EFMB 2021 Detainee Ops Study Guide

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.

Who is responsible for detainee security, custody, and control?

Designated security personnel are solely responsible for detainee security, custody, and control. At no time, when outside of the TIF, 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 or area of concentration Soldiers. Medical military occupational specialty or area of concentration personnel will not serve as security personnel.

How often do detainees in segregation receive medical care/contact?

Detainees maintained in segregation will be *monitored daily* to assure health and well-being and to address current medical complaints.

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.* Health care personnel will isolate the detainee in a singleoccupancy observation room and deny him contact with other detainees, when medically advisable. -The medical officer will immediately report the hunger strike to the TIF commander.

What is the detainee death notification process?

*The attending medical officer will immediately furnish the TIF commander, DOMD, or other officer charged with the detainee custody before death the following information*: -Full name of deceased. -Internment serial number of deceased (if the ISN has not been issued, use the capture tag number). -Date, place, and cause of death. -Statement that death was or was not the result of the deceased's own misconduct. -When the cause of death is undetermined, the attending medical officer will make a statement to that effect. When the cause of death is finally determined, a supplemental report will be made. The Criminal Investigation Division will contact the Office of the Armed Forces Medical Examiner to determine whether an autopsy will need to be performed. The TIF commander, DOMD, or other officer charged with custody of the person before death will notify the detainee reporting system of the death immediately by the most expeditious means available

What are the indications/behaviors of severe depression?

*Think SIGECAP* including depressed mood & anhedonia -Extreme feeling of sadness. -Apparent feelings of hopelessness and helplessness. -Guilt and self-blaming. -Lack of energy and lack of interest in activities. -Withdrawal from other people, including other detainees. -Eating problems (eating very little or too much). -Sleep problems (inability to sleep well or sleeping too much). *Any of the above indications of depression combined with a detainee's talk of suicide, wishing for death, or similar statements is a serious suicide indicator*

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 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 -*Medically Necessary—Non-emergent.* Medical conditions that are not immediately life-threatening 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 -*Medically Acceptable—Not Always Necessary* Medical conditions which are considered elective procedures, when treatment may improve the detainee's quality of life. -*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. -*Extraordinary.* Medical interventions are deemed extraordinary if they affect the life of another individual, such as organ transplantation, or are considered investigational in nature.

What are the water consumption planning factors for the different climates?

-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 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 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.

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. -. Consider the use of photography for documentation and treatment purposes. Detainees may arrive at the TIF with photographs of wounds or injuries taken by health care personnel at the detainee collection point or detainee holding area -Medical photography can also be used for medical diagnosis and treatment and used for the management of a number of medical conditions.

When will a detainee be screened by behavioral health?

-Behavioral health services will be provided to detainees based on the availability of medical resources and patient workload. Resources to provide this care may be task-organized and may include inpatient and outpatient care. Health care personnel providing BH services to detainees may include a psychiatrist, psychologist, social worker, BH nurse, occupational therapist, and BH specialist. - All detainees will receive a BH screen at the time of in-rocessing prior to distribution into the general population. A translator will be used to translate between the screener and detainee.

What warrants a body cavity search?

-Cavity examinations and searches may conflict with the customs of some detainees. Therefore, intake 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 the chain of command.

What happens when a detainee refuses care?

-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. -Involuntary treatment or intervention in a TIF 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 U.S. Armed Forces

What is the internment serial number (ISN)?

-Detainees are provided an ISN when being in-processed 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. -Detainees require an ISN in order to begin medical processing, so that tests and medications can be ordered as required. This particular aspect is governed by the MP unit in charge of in-processing. Any computer malfunctions or systems problems can affect how quickly a detainee is ready for medical screening. Of course, at any time if a detainee requires urgent or emergent care, capture tag numbers will suffice until the proper processing can be accomplished.

What actions should you take if the medical personnel is in a hostage situation?

-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 are the four separate international treaties of the Geneva Conventions?

-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 is the responsibility of health care personnel in detainee operations?

-Health care personnel 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. -Charged with the medical care of detainees have a duty to protect detainees' physical and BH 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 U.S. 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 BH. -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 BH 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

What are the three principal types of civilian organizations?

-International organizations. -Nongovernmental organizations. *Mandated*. A mandated nongovernmental organization has been officially recognized by the lead international organization in a crisis and is authorized to work in the affected area. *Nonmandated*. A nonmandated nongovernmental organization has no official recognition or authorization and, therefore, works as a private concern. -International humanitarian organizations. Per DOD policy, generally the International Committee of the Red Cross is the only international humanitarian organization authorized conditional access to detainees.

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 medical services provided in the TIF?

-Medical services provided in the TIF to 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 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 preventive medicine, animal health care, and oversight of animal welfare, as required). -Neuropsychiatric treatment and stress prevention (as required) and BH support. -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.

What standardized form is used for detainee physical screening?

-Preprinted physical examination, BH, and dental screening forms can streamline initial in-processing. Past medical history should focus on past and current communicable diseases (such as, TB, human HIV, and STDs); major health problems (asthma, cancer, diabetes, epilepsy, hemophilia, heart disease, and hypertension); allergy to foods, medications, or insects; past surgeries; recent or current medication use; and social habits such as alcohol and tobacco use. Translating routine past medical history questions into the local language can accelerate the preprovider contact, as long as the detainee is able to read. Refer to Appendix B for sample preprinted formats for the SF 600 for detainee physical screening and quality assurance screen of a detainee's medical record.

What is the process for a compassionate release?

-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 theater internment facility (TIF). 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.

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 are the principles of detainee health care?

-Treat enemy casualties and detainees with the same ethics and medical standards of care -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.

What assistance can health care personnel provide interrogation teams?

-Under the provisions of the Geneva Conventions, health care personnel are prohibited from engaging in acts that are considered harmful to the enemy. -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 personnel will not be used to supervise, conduct, or direct interrogations.

When will a detainee undergo vision screening?

All detainees will undergo a vision screening, to include measurement of best-corrected visual-acuity, during in-processing. The screening can be accomplished with a written form or done by interview. If any problems are detected during the screening or if the best-corrected visual acuity is worse than 20/40 with both eyes together, then an SF 513 should be generated.

What are the considerations for administering detainee medications?

All prescription medications must be ordered by a licensed provider; however, if compound dispensary stock allows, the provider may directly dispense common medications out of the on-site stock. Over-the-counter medications do not require approval prior to dispensing, however unlicensed providers must be fully trained by either a licensed provider or licensed pharmacy staff regarding each medication, its indications for use, and any potential side effects.

What matters are excluded for healthcare professional prohibited list of info disclosure about detainees?

Discuss the following matters with a detainee, a former detainee, a family member of a detainee or former detainee, the general public, or anyone else not having a need to know, except in the course of official business: -Allegations of misconduct against any medical personnel. -Allegations of misconduct against any internment or holding facility personnel. -Recommendations of any individual board, panel, or hearing body and/or the vote of any member of such entity. -Detainee mail, notes, or other written material of detainees. -Requests from former detainees for assistance in obtaining employment, including requests for recommendations. -Any information from the medical or dental treatment records of a detainee or former detainee. Only MTF personnel whose assigned duties include the disclosure of such information may reveal such information. -Information concerning particular incidents, occurrences, disturbances, acts of misconduct, or the handling of incidents involving detainees occurring at MTFs

What are the restrictions/limitations for health care personnel and the interaction with detainees?

Health care personnel will not— -Fraternize with or act with undue familiarity towards a detainee, a former detainee, or a family member of a detainee or former detainee. Any contact or communication (oral or written, direct or mediated) between a health care worker and a detainee will be for an official purposes only. -Place hands on or touch a detainee except in self-defense or to— -Prevent or aid in 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, or family member of a detainee or former detainee except in the performance 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 a detainee or former detainee. -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 a Theater Internment Facility (TIF)?

Key organizational elements in the TIF may be task-organized and include a joint security group, a joint interrogation group, a detainee MTF, 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 inspector general, the staff judge advocate, public affairs office, a surgeon, a forensic psychologist, a forensic psychiatrist, a medical plans and operations officer, an environmental science and engineering officer, and a provost marshal and/or security forces.

What is the two-person verification rule?

MENTAL COMPETENCY FOR INFORMED REFUSAL 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.

What are the procedures for use of mechanical leather restraints on detainees?

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

How often should detainees have access to medical care?

Regulatory guidance requires that detainees must be offered the opportunity for daily medical contact. Medication administration and emergency medical care are considered medical contact.

The Geneva Conventions provide for the repatriation of what?

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.

How does the Health Insurance Portability and Accountability Act (HIPAA)pertains to detainees?

The Health Insurance Portability and Accountability Act does not apply to the medical records of detainees and EPWs. Given that the Geneva Conventions require the military to provide the same standard of care to detainees and EPWs as U.S. Forces, detainee/EPW medical records should be initiated and maintained at the same standard. The procedures outlined in AR 40-66 regarding the release of medical information for official purposes should be followed for detainee/EPW medical records.

What was the Law of Land Warfare derived from?

The Law of Land Warfare is derived from two principal sources— -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)

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. At Roles 1 and 2 MTF the senior physician supervises the receipt, storage, and issuance of medications. The chief, pharmacy services at the supporting Role 3 MTF provides consultation and assistance on pharmaceutical issues arising at the supported facilities.

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 -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. -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 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.

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 health care personnel. During this screening, the detainee's weight is recorded on DA Form 2664-R which provides a concise, chronological weight history for the detainee. Significant fluctuations in weight can signal an underlying medical condition or can indicate that the detainee diet is not meeting his nutritional requirements.

Who can authorize disclosure of information in advance?

Unless specifically authorized in advance by the DOMD or the detainee operations commander, health care personnel and detainees will not: -Review detainee medical or dental treatment files without having a clearly established and official need to know. Discuss the following matters with a detainee, a former detainee, a family member of a detainee or former detainee, the general public, or anyone else not having a need to know, except in the course of official business:

What actions do you take if you suspect any abuse?

When conducting monthly weigh-ins, health care personnel should also be alert to the signs and symptoms of communicable diseases, louse infestations, hydration status, and other indicators of health status. If a detainee has any signs of unexplained physical injuries (such as burns, fractures, severe sprains, or bruises), health care personnel should ask the detainee about the cause of the injury. However, health care personnel do not investigate allegations or suspected incidents of abuse. Any cases of suspected abuse, both by TIF personnel or other detainees, should be documented and immediately reported to the TIF commander, the supporting Criminal Investigation Division, and the DOMD.