Army Health System Support to Detainee Operations ATP 4-02.46
. What is the Detainee Operations Medical Director (DOMD) responsible for?
Advising the detainee operations commander on the health of the detainee population to include contagious disease, nutritional issues, and public health concerns. Providing guidance, in conjunction with the staff judge advocate, 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 detainee operations. 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 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, fabrication of single- and multivision optical lenses, and spectacle fabrication and repair. Recommending medical evacuation policies and procedures and monitoring medical evacuation of 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 U.S. 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 the nutritional adequacy (quality, quantity, and variety) of the menu served to the detainees to prevent the development of deficiencies through menu approval and evaluation by a dietitian. He further monitors the adequacy of the menu served to the detainees by ensuring detainees are monitored for weight loss by ensuring monthly weigh-ins are conducted and reported in accordance with regulations and international law. Planning for and implementing preventive medicine operations and facilitating health risk communications (to include preventive medicine programs and initiating preventive medicine measures to counter the health threat). For additional information refer to Appendix C on preventive medicine inspection checklist. Planning for medical support to the detainee population. For additional information refer to Appendix D on the planning checklist for medical support to detainee operations.
What are the four separate international treaties of the Geneva Conventions? (understand the highlighted articles in each of the four treaties)
Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field. 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.
What was the Law of Land Warfare derived from?
Lawmaking treaties or conventions (such as The Hague and Geneva Conventions). Customary International Law (unwritten customary law binding on all States developed from a general and consistent practice of States followed by them out of a sense of legal obligation).
. During an initial evaluation of a hunger-striking detainee, the medical staff will?
Measure and record the detainee's height and weight. Measure and record vital signs. Perform a urinalysis. Conduct a psychological/psychiatric evaluation. Examine the detainee's general physical condition and if clinically indicated, proceed with radiographs and or laboratory studies. Take and record weight and vital signs at least once every 24-hours during the hunger strike. Take other medical measures as required.
. What are the five categories of the detainee health care system?
Medically Necessary—Acute or Emergent. Medical conditions that are of an immediate, acute, or emergent nature that without care would result in the rapid deterioration of the detainee's health, significant irreversible loss of function, or may be life-threatening. Conditions in this category are included in the scope of services provided to detainees. Medically Necessary—Non-emergent. Medical conditions that are not immediately lifethreatening but without care the detainee could not be maintained without significant risk of serious deterioration leading to premature death; significant reduction in the possibility of repair later without present treatment; or significant pain or discomfort which impairs the detainee's participation in activities of daily living. Conditions in this category are included in the scope of services provided to detainees. Medically Acceptable—Not Always Necessary. Medical conditions which are considered elective procedures, when treatment may improve the detainee's quality of life. Conditions in this category are usually excluded from the scope of services provided to detainees. Limited Medical Value. Medical conditions in which treatment provides little or no medical value, are not likely to provide substantial long-term gain, or are expressly for the detainee's convenience. Conditions in this category are usually excluded from the scope of services provided to detainees. Extraordinary. Medical interventions are deemed extraordinary if they affect the life of another individual, such as organ transplantation, or are considered investigational in nature. This category will not be provided unless directed by the appropriate authority.
What are the four "Ps" of abuse prevention?
Priorities—Has a command philosophy that places honor and dignity at the top of priorities been 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.
. 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 (Articles 28, 30, and 31, Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field). Seriously wounded and sick POW.
What are the indications/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 .- Wit 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).
. What are the three principal types of civilian organizations?
- International organizations. These are established by intergovernmental agreements and operateat 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.
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.
. What are the considerations for administering detainee medications?
. All medications to be administered to detainees must be dispensed by health care 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 health care personnel. Health care personnel must verify the identity of the detainee (usually a wristband), obtain their signature on the medication issue register (Figure 3-4), and watch/verify that the detainee takes the prescribed dose. When dispensing oral medications, the detainee's hands and mouth should be inspected to ensure the detainee swallowed the medication and is not attempting to hoard the medications for later use. The medication issue registry is primarily used to accurately track the medications each detainee takes, as well as to prevent medication duplications, and potentially dangerous interactions. A local form can be developed to document the dosing schedule and the receipt and administration of the medication to detainee. This register requires the detainee to sign for his medications and when he has completed his course of treatment it can be filed in his medical record.
What happens when a detainee refuses care?
. 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.
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. Health care personnel must also 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.
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.
. What actions do you take if you suspect any abuse?
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 Assistant Secretary of Defense for Health Affairs 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.
When is medical photography authorized?
Army Regulation 190-8 prohibits the photographing, filming, or videotaping of individual detainees except for TIF administration and intelligence/civilian internee purposes. Health care personnel are permitted to photograph detainees to document preexisting conditions, injuries, and wounds. The individual's identity should be clearly visible. These photographs are invaluable, if a claim of unnecessary surgery or amputation is made. Any detainee who requires amputation or major debridement of tissue should be photographed. Once taken, these photographs are maintained as part of the individual's medical record.
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
What is the process for a compassionate release?
Compassionate release requests must be submitted to the higher command governing detainee operations via secret internet protocol router network. All requests must be cleared through military intelligence and the staff judge advocate before the request is submitted to the commander, detainee operations.
. Understand unauthorized disclosure of information. Who can authorize disclosure of information in advance?
DOMD or the detainee operations commander
.How often do detainees in segregation receive medical care/contact?
Daily
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.
. 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 forcesto include respect for their dignity and privacy.
. What are the procedures for 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 and ensure a health care provider examines 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 can 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 health care providers will be issued one restraint key. The MP guard for the ward will have one restraint key. All assessments and treatment rendered due to restraint use will be documented in the detainee's medical record
What assistance can health care personnel provide interrogation teams?
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.
. What are the rules for health care personnel contact with nongovernmental organizations?
Health care personnel engaged in detainee health care will have no contact with nongovernmental organizations without direct authorization from their chain of command. The public affairs officer is the staff officer responsible for understanding and fulfilling the information needs of the Soldier, the Army community, and the public. A public affairs officer is located at brigade and echelons above brigade. The medical task force supporting detainee operations will designate a staff officer (normally the personnel staff officer) to serve as the public affairs officer. The medical task force public affairs officer is the primary point of contact for the public affairs office supporting the detainee operations commander, and coordinates and facilitates media efforts within the MTF.
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
What is the two-person verification rule?
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.
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
. How often should detainees be screened for weight?
Monthly
What is the internment serial number?
Number issued to detainees when being inprocessed into the TIF
. What actions should you take in a hostage situation?
Personnel should remember if they find themselves in a hostage situation that hostages— Do not have any rank once they have been taken and they should not act as if they do. They should avoid making demands or giving orders and should not give suggestions to their captors. Should listen carefully for clues regarding the emotional state of the detainees who have taken them hostage. Should remain calm and alert; and they should not become aggressive. Should avoid political or religious discussions. Should not make any promises that they cannot fulfill.
What standardized form is used for detainee physical screening?
SF 600
Understand how the Health Insurance Portability and Accountability Act pertains to detainees
The Health Insurance Portability and Accountability Act does not apply to the medical records of detainees and EPWs
Who is responsible for the operation of the pharmacy?
The MTF commander
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.
What is the Law of Land Warfare and what is the purpose?
The conduct of armed hostilities on land 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 who fall into the hands of the enemy, particularly prisoner of war (POW), the wounded and sick, and civilians. Facilitating the restoration of peace. 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.
What are the rules for use of restraints?
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 -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. - 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. -. 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 the MPs. - For exercise or physical therapy, the detainee will not be restrained but will be escorted by medical staff and remain in clear sight of, and in proximity to, the MP security personnel at all times. -Use of leather restraints in the MTF emergency room will be at the discretion of the emergency room physician or clinic physician and charge nurse, in consultation with the MTF commander-
What does the Detainee Operations Commander do?
The operational commander shall designate the commander of the senior MP headquarters as the detainee operations commander with operational control of forces conducting detainee operations. While the detainee operations commander exercises operational control of all forces conducting detainee operations, technical supervision of medical assets remains in the medical channels to ensure medical guidelines and standards are met.
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." 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.
What are the principles of detainee health care?
Treat enemy casualties and detainees with the same ethics and medical standards of care as for multinational forces. Triage by medical condition only. Treat all detainees with dignity and respect for the culture, age, and gender. Cavity searches may be performed for legitimate medical reasons, but if done for purposes of a search, must be approved by the first general officer in the chain of command. Detainees have the right to informed consent and the right to refuse medical treatment and medication unless such refusal could jeopardize their life or the safety of others. All detainee health care/examinations must be documented in their medical record. All allegations or possible signs/symptoms of abuse, torture, or maltreatment must be immediately reported to the Criminal Investigation Division, as well as detainee operations and medical chains of command, regardless of who may be involved, where it occurred, or when it occurred. Health care personnel will never participate in interrogations, provide detainee medical information to interrogation personnel, or serve as a detainee guard. Maintain the moral high ground. How would you want to be treated?
. What are the water consumption planning factors for the different climates?
Water consumption planning factors should be the same as for U.S. Forces. These factors are— 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 person 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 to 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.
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.
When will a detainee be screened by behavioral health?
at the time of inprocessing prior to distribution into the general population.
When will a detainee undergo vision screening?
during inprocessing.
What is considered a prohibited act?
killing, torture, medical/scientific experimentation, physical mutilation, removal of tissues/organs for transplantation, and causing serious injury, pain, and suffering
