Army Health System Support to Detainee Operations ATP 4-02.46
17. What is the Detainee Operations Medical Director (DOMD) responsible for?
- Advising the detainee operations commander on the health of the detainee population. - Providing guidance, in conjunction with the SJA, on the ethical and legal aspects of providing medical 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 medical evacuation policies and procedures and monitoring medical evacuation support to detainees. - 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 in accordance with AR40-66 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)
21. Who is responsible for detainee security , custody, and control?
- Designated security personnel are solely responsible for detainee security, and custody and control. At no time, when outside of the internment facility, will a detainee be without a designated security person as overwatch.
26. What are the procedures for use of mechanical leather restraints on detainees?
- Ensure that the detainee patient 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. - 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 kerlix 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.
40. What are the indication/behaviors of severe depression?
- Extreme feeling of sadness. -Apparent feelings of hopelessness and helplessness. - Guilt and self-blaming. - Lack of energy and lack of interest in activities. - With drawal from other people, including other detainees. - Eating problems (eating very little or too much). - Sleep problems (inability to sleep well, or sleeping too much).
22. What are the three principle types of civilian organizations?
- International organizations. These are established by intergovernmental agreements and operate at the international level (such as various United Nations [UN] organizations). - Nongovernmental organizations. These are voluntary organizations that are not funded by governments. - International humanitarian organizations (IHOs). These are impartial, neutral, and independent organizations whose mandate is to assist and protect victims of conflict.
23. What are the rules for health care personnel contact with non-governmental organizations?
- Medical personnel engaged in detainee health care will have no contact with NGOs without direct authorization from their chain of command. - The PAO is the staff officer responsible for understanding and fulfilling the information needs of the Soldier, the Army community and the public. A PAO is located at division, corps, and theater levels.
12. What are the four "Ps" of abuse prevention?
- Priorities—Have a command philosophy that places honor and dignity at the top of priorities. - 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.
7. 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, GWS). - Seriously wounded and sick POWs.
5. What are the four separate international treaties of Geneva Conventions?
-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.
19. What are the medical services provided in the TIF?
-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 support (food inspection and quality assurance), veterinary PVNTMED, and animal medical care, if required. - Neuropsychiatric (NP) treatment and stress prevention (as required) and MH.
4. What was the Law if the Land Warfare derived from?
-Law making 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).
39. When will a detainee be screened by behavioral health?
All detainees will receive a MH screen (Appendix G) at the time of inprocessing prior to distribution into the general population.
38. When will a detainee undergo vision screening?
All detainees will undergo a vision screening, to include measurement of best-corrected visual acuity during inprocessing.
34. What are the considerations for administering detainee medications?
All medications to be administered to detainees must be dispensed by medical personnel. Depending upon the detainee's medical condition, health care providers, when possible, should prescribe medications which can be dispensed on a once or twice a day basis. To ensure the safety of detainees, medications are dispensed in unit doses by medical personnel.
24. What are the general/cultural considerations that health care personnel must understand when interacting with detainees?
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).Be sensitive to male-female interactions.
35. What is a hunger strike?
Any detainee refusing food for 72 hours is considered to be on a hunger strike and will be referred for medical evaluation and possible treatment.
30. When is medical photography authorized?
Army Regulation 190-8 prohibits the photographing, filming, or videotaping of individual detainees except for camp administration and intelligence/counterintelligence (CI) purposes. Medical personnel are permitted to photograph detainees to document preexisting conditions, injuries, and wounds.
14. What warrants a body cavity search?
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 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.
8. What is the process for the compassionate release?
Compassionate release requests must be submitted to the higher command governing DO via SECRET internet protocol routing network (SIPRNET). All requests must be cleared through military intelligence (MI) and higher headquarters before the request is submitted to the Commander, Detainee Operations (CDO).
32. How often should detainees have access to medical care?
Detained personnel must have access to the same standard of medical care as the US and coalition forces to include respect for their dignity and privacy.
27. What is the internment serial number?
Detainees are provided an ISN when being inprocessed to the TIF. The TIF is the only location where this number will be assigned. To identify detainees prior to the issuance of the ISN, the capture tag number (DD Form 2745) is used on all documentation concerning the detainee. Once the ISN is issued, existing records are updated.
33. How often do detainees in segregation received medical care/contact?
Detainees maintained in segregation will be monitored daily to assure health and well-being, and to address current medical complaints.
15. What happens when a detainee refuses care?
Detainees may refuse routine examinations or parts of physical examinations. Competent, nonconsenting detainees 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 medical 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.
43. What are the restrictions/limitations for health care personnel and the interaction with detainees?
Health care personnel will not - Fraternize - place hands on or touch a detainee except in self-defense or to: - prevent escape - prevent injury to persons or damage to property - render medical assistance - conduct a search or inspection for other than medical reasons - apply the priorities of force, as specified - demonstrate how-to procedures in training - visit or enter the personal space of a detainee, former detainee, family member in performing of official duties - engage in any act or attempt to engage in any act of sexual misconduct with a detainee, former detainee, or family member of - engage in any act or attempt to engage in any act of sexual abuse, assault, or harassment of a detainee - knowingly allow a detainee to engage in sexual misconduct with another detainee
13. What actions do you take if you suspect any abuse?
Medical personnel are obligated to report any suspected abuse or torture through the chain of command. Additionally, medical personnel (whether assigned to a MP unit or a medical unit) may also report any suspected abuse/torture through functional medical channels to the DOMD.
9. What is the responsibility of health care personnel in detainee operations?
Medical personnel provide all detainee health care to include inprocessing, periodic, and out-processing screening examinations, all routine and emergency outpatient care, all dental and mental health (MH) care, all inpatient care including critical care, and all detainee medical transfers. Detainee health care personnel will not provide or share detainee medical information with Joint Interrogation and Debriefing Center (JDIC) intelligence or interrogator personnel
36. During an initial evaluation of a hunger-striking detainee, the medical staff will?
Medical personnel will isolate the detainee in a single- occupancy observation room, denying contact with other detainees, when medically advisable. If measuring food and liquid intake/output becomes necessary, medical personnel may place the detainee in a special management unit or in a locked hospital room. The detainee may remain in the special management unit, based on the detainee's medical condition, until medical personnel determine a move advisable. The medical officer will immediately report the hunger strike to the TIF commander.
2. What are the five categories of the detainee health care system?
Medically Necessary - acute or emergent Medically Necessary - Non-emergent Medically Acceptable - Not always Necessary Limited Medical Value Extraordinary
10. What is considered a prohibited act?
Prohibited acts include killing, torture, medical/scientific experimentation, physical mutilation, removal of tissues/organs for transplantation, and causing serious injury, pain, and suffering.
28. What standardized form is used for detainee physical screening?
SF 600
29. Understand how the Health Insurance Portability and Accountability Act pertains to detainees?
The Health Insurance Portability and Accountability Act (HIPAA) does not apply to the medical records of detainees and EPWs.
3. What is the Law of Land Warfare and what is the purpose?
The Law of Land Warfare in assuring that all detainee personnel in custody will receive medical care consistent with the standard that applies to United States military personnel in the same geographic area.
42. Who is responsible for the operation of the pharmacy?
The MTF commander is responsible for operation of the pharmacy and exercises careful supervision over all phases of its operations.
18. What is a Theater Internment Facility (TIF)?
The TIF is a permanent or semipermanent facility (normally located at the theater level) that is capable of holding detainees for extended periods of time. The TIF is a long-term internment facility that is run according to all applicable laws and policies.
25. What are the rules for use of restraints?
The degree of security and restraint exercised over detainee patients will reflect the conditions of, and reasons for, their internment and will recognize the potential for escape and difficulties of apprehension posed by detainee patients.
20. What does the Detainee Operations Commander do?
The operational commander shall designate the commander of the senior MP headquarters as the CDO with OPCON of forces conducting DO. While the CDO would exercise OPCON of all forces conducting DO, TECHCON of medical assets remains in the medical channels to ensure medical requirements are met.
6. What is the importance of the words "respect" and "protect" in Article 12, Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field?
The word respect means "to spare, not to attack," and protect means "to come to someone's defense, to lend help and support."
11. What assistance can health care personnel provide interrogation teams?
Therefore, medical personnel providing direct patient care for detainees will not provide assistance to detainee interrogation teams. However, medical 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. What are the principles of detainee health care?
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.
31. How often should detainees be screened for weight?
To ensure the continued health of detainees, international law requires that each detainee be screened monthly by medical personnel.
16. What is the two-person verification rule?
Unconscious or psychotic individuals, under customary rules, may be examined without expressed verbal consent. Coalition medical 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 theexamination report. Preferably, one of the two individuals assessing competency shall possess behavioral health expertise.
41. What are the water consumption planning factors for the different climates?
Water consumption planning factors should be the same as for US Forces: - 1.5 gallons per person per day for drinking in temperate climates - 3.0 gallons per person per day for drinking in tropical and arid climates - 2.0 gallons per person per day for drinking in arctic climates - 1.7 gallons per person per day for personal hygiene - 1.7 gallons per person per day for centralized hygiene (showers) (1 shower per week per person) - 2.8 gallons per person per day for food preparation - 3.1 gallons per day for laundry -1.24 gallons per person per day for medical treatment - Detainees of certain religious faiths (such as Islam) should be provided an additional 0.5 to 1.5 gallons (2-5 liters) of potable water per person per day for washing and drinking associated with religious practices - Detainees who practice anal washing following defecation require an additional 0.25 to 0.5 gallons (1 to 2 liters) per day
37. What is the detainee death notification process?
When an EPW or RP in US custody dies, the attending medical officer will immediately notify the medical commander, DOMD, or the commander of the facility (or if the death did not occur in a facility, the commander of the unit that exercised custody over the individual). The commander of the facility will immediately report the death to the CID, the responsible investigative agency. The CID will contact the Office of the AFME to determine whether an autopsy will need to be performed.
