1. The objectives of the medical support to mine clearance operations include (a) the provision of a safer environment for mine-clearance operations by delivering medical support, advising on prevention of injuries and first aid training of demining personnel; and (b) participation in the extrication of the injured and safely transporting them to proper medical attention.

2. Rescue and extrication. Casualties will have to be rescued/extricated from the mine field before receiving medical care. Medical personnel may be required to assist in the rescue operations from the mine field, providing only essential first aid before moving the casualty. Thorough examination and stabilization will be possible only after the transfer to a safe area.

3. First aid involves the provision of basic and advanced life support to casualties at the site and transporting them to the nearest, proper medical facility. The level of on-site medical care will be dictated by the presence of qualified medical personnel. (From basic life support, provided by first aiders to advanced life support, provided by paramedics and doctors.)

4. Main injuries caused by anti-personnel mines commonly include the following:

1. Trauma to lower limbs, including lacerations of soft tissues, injury to neuro-vascular structures, open fractures, skin avulsions and penetration of fragments;
2. Internal injuries, such as:
   1. Penetrating fragment injuries, causing damage to vital organs;
   2. Internal hemorrhage;
   3. Blast injuries causing damage to the ears, lungs, intestines and other hollow organs;
3. Burns, especially flash burns, caused by the proximity of the explosion;
4. Eye injuries, caused by the penetration of foreign bodies into the eye globe;
5. Post Traumatic Stress Disorder (PTSD) usually caused by witnessing traumatic events.

5. This variety of injuries requires thorough basic knowledge and skills in diagnosing and providing immediate and appropriate basic medical care. To attain these requirements, each medical professional should undergo a special training programme.

6. Education and training in first aid should be specially geared to mine injuries and should be separate for demining personnel and medical personnel.

7. The programme should be planned and supervised by a medical doctor with experience in traumatology and preferably in treating mine victims.

8. The instructors should be at a level of advanced medical orderlies or paramedics, with skills and experience in the treatment of trauma cases. They should also be experienced in modern instruction techniques, utilizing training aids, simulation methods and be proficient in the local language (if training is to be provided to the local population in a United Nations mission).

9. Demining personnel should be instructed in basic life support, which includes skills in basic life-saving procedures, such as:

1. Airway control by using proper positioning of the victim and the use of an airway;
2. Ventilation by mouth-to-mouth technique and through an airway;
3. Control of external hemorrhage by using compressive dressings and tourniquets;
4. Dressing of wounds and burns, preventing contamination;
5. Splinting simple fractures, using splints and improvisations;
6. Proper positioning of the casualty during extrication, first aid treatment and Casevac, preventing further injuries or complications, such as aspiration.

10. First aiders and medical orderlies should receive more advanced training in first aid, including, in addition to the above-mentioned basic skills, instruction in the following:

1. Diagnosing airway obstruction and ventilation problems. Use of suction devices, ventilation bags and oxygen;
2. Treating hemorrhage by introducing intra-venous fluids;
3. Diagnosing signs of internal injuries;
4. Proficiency in using more advanced dressing and splinting methods;
5. Limited usage of analgetic and narcotic drugs;
6. Proper medical recording and proficiency in radio communication, requesting assistance of additional medical teams and means for Casevacs.

11. Additional training should be provided to medical personnel in the following fields:

1. Preventive medicine and hygiene for supervision of demining teams living in the field;
2. Treating minor ailments which do not require the attention of a doctor.

12. Medical support at the demining site should be deployed at two levels:

1. At Level 1 the Medical Section should deploy a first aid point at the mine clearing site adjacent to the team's Headquarters. At least two first aiders/medics should deploy their medical kits so that medical care can be provided simultaneously, preferably in a sheltered area. The area of deployment should be established near an access/evacuation route. Usually first aiders should not be deployed in minefields before the area is pronounced safe.
2. An ambulance, well equipped to treat two to four casualties during evacuation, should be available on 5 to 10 minutes notice. The ambulance should be manned with one ambulance driver/first aider and an attendant/first aider, equipped with a two-way radio on the demining unit's operational/support channel.
3. At Level 2 a Medical Unit with a doctor/paramedic should be accessible within 15 to 20 minutes by vehicle or by Airevac. The unit should be on stand-by during demining operations ready to receive any casualty from the area.

13. Medical evacuation will commence from the time and place of injury until the casualty is brought to definitive medical treatment. The stages of evacuation will be as follows:

1. The casualty will be extricated from the minefield by other deminers operating in the area. These individuals know best how to avoid further hazards and are familiar with open paths in the minefield. First aid will be very limited at this stage and will include mainly control of external hemorrhage and maintaining a patent airway. The casualty will usually be hand-carried, preferably on a stretcher, to the team's first aid point.
2. After completion of the treatment at the site's first aid point, the casualty will be evacuated by ambulance/helicopter to the nearest medical unit. The doctor/paramedic will provide advanced life support treatment and, if necessary, the casualty will be evacuated (by air or road) to the next level of care.
3. Any severe casualty that requires surgical or specialized care will be Medevaced to a field hospital (Level 2 or Level 3 facility).

14. Each deminer should be equipped with two personal, military-type aid dressings at all times.

15. Medical personnel should be equipped with the following medical kits:

1. First aiders (3 to 4 per demining team) with a first aiders kit, containing basic dressing material, infusion airways and some splints;
2. Medical orderlies (1 per demining team) with an orderlies' kit, including additional dressing material;
3. A paramedic or doctor (1 per demining unit) should carry a doctor's kit, including additional supplies, instruments and material to provide advanced life support to 2-3 casualties.

16. Resupply should be provided through the unit's Headquarters, or from an adjacent medical unit. Non-disposable items, such as stretchers, blankets and airways oxygen bottles, should be replaced by the receiving medical facility when the casualty is handed over.

17. The following is a proposal for the medical equipment and supplies for a Demining Unit. Medical equipment should be organized in two basic "kits".

1. An Ambulance kit, which would include the necessary equipment and supplies for the continuous treatment of casualties during Casevac or Medevac. The equipment will suffice for the treatment of two severe or medium and two light casualties.
2. A first aiders' kit would be carried by the demining teams' first aiders to provide basic life support to casualties at the incident site.

18. The teams' equipment will suffice for the treatment of five to ten casualties (50 per cent severe and medium and 50 per cent lightly wounded).

19. Both kits will essentially contain the same medical equipment. Ambulances will be equipped with one kit, whereas the first aiders will each carry his own kit. In addition, the First Aiders' Team will be equipped with additional items, for example, additional stretchers and back-boards.

20. Resupply. Supplies of consumables, such as infusion sets, fluids, dressings and drugs, will have to be packed separately and kept ready at the Demining Unit for immediate resupply.

TABLE OF EQUIPMENT TYPE ITEM AMOUNT COMMENT Ventilation (1 set for each ambulance and first-aider) Airway, disposable 2 adults/1 pediatric Guedel type Manual ventilation bag 2 Adult size and masks Foot-operated suction pump 1 Oxygen cylinder 3.5 kg 1 Including and value disposable mask Intra-venous fluids (1 set for each ambulance and first-aider) Hartmann solution 5 litres Including disposable mask Intra-venous cannula 10 sizes 14G-20G Short-arm splint 2 Venous tourniquet 2 Alcohol swabs 5 x 5 50 Drugs (1 set for each ambulance and first-aider) Tramal (Amp) 5 Morphine HCL (Amp) 5 Autoinjector Dressings (1 set for each ambulance and first-aider) Personnel field dressing 15 small Abdominal/Chest 5 large field dressing Burn dressing 5 Methalline Triangular bandages 5 Elastic aid bandages 5 15cm Adhesive tape rolls 2 Arterial tourniquet 1 Disposable gloves 20 pairs Multi-purpose scissors 1 Sterile gauze pads 10 x 10 50 Gauze bandage rolls 20 15 cm Polydyne solution 200cc Polydyne cream 1 tube Cotton roll 200g Splints (1 set for each ambulance and first-aider) Kramer splints 1 metre 2 for upper/ lower limbs Thomas splints 1 or similar splint Back boards 2 Cervical collars 4 "Stiffneck" Diverse (1 set for each ambulance and first-aider) Nurse stethoscope 1 Blood pressure manometer 1 Including cuff Mouth-to-mouth 2 "Laerdal type" ventilation mask Stretchers Army-type 2 Blankets 5 Spot (flash) lights 1 Strobe light 1 Signal smoke grenades 4 for marking helipad Water container 20 litres Boxes for equipment 3 Back pads for equipment 2 Red Cross arm bands 2 Communications 2-way radio set 2 1VHF and 1 UHF

Additional Tasks of Medical personnel:

* Participation in operational planning;
* Participation in post-deployment debriefings;
* Operation of the unit's Dispensary; and
* Preparation of medical standard operating procedures (SPOs)
and monthly routine reports.