. When using linguists, talk to the detainee, not to the linguist. Speak in brief, short sentences. Speak

only about medical issues and not reasons for capture or social, religious, or political issues.

3-13. For additional information on linguist support refer to Appendix G.

RETAINED/DETAINED PERSONNEL

3-14. If a professional linguist is not available, use medical detainees (physicians, nurses, dentists, and

veterinarians) first if at all possible and then detainees with good English skills. Develop a good working

relationship with the translator because the success of your mission depends upon a good medical history.

DEFINITION OF TERMS

3-15. Make sure that your definition of a term matches what the detainee really means. Do not assume that

you know what they mean. Ask questions in different ways to obtain a full and accurate medical history.

Many times, the detainees will complain of symptoms or problems that may sound foreign to US providers.

Some common examples are: “colon infection” (generally means heartburn or chronic diarrhea); “allergies

in the blood” (means anything from seasonal allergies to rashes and itching); “fluenza” (refers to the

common cold); “low blood” (suggests anemia); “no sleep” (usually means poor or interrupted sleep); “I

have psychology” (refers to any psychological disorder); and “blisters” on the feet (are usually warts).

Having a good translator who knows your train of thought can really go a long way in determining what

the detainee’s real problem is especially since some descriptions are very similar.

3-16. The linguist must give you the exact translation of an interaction, not his “cleaned-up” version. At

times, the detainee will speak for several minutes and the translation will be a short sentence. This is a

very frustrating situation and commonly occurs with detainee translators as well as with linguists.

Detainees like to take off on multiple tangents when giving a history. Repeatedly encourage your

translator, whether a detainee or employed, to tell you exactly what the detainee is saying. Questions about

a coughing condition may result in a story about how the detainee has knee pain during prayer times. It

can be very frustrating to wait patiently and listen to the detainee and translator talk for minutes and then

receive a “yes” or “no” answer. In many cultures it is common for a person to try to protect one’s friends

and neighbors from embarrassment and from trouble; detainees are no exception. The translator may try to

save you and the detainee from embarrassment related to the area of the body that is causing trouble or in

reference to off-color comments that the detainee may be making without your knowledge of the language.

Some detainees will say hateful things which are translated as innocuous statements or which are not

translated at all. If you get the feeling that something is not right, push the issue and ask for an accurate

translation. This sort of behavior by the detainee and translator can result in impatience and frustration on

the part of the provider, who must always remember that the translator thinks he is doing the right thing.

DIALECTS

3-17. Different regional beliefs, dialects, and customs will affect detainee interactions and communication.

As with any large nation, people from different geographic regions can speak and sound differently from

the other parts of the nation. Because of the subtle differences in dialect, voice inflection, or other vocal

characteristics, translators can experience difficulty understanding a detainee who fundamentally speaks

the same language. Many times, finding a translator with experience in different languages or dialects can

be very difficult. Know which of your translators speak other dialects or languages; ask for them and use

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them for these more difficult situations. It is also common to encounter a detainee from another country

who may not speak the predominant language at all. This can significantly impact the delivery of health

care and force the provider to rely on other communication means.

TRUST

3-18. Constantly emphasize trust between the health care personnel and the detainees. Always reinforce

that you are not there to poison the detainees, make them sick, or hurt them in any way. This refers to

medical treatments, immunizations, and medications (both oral and injected). Many detainees may refuse

the optional immunization because they believe it might be harmful to them, despite strong educational

programs developed by providers and provided by fellow detainees and others, to include common

language handouts. Refer to Appendix H for more information on immunizations. Signs in the local

language, or in different dialects (if required), and in English are useful and may help alleviate some

reservations that the detainees have. Caring and compassion go a long way to bolster the medical

relationship with the detainees. Also, enlist the help of the detainee leaders to reassure their fellow

detainees of your actions and intentions. Never make promises. Always say “I'll try,” “I will look into it,”

or “We will see.” Even general or off-hand statements can be construed as promises if one is not careful.

Credibility can be easily ruined if perceived promises are not met.

TRANSLATION GUIDES AND DEVICES

3-19. During recent operations, some medical units devised flash cards that pictorially depicted a variety of

medical complaints. Additionally, similar commercial products may also be available for use. Units

developing or using this type of communications tool, must be cautious and ensure that the images used do

not offend the cultural or religious beliefs of the individual.

3-20. In some cases, health care providers may be able to leverage advances in communications

technology that can provide an automated translation service through a handheld device.

SECURITY CONSIDERATIONS

TEMPORARY DETENTION LOCATIONS

3-21. At the DCP and DHA, the Role 2 MTF providing support on an area basis may have to provide EMT

to temporary concentrations of detainees being held.

The security measures instituted at these points are dictated by the unit that established the

collection point. Health care personnel should not enter the holding area until necessary security

precautions have been taken.

Health care personnel should inventory those medical supplies

(especially sharps) and

equipment they are taking into the enclosure. While in the enclosure, health care personnel must

be alert and be prepared to defend themselves should the need arise. Prior to exiting the

enclosure, health care personnel must ensure they have all supplies, equipment, empty vials, or

medical supply packaging.

THEATER INTERNMENT FACILITY

3-22. Use of force, security, and control of detainees are entirely functions of the assigned facility security

personnel; however, planning, training, and preparing for the use of force is a necessary element in

maintaining order in a facility. The TIF commander and the medical commander ensure that health care

personnel are trained and prepared for the effective use of force when necessary to protect themselves and

the detainees. Health care personnel will also ensure that the use of force continuum is applied when force

is required for self-defense. Health care personnel assigned the mission of providing health care to

detainees at the TIF should be issued and trained on rules of engagement (rules for the use of force specific

to that mission).

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Medical Guidelines for Detainee Operations

3-23. At the TIF, health care personnel should observe the same precautions as they would use at a DCPs

and/or DHAs. The MP unit establishing the facility also dictates what security procedures will be observed

when treating detainees at the facility. Health care personnel should never enter the general population

area by themselves. Whenever possible, it is better to have the detainee taken to the established medical

treatment area rather than having health care personnel enter confinement areas. The medical treatment

area should have all medical supplies (especially sharps), medical equipment, and pharmaceuticals secured

prior to permitting the detainee to enter the medical treatment area. Health care personnel must remain

continuously alert while in the presence of detainees. Although health care personnel may treat the same

detainee for a recurring or chronic condition and feel as though they have gotten to know the detainee,

health care personnel should remain vigilant and be prepared to react if threatened.

3-24. In addition to medical items, health care personnel must secure any items that have the potential of

being turned into a weapon, such as pens, pencils, or scissors.

MILITARY POLICE OVERWATCH

3-25. Medical interactions must always involve MP overwatch, especially when a detainee is outside of the

compound, such as for examinations and treatment. As a rule, health care personnel do not carry weapons

within the detention compound. This is for their safety and is generally dictated by the MP command.

Since the vast majority of outpatient care occurs inside the detention compound, MPs must be vigilant in

protecting the safety of health care personnel. Even the most friendly or helpful detainee may be harboring

the desire to harm a Soldier, even if that Soldier is a health care provider.

3-26. Maintain close working relationships with the MPs, especially between guards and health care

personnel. The MPs working inside the compound know their detainees very well and are able to provide

valuable input into the detainee’s health care or concerns. For instance, an MP knows which detainees

repeatedly do not come up for head count and can point them out for medical evaluation. In addition, MPs

tend to know the disposition of their detainees very well and can usually let the health care personnel know

when a detainee is really ill or simply looking for attention.

ORDERLY CONDUCT

3-27. Detainees are always interested in what is going on at the gate, but they must not crowd health care

personnel providing care. Detainees crowd around the person being evaluated and often try to offer input

into the situation. Interactions must remain orderly to avoid confusion and potential escapes. Frequently, a

detainee will need to come out of the wire for an examination. Having a large group of detainees crowded

around the entry point while it is open, makes it very easy to overlook the one or more detainees that may

be trying to escape. It is best to require the detainees to line up a short distance away from the gate so that

the detainee, translator, and provider can accomplish the evaluation while maintaining privacy and dignity.

Detainees must always wear their designated clothing (usually a jumpsuit type of garment) and have their

identification band on hand. In addition to security, the MPs provide behavior control as well. Any

detainee that fails to follow orders or rules can be disciplined appropriately by the MPs.

Note. Health care personnel should not discipline or participate in the discipline of detainees.

Any problems should be immediately reported to the on-site MP authority.

WEAPONS AND AMMUNITION

3-28. Weapons and ammunition must be secured away from treatment areas. In some instances, MPs may

allow health care personnel to maintain the security of their weapons within a separate area, if that area is

completely removed from all detainee care areas and as long as that area is properly secured.

3-29. At Role 3 hospitals, detainees should be segregated from US, allied, and multinational patients.

Detainees are guarded by nonhealth care personnel designated by the echelon commander while they are

patients in the facility. All medical equipment, supplies, and pharmaceuticals should be stored and secured

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Chapter 3

off of the ward. Whenever possible, it is preferable to have detainees treated in a room outside of the ward

setting. Whenever detainees are required to leave the ward, they should be escorted under guard to ensure

they do not attempt to escape, injure hospital personnel or other detainees, or damage and/or destroy

hospital property.

MEDICATION DOSAGE CONSIDERATIONS

3-30. Consider unit-dose packaging for chronic medications to prevent hoarding, bartering, overdose, and

waste. At no time should a detainee have possession of his medications, except for albuterol inhalers,

moisturizing creams, and antifungal or mild steroid creams. It is a common occurrence to find pills of

various kinds during a “shakedown” or facility search. The MPs should bring the pills to health care

personnel, in a bag labeled with the respective detainee’s ISN and name. The detainee medical record is

then reviewed for evidence of those particular prescriptions and to ascertain compliance. Trading

medications is a common occurrence and on occasion, a detainee will “cheek” his medication and store it

for future use. The most worrisome use would be plans for an overdose, potentially as a distraction for an

escape attempt, or to commit suicide.

Note. Standard precautions for narcotics apply. They should be kept secured in a double-lock

system, either within the TIF or another secure location inside the main hospital.

HEALTH CARE PERSONNEL

Identification

3-31. Special identification for health care personnel (such as a “Red Cross” or “Red Crescent” brassard)

can assist with facility security. It is extremely important for the MPs to know who has access to the

facility on a regular basis. Although sight recognition occurs early on, rotations of both MPs and health

care personnel do regularly occur throughout the medical areas and the TIF. Health care personnel should

notify the facility noncommissioned officer in charge (NCOIC) of their areas whenever a change in

personnel occurs.

Staffing

3-32. Adequate staffing will improve detainee behavior and help enforce compliance with medical

recommendations and treatment. Health care personnel should have MP overwatch whenever interactions

occur with detainees, regardless of whether the detainee is inside or outside the wire.

RIOTS AND ESCAPES

3-33. Sudden or unusual medical problems can distract attention from efforts to riot or escape. Many

times, these distractions are well-planned and executed. Although the medical mission is to provide

treatment, it is critical that all personnel follow proper precautionary measures to avoid friendly forces and

detainees’ injuries or detainees’ escapes. Boycotts of medication or treatment are allowed, but must be

well-documented. This usually occurs when the detainees try to make a statement or protest some action

by MPs or other US Forces. In addition, with the exception of insulin, detainees may refuse medications or

other treatment outright or by fasting. Proper documentation is required and the detainee must be aware of

the consequences of his actions, to include serious medical problems or death.

3-34. Health care personnel will at all times be vigilant and not become complacent when around

detainees. Many items in the MTF can be used as weapons to take lives or to take personnel hostage.

When the detained personnel have taken over the internment facility, the health care personnel’s first

option is to use force to defend themselves, their detainees, and other US and multinational forces. When

this fails, members of the health care personnel designated in Article 25 of the GPW who have fallen into

the hands of the detained personnel, shall become EPWs, but shall be employed on their medical duties in

so far as the need arises. The health care personnel shall continue to fulfill their duties under the orders of

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Medical Guidelines for Detainee Operations

the adverse Party and shall preferably be engaged in the care of the wounded and sick of the Party to the

conflict to which they themselves belong.

USE OF RESTRAINTS

STANDARD RESTRAINTS FOR ALL DETAINEE INPATIENTS

3-35. The degree of security and restraint exercised over detainees will reflect the conditions of and

reasons for their internment and will recognize the potential for escape and difficulties of apprehension

posed by detainees.

3-36. Ordinarily, detainee inpatients will be restrained consistent with command policy. This may include

using two-point restraints at all times. The two-point restraints will be placed on opposing limbs (one arm

and one leg) unless contraindicated due to the detainee’s medical condition.

3-37. Restraints in addition to the two-point standard will be applied when detainees become combative or

dangerous to themselves or others. Once the detainee becomes oriented or cooperative, the restraints in

addition to the two-point standard will be removed. Restraint removal will be the result of a joint vetting

process in close coordination with the commander of the security forces.

3-38. Restraints will be removed when detainees are transported between areas of the MTF. During such

transfers, detainees will be accompanied by a medical staff member and an MP.

3-39. For exercise or physical therapy (PT), the detainee will not be restrained but will be escorted by

medical staff and remain in clear sight of, and in close proximity to, the MP security personnel at all times.

3-40. Use of leather restraints in the MTF emergency room (ER) will be at the discretion of the ER

physician and charge nurse, in consultation with the MTF commander.

RESTRAINTS FOR CIVILIANS/HOST-NATION PATIENTS

3-41. Patients deemed by authorities to be host-nation (HN) civilians, rather than detainees, are not

routinely placed in restraints. However, they may be restrained for reasons of medical necessity. For

security reasons, they will be accompanied off the wards at all times by staff members or MPs.

RESTRAINT NECESSITY

3-42. Unless a restraint procedure is deemed necessary based purely on medical criteria for the protection

of the physical or mental safety of the detainee, other patients, or the MTF staff, health care personnel will

not participate in the process of restraining the detainee. Rather, MP or other security personnel will be

responsible for restraint of the detainees.

COMBATIVE PATIENTS (DETAINEES OR OTHERS)

3-43. Any patient who becomes combative, or when otherwise medically indicated, may be restrained for

his own safety and that of other patients and staff.

3-44. A gradually increasing level of appropriate restraint will be used. The first level will be physical

restraints and typically will be either standard leather restraints of the wrist and/or ankles or a bed sheet

specifically used to secure the patient to the gurney.

PROCEDURES FOR USE OF MECHANICAL LEATHER RESTRAINTS ON DETAINEES

3-45. Personnel will comply with the following guidelines in connection with the use of mechanical

leather restraints on detainees:

Ensure that the detainee or any other patient is not able to manipulate the restraint buckle.

Check the integrity of the restraints, examine the patient’s skin for redness or breakdown, and

check pulses distal to the restraint site at least every two hours.

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Chapter 3

Check capillary refill within five minutes of the application of the restraints.

Rotate sites daily if not contraindicated by the patient’s medical condition.

Ensure the patient is able to reach the urinal or offer toileting at least every two hours.

Pad the extremity with an antiseptic wound care dressing before applying the restraint if skin

redness or breakdown occurs at the location of the restraint.

All ward staff members will be issued one restraint key. The MP guard for the ward will have

one restraint key.

NONPATIENT COMBATIVE DETAINEES

3-46. The CDO will determine the appropriate policy as it pertains to these detainees. However, normally

there will be an actual and perceived separation between the functions of interrogation, custody, and

control, and detainee health care. At no time will health care personnel provide custody or control for

detainees, whether or not they are patients. Detainee security and control are entirely functions of assigned

security personnel, who are usually MPs.

3-47. Rare exceptions to this policy exist, such as where an extremely combative detainee is overpowering

security personnel. If a detainee is so combative and violent that all available specialized restraint

techniques are ineffective and the detainee is a danger to himself, other detainees, or DO staff, then

pharmacologic restraints may be considered. If time allows, use of this level of restraint will require the

authorization of the CDO. All pharmacologic restraint agents will be administered by a licensed clinician

under strict medical standards of care. A detainee should be under one-to-one observation by security

personnel overseen by an independent licensed health care provider for at least 12 hours after receiving a

pharmacologic restraining agent.

SECTION II — PRIOR TO TRANSFER TO AN INTERNMENT FACILITY

MEDICAL SCREENING

3-48. The medical screening that can be accomplished at a DCP or a DHA is limited. Health care

personnel assigned to the MP unit normally treat detainees at collection points; however, if these personnel

are not available, the Role 2 MTF providing area support may be required to perform a hasty assessment of

the detainees at the request of the detaining unit. Whenever possible these support requirements should be

included in the operations order (OPORD). The purpose of this medical screening is to ensure the

detainees do not have significant wounds, injuries, or other medical conditions

(such as severe

dehydration) that require immediate medical attention and/or medical evacuation. Medical personnel are

screening for conditions which could deteriorate prior to the transfer of the detainees to a TIF. This

screening does not include the use of diagnostic equipment such as x-ray or laboratory tests as these

resources are not available at a DCP or DHA. Any medical treatment provided during screening would be

entered on the Department of Defense (DD) Form 1380 (US Field Medical Card [FMC]). Each detainee

has a completed DD Form 2745 (Enemy Prisoner of War [EPW] Capture Tag) to identify him. The

detainees capture tag number is used as the identification number on the DD Form 1380. If the detainee is

not to be evacuated through medical channels, one copy of the DD Form 1380 is provided to the detaining

unit for inclusion in the detainee’s medical record to be initiated and maintained at the TIF.

EMERGENCY MEDICAL TREATMENT

3-49. If health care personnel are not available, EMT is provided by the Role 2 MTF providing area

medical support. Detainees whose medical conditions require hospitalization are treated, stabilized, and

evacuated to a supporting MTF. All medical treatment provided to the detainee is annotated on DD Form

1380 and is evacuated with the detainee for inclusion in his medical records established at the Role 3

hospital. The ISN is only assigned at the TIF. Medical records initiated prior to assignment of the ISN

will use the capture tag number for identification purposes.

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FMI 4-02.46

8 November 2007

Medical Guidelines for Detainee Operations

MEDICAL EVACUATION

3-50. Injured and ill detainees requiring hospitalization are evacuated through medical channels prior to

their being entered into the Detainee Reporting System (DRS). Health care personnel do not search,

interrogate, or guard detainees being evacuated through medical channels. The echelon commander is

responsible for providing this support.

3-51. Detainees evacuated from Roles 1 and 2 treatment facilities must be accompanied by all original

medical documentation. The outpatient and screening documentation will accompany the detainee to the

Role 3 hospital supporting the TIF.

3-52. Detainees treated at an FST should have an extended ambulatory record generated. When detainees

are evacuated from Role 2 to Role 3 MTFs, a copy of the extended ambulatory record will accompany the

detainees. The following minimum documentation is required to accompany the detainees if copying

capabilities are limited:

Operative notes.

Transfer/narrative summary of care.

Radiographs.

3-53. Whenever possible, detainees should be segregated from US, allied, and multinational forces during

evacuation.

3-54. In the event that a detainee may require formal regulation, validation and movement in the patient

movement system (particularly aeromedical evacuation), the United States Transportation Command

(USTRANSCOM) surgeon and global validating flight surgeon will be consulted and will concur with the

plan for the proposed patient movement of a detainee. This consultation will begin prior to entering any

detainees in the US Transportation Command Regulating and Command and Control Evacuation System

(TRAC2ES), the web system used for global patient movement validation, mission planning, and intransit

visibility. Detailed detainee movement guidance should be in the operational plans.

Note. As with medical treatment, only medical urgency can justify the priorities established for

medical evacuation.

FIELD SANITATION AND PERSONAL HYGIENE CONSIDERATIONS

3-55. At DCPs and DHAs, field expedient measures may be required to sustain field sanitation practices of

detainees. If sanitation facilities are not feasible, commanders will provide personal hygiene/field

sanitation facilities commensurate with those that they would provide for their Soldiers based on available

resources and duration of stay. Cultural considerations should be taken into account and could affect the

feasibility and success of sanitation measures. If health care personnel are requested to provide EMT at

DCPs and DHAs, they should ensure they review how field sanitation measures are being implemented at

the site. Any deficiencies noted should be corrected on the spot and reported to the chain of command and

the DOMD.

ADMINISTRATIVE PROCESSING

3-56. The ISN is the DOD mandated identification number used to maintain accountability of detainees.

The ISN is generated by the DRS.

3-57. Once the DRS creates the ISN, no component may be changed or corrected at the division, corps,

and theater level without approval from the National Detainee Reporting Center (NDRC). All changes to

an ISN must be requested in writing and approved by the NDRC.

3-58. The only authorized tracking document/number from point of capture until the issuance of an ISN is

the unique capture tag number that is found on DD Form 2745. For example, if a detainee is evacuated to

a Role 3 hospital from the point of capture, medical channels will use the capture tag number to track a

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FMI 4-02.46

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Military reference books and manuals (2009-2023, Volume 6) - page 43