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16.2  |  Support for injured Service Personnel and veterans
Structure of medical support to operations
Military medical support was organised in four tiers, on the basis of the medical
capabilities and resources available:
Role 1 (broadly equivalent to Echelon 1 for maritime forces) medical support was
integral or allocated to a small unit, and included the capabilities for providing
first aid, immediate lifesaving measures, and triage.
Role 2 support was normally provided at larger unit level, and included
pre-hospital care.
Role 3 support was normally provided at Division level and above. It included
specialist diagnostic resources, and specialist surgical and medical capabilities.
Support would usually be provided in field hospitals and (as Echelon 3) in
hospital ships.
Role 4 support was the definitive hospital and rehabilitative care of patients.
That would usually be provided in the UK.8
25.  General Sir Kevin O’Donoghue, Deputy Chief of Defence Staff (Health) (DCDS(H))
from September 2002 to 2004, told the Inquiry that medical planning was “quite
advanced” by the time he took up post.9 Staffing plans were in place and gaps in medical
equipment and supplies had been identified, although approval had not yet been
received to begin procurement to fill those gaps.
26.  On 31 October, Mr Blair agreed that the UK should offer Package 3 to the US on the
same basis as Package 2, for planning purposes.10
27.  In early December, an MOD official invited Mr Geoff Hoon, the Defence Secretary,
to agree that the MOD should hold detailed talks with the Department of Health (DoH)
on the withdrawal of Regular and Reserve medical personnel from the NHS, and on
the reception of casualties under the RAMP.11 Package 3 would require around 2,000
medical personnel, of whom approximately 60 percent would be Reservists. The majority
of those Reservists would be working within the NHS; their withdrawal would have a
“local impact”. DoH was pressing the MOD for details on the withdrawal of medical
Reservists.
28.  The official also advised that the procurement of medical equipment through the
Urgent Operational Requirement (UOR) mechanism to support Packages 0 (Special
Forces only) and Package 1 was under way. The Treasury was expected to authorise
procurement of medical equipment to support Package 2 shortly. The MOD’s Directorate
of Capability, Resources and Scrutiny (DCRS) had not yet approved the business case
8  NATO, Logistics Handbook, October 1997.
9  Public hearing, 14 July 2010, pages 4-5.
10  Letter Wechsberg to Watkins, 31 October 2002, ‘Iraq: Military Options’.
11 Minute PS/VCDS to PS/Secretary of State [MOD], 6 December 2002, ‘Medical Support to Operations
against Iraq’.
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