86. The paper on "Standards for Medical Support to Mine Clearance Operations" as presented to the International Conference on Mine Clearance Technology was a discussion paper to establish a framework for the Working Group to address the medical support required for mine clearance operations. The paper addressed the training of medical personnel, the deployment of medical units and personnel, and the medical equipment and supplies required at each level.

87. The Working Group expanded their discussion to cover not only the points raised in the paper presented but also to address the structure and organization of medical teams and the reporting requirements to establish a database of mine victims.

88. Deployment and operation of medical teams. The Working Group made the following recommendations on the deployment and operations of medical support teams:

1. Mine clearance will only be conducted when a medical team is on site.
2. A medical plan should be developed in advance of the deployment of mine clearance teams. At minimum, the planning should be based on a map survey but recommended that a site visit take place. As part of the medical plan helicopter or fixed wing landing sites must be determined.
3. Medical teams should not enter a mine field. Deminers are responsible for provision of immediate first aid and the extraction of injured personnel to safe areas for medical treatment.
4. Medical teams should be located at a static medical point 200m from the mine clearance operation. This may be reduced in suitable terrain.
5. The medical team is always included on the internal site communications net.
6. A Level 2 medical facility should not be more than three hours from the mine clearance site. Should this not be achievable the mine clearance operation must make provision for level 2 medical support.
7. A helicopter or alternate air transport must be available within one hour of an accident.
8. A level 3 or 4 hospital must be available in a host country.

89. Structure and Organization of Medical Teams. The Working Group made recommendations on the structure and organization necessary to support a mine clearance operation:

1. For each mine clearance team of up to 30 people, the medical support required is:
   1. Two medics;
   2. One paramedic;
   3. An ambulance with a driver.

2. A doctor is required for each mine clearance operation of up to 15 mine clearance teams. The doctor will be the medical manager responsible for the selection, training and supervision of medical staff. The doctor will also provide medical advice to team commanders and establish a quality assurance system for the provision of medical support.

90. Skills and Knowledge Requirements for Medical Teams. The Working Group recommended that all medical staff be trained in trauma treatment within the following guidelines:

1. First Aiders/Medical Clearers. Minimum of 24 hours' medical training;

2. Ambulance Drivers. Ambulance drivers must be trained to the level of the first aiders. A stand-by ambulance driver must be available. The stand-by ambulance driver may be one of the First Aiders.

3. Medical Orderly (First Level Medical Technician). The recommended duration of training for a Medical Orderly is three to four weeks covering the following basic requirements:
   1. Airway management;
   2. Ventilating;
   3. Proper positioning;
   4. Dressing;
   5. Simple splinting.

4. Paramedics. The recommended duration of training for Paramedics is one year covering the following recommended subjects:
   1. Intubation;
   2. Artificial ventilation;
   3. Intercostal drainage;
   4. Venous cut down;
   5. Intravenous fluid.

5. If Paramedics are not rotated or changed every half year they must be tested and retrained for invasive procedures such as coniotomy, intercostal drainage and venous cut downs.

6. In addition to the provision of trauma treatment, the Paramedics are responsible for running a clinic to provide basic medical attention to demining teams and the provision of advice on the prevention of diseases, sanitation and hygiene. They are responsible for the maintenance of medical stock levels.

91. Medical Equipment. For the proposed standard for medical kits, see the appendix below. Three kits are proposed:

1. The main kit to be carried by the Paramedic;
2. The kit to be carried by the Medics (2);
3. Every deminer must carry two field dressings;
4. All operational vehicles must carry a basic kit.

92. Quality Control. Medical cards are to be standardized with information about the injuries incurred during mine clearance operations. Copies of the cards can be anonymous and should be forwarded to a central medical office on a monthly basis for evaluation and quality assurance. The level of competence and medical treatment will be supplemented by incident reports. The Medical project managers will be responsible for quality assurance.

93. Standard Operating Procedures (SOP). Each medical unit must establish an SOP, which must include a medical examination of mine clearers periodically (including hearing disabilities).

94. The recommendations of Working Group IV are as follows:

1. That the standards agreed to in Working Group IV be accepted as the optimum requirements for Medical Support to Mine Clearance Operations;
2. That the deployment and operation of medical teams for mine clearance operations, as discussed in the working group, be adopted;
3. The recommendations of the working groups regarding the structure and organization of medical teams necessary to support a mine clearance operation be adopted;
4. That the required skills and knowledge for all medical staff in trauma treatment, as elaborated in the working group discussion, for mine clearance operations be adopted;
5. That the proposed standard for medical kits, as listed in Appendix I of Working Group IV, be adopted;
6. That medical cards, to be standardized with information about injuries incurred during mine clearing operations, will supplement incident reports and be the responsibility of the Medical project manager;
7. That each medical unit, supporting a mine clearance operation, must establish an SOP.

95. The Conference endorsed the recommendations of the Working Group and the papers presented to it on "Standards for medical support to mine clearance operations" as the optimum requirements. These requirements may not be necessarily practical to implement in all countries, so a further detailed analysis is required to establish the minimum safe standards that can be achieved. The minimum standards must be further agreed by an "expert panel" and published as the International Standard for Medical Support to Mine Clearance.

Appendix I Medical Kits Required for Mine Clearance Operations Paramedic Kit Serial Item Quantity 1 Ventilation Equipment 2 Airways 2 3 Ventilating bags and masks 1 4 Foot operated suction pump 1 5 Intravenous Fluids 6 Hartmann sol 21 7 Infusion sets 2 8 Intravenous cannula 5 9 Short arm splint 1 10 Venous tourniquet 1 11 Arterial tourniquet 1 12 Alcohol swabs 50 13 Drugs 14 Morphine or Ketamine 2 amp 15 Dressings 16 Field dressings 5 Serial Item Quantity 17 Abdominal dressing 2 18 Burn dressings 2 19 Triangles 3 20 Aid bandages 2 21 Adhesive tape 1 roll 22 Disposable gloves 5 pairs 23 Scissors 1 24 Gauze pads 20 25 Bandage gauze rolls 10 26 Polydyne solution 50 cc 27 Polydyne cream 1 tube 28 Diverse 29 Stethoscope 1 30 Blood pressure manometer 1 31 Coniotomy set 1 32 Intercost drain 1 33 Surgical kit 1 Medical Orderly Serial Item Quantity 1 Ventilation 2 Disposable mask 1 3 Field dressing 4 4 Abdominal dressing 2 5 Burn dressing 2 Serial Item Quantity 6 Triangles 3 7 Adhesive tape 1 roll 8 Gauze rolls 5 9 Gauze pads 5 10 Diverse 11 Arterial tourniquet 1 12 Disposable gloves 2 pairs 13 Scissors 1 14 Flash light 1 Ambulance Serial Item Quantity 1 Hartman Solution 51 2 Dressings 20 3 Diverse splints 3 4 Back boards 2 5 Stretchers 2 6 Blankets 5 7 Strobe light 1 8 Signal smoke grenade 4 9 Water container 20 L