18TH COMBAT SUSTAINMENT SUPPORT BATTALIONUMT TACTICAL MASSIVE CASUALTY (MASCAL) RESPONSE SOP

1. REFERENCES:

a. JP 1-05, Religious Affairs in Joint Operations

b. FM 1-05, Religious Support

c. TC 1-05, Religious Support Handbook for the Unit Ministry Team

2. PURPOSE: To provide guidance for comprehensive religious support given by UMT during all phases of a tactical mass casualty situation occurring during training or combat maneuvers.

3. DEFINITIONS:

a. Mass Casualty (MASCAL). Usually defined as injury to more than one person. However, several persons may be involved as stress casualties, even when there may be only one or no physical casualties. If the casualty needs exceed the medical assets, then the senior medical person on the scene may call a MASCAL. Even if the medical assets are not overwhelmed, the UMT may still feel overwhelmed. If the casualties overwhelm the ability of the UMT, then contact the Brigade UMT. The Brigade UMT will attempt to send support based upon assets and METT-TC.

b. Medical Treatment Facility (MTF). Any facility in which casualties are treated. This may vary from an aid station to a medical center.

c. MASCAL SOP. The Standard Operating Procedure of a MTF when treating MASCAL’s. MTF’s have established and exercised these SOP’s in order to maximize their efficiency in the event of a MASCAL.

d. Triage. Literally, “sorting” of patients to determine casualty category, and priority of treatment.

e. Psychological Triage. The process by which psychiatry patients are triaged and evacuated along with other patients. They are placed into the above patient categories according to their psychiatric condition.

f. Spiritual Triage. The process by which patients are categorized so that they

can receive religious rites and supports. Usually according to patient category codes. Black/Expectant being top priority and Green/Minimal to Duty being lowest priority.

g. Patient Categories. Categories describing the condition of patients. Categories are usually color coded according to an international code. However, in the field patients are not always color-coded. Categories:

(1) Expectant (Black). Patients, who have no reasonable hope of recovery, even when all medical resources are concentrated on them. They usually are not treated, except to receive pain relief and comfort.

(2) Immediate (Red). Patients who can reasonably be expected to survive with concentrated medical care. These patients are the first to receive surgery or other life-saving care. They cannot wait.

(3) Delayed (Amber). Patients who will require surgery or other concentrated medical care, but are not in danger of dying. They can wait.

(4) Minimal (Green). Patients who, while injured, will probably not need surgery or other extensive care. They are usually ambulatory and can wait until the other categories are treated.

4. GENERAL GUIDELINES

a. When moving to MASCAL support ensure accountability of UMT has been made with HHC TOC. The primary means is to notify the HHC TOC of FM according to the provided frequency. The secondary means is face-to-face accountability informing HHC TOC that the UMT is moving to the Medical Aid, Casualty Collection Point, or Expectant Casualty Collection Point. Destination will be determined by analyzed TTP for unit site.

b. As a general rule, the first UMT member at the scene of the Mass Casualty will take the lead in directing the efforts of UMT members who arrive later. However, if the lead UMT member feels that he or she is “in over his head”, there should be no hesitancy (and no shame) in passing the lead to another UMT member

c. The UMT’s first priority at the Mass Casualty scene is to perform a Spiritual Triage, according to the patient category codes (above). Then the Chaplain Assistant will inform the UMT, providing an initial assessment of religious support needs. After

contacting next higher headquarters, Chaplain Assistant returns to assist chaplain(s) at the scene. While the chaplain gives care to individual casualties, the chaplain assistant moves among the other soldiers to identify those in greatest need and to provide care. Assistants can pray, read Scriptures, talk with the wounded; write letters, and more, to assist in casualty ministry.

d. The UMT is not expected to perform primary medical care at the scene. The first priority for the UMT (both chaplain and assistant) is the spiritual care of the wounded and dying. Neither the chaplain nor chaplain assistant should do medical care, pull security, or be a litter bearer until all spiritual needs are met. However, UMT members should not hesitate to do first aid and/or other medical care that they are trained to do following spiritual triage and care.

e. A primary concern for caregivers at a MASCAL scene is to avoid becoming one of the casualties. In the excitement of the moment, caregivers must be aware of the situation so as to avoid unnecessary risk to themselves, whether physical or psychological. UMT members must practice good self-care. This includes checking on the welfare of each other, taking “time outs” as needed, acknowledging and temporarily setting aside distracting feeling and emotions, and knowing when to get out of the situation.

f. Patients will be tagged with a patient identification card (DD Form 1380 or SF 600). The for the patient will be indicated on the card. Do not forget to sign, date and indicate time ministration performed. If the soldier does not survive his/her injuries, then this ID card will be included with his/her permanent records. A loved one of a deceased service member may find some comfort in their loss with the knowledge their loved did not die alone on the battlefield.

g. Pastoral Ministry Guidance.

(1) Be Present. Ministry of presence is probably the most important thing that the UMT brings to a mass casualty/trauma situation. Remember, you never go in alone, God’s presence is there for you and with you.

(2) Be Helpful. Look for opportunities to minister. The place for the UMT member is at the head of the patient reassuring him or her. You carry instant credibility. Remember you are a visible symbol of God’s presence, which brings assurance and comfort to the patient. Ask yourself what you would want done for you if you were in the

place of the one you are helping. Then do it.

(3) Be in Control. You may experience fear and uncertainty, confront and acknowledge these feelings. God will enable and equip you for the situation, remain calm and confident. Remember that you are the calm in the midst of the storm!

(4) Be Positive. Look for God to do something great. Charles Beard, the great American historian, once said, "When it gets the darkest, the stars shine the brightest." People will bless you by their courage and faith during the times of great crisis. Even those who will question God during these times will be more open to ministry than ever before. God wants to use the UMT to bless people and show them His love, even in the worst of times.

h. Have necessary ecclesiastical supplies on hand. While maintaining your denominational distinctive, be prepared to perform or provide for the various faith groups of soldiers wounded. Some logistical supplies you may want to have on hand are: communion wafers, grape juice/wine, anointing oil, rosaries, crosses, emergency baptism support, good writing waterproof pens, checklist of talking points, ministration cards, Bibles, Koran, Jewish Prayer Book, and other religious literature. (See Appendix D for Sample Prayer Cards)

5. MASS CASUALTY MINISTRY AT THE SCENE

a. PHASE I: RESPOND AND NOTIFY UNIT AND CHAPLAIN SUPERVISOR

(1) UMT should report their location to the HHC TOC and Brigade UMT upon learning of a mass casualty. Go to the mass casualty site and provide ministry of presence, immediate pastoral care and crisis intervention. When multiple UMTs are present, the nearest UMT available will assume the responsibility of providing emergency pastoral care.

(2) If you are the first on the scene, notify emergency medical assistance, command, and depending on the situation, the civilian authorities.

(3) Notify the Brigade UMT as soon as possible concerning the details of the mass casualty. Your verbal report should include the unit losses, nature of the mass casualty, present circumstances, and assessment of denominational needs.

(4) UMT will not release information to the media unless authorized by the

PAO or Corps/Installation Chaplain.

b. PHASE II: ASSESSMENT AND DECISIONS If responding UMT or assigned UMT.

(1) Continue to provide ministry as outlined above.

(2) Maintain a journal (DA 1594) and appropriate records.

(3) Assess your own UMTs level of functioning.

(4) Establish Ministry Ops Center. (Tent, chapel, nearby office, etc.)

c. PHASE III: EXECUTION

(1) Provide Grief Ministry.

(2) Provide Traumatic Event Management (TEM) IAW TC 1-05.

(3) Plan for Memorial Ceremonies Battalion Memorial SOP.

d. PHASE IV: RE-ASSESSMENT

(1) Re-assess the grief process of the unit, leaders, and families.

(2) Evaluate present ministry. What are the strengths and weaknesses of the mass casualty ministry? Is it working?

(3) Based upon re-assessment data, begin planning memorials.

e. PHASE V: SUSTAINMENT

(1) Continue ministry of presence, visitation to units, families, and leaders.

(2) Facilitate and support the natural support groups within unit.

(3) Finalize debriefings with the unit. Identify at risk individuals.

f. PHASE VI: CLOSURE

(1) Conduct Memorials IAW Battalion Memorial Ceremony SOP.

(2) Finalize records and lessons learned.

(3) Schedule follow-up visits.

g. PHASE VII: REVIEW

(1) Complete written analysis of lessons learned.

(2) Re-supply resources.

Includes1. Appendix A 2. Appendix B 3. Appendix C4. DA 1594 (Official Log)5. DD1380 (Tactical Combat Casualty Care Card, TCCC)6. DA 1156 (Casualty Feeder Card)

APPENDIX A RESPONDING UMT CHECKLIST

1. Provide emergency pastoral care.

2. If first on scene, notify command and emergency personnel.

3. Notify Chaplain Supervisor of the details: Nature of the mass casualty Unit LossesPresent Circumstances Denominational needs

4. Establish Operations Center (Tent, chapel, nearby office, etc.).

5. Do not speak with media without permission.

6. Provide grief ministry and ministry of presence.

7. Maintain a journal (DA 1594).

8. Provide Traumatic Event Management Debriefings.

9. Plan and conduct memorials.

10. Write lessons learned.

APPENDIX BMASCAL EMERGENCY BAG PACKING LIST

Item Amount Note

Carrier, Chaplain’s Kit 1MASCAL Quick Reference 2Religious Support Cards 5 of eachWater 1 bottle for emergency baptismsAnointing Oil 1 small containerBibles 3Cross 10Crucifix 10Rosary 10Icon/Prayer Cards 10UMT Armbands 2 to clearly identify UMTHand Sanitizer 1 small container

Other Items To Consider/Bring:

Chaplain’s Kit (for administration of communion) Force Protection Equipment (IBA, Kevlar)MOPP GearHandheld Radio/Cell Phone

APPENDIX CRELIGIOUS SUPPORT CARDS

Christian Soldiers: Last Requests Emergency Baptism

If a dying Soldier wants to be baptized, and a chaplain is unavailable, any Christian person may administer emergency baptism, as listed on the following page:*Recognize and be sensitive to the differences and requirements concerning baptism. Respect the desires of the one being baptized.

*For those desiring baptism by immersion you may say the following: "In obedience to the command of our Lord and Savior I baptize thee in the name of the Father, and of the Son, and of the Holy Spirit, Amen"*For those individuals desiring or accepting pouring as a method of baptism, pour water three times on the brow of the Soldier being baptized while saying the Soldier's first name and "I baptize thee in the name of the Father, and of the Son, and of the Holy Spirit, Amen."*Report the facts (action taken, date, time, place and, Soldier's name) to a chaplain immediately.

Catholic Soldiers:

If a dying Catholic Soldier desires religious support and a Chaplain is unavailable, the chaplain assistant, commanding officer, platoon leader, or another Soldier may voluntarily repeat "The Hail Mary", "The act of contrition", and make "The sign of the Cross" with the Trooper.The Hail Mary: "Hail Mary, full of grace! The Lord is with thee; blessed art thou among women, and blessed is the fruit of thy womb, Jesus. Holy Mary, Mother of God, pray for us sinners, now and at the hour of our death. Amen."

The Act of contrition: "O my God, I am heartily sorry for having offended Thee, and I detest all my sins, because of thy just punishments, but most of all because they offended Thee, my God, Who art all-good and deserving of all my love. I firmly resolve, with the help of Thy Grace, to sin no more and to avoid the near occasions of sin, Amen"

The sign of the Cross: "In the name of the Father, and of the Son, and of the Holy Spirit. Amen."

In the event of the death of a Catholic Soldier, the following prayer may be said: "Eternal rest grant unto him (her), O Lord, and let perpetual light shine upon him (her). May his (her) souls and all the souls of the faithfully departed, through the Mercy of God, rest in peace. Amen."

Protestant Soldiers:

If a dying Protestant Soldier desires religious support and a chaplain is unavailable, the chaplain assistant, commanding officer, platoon leader, or another Soldier, may voluntarily repeat "The Lord's Prayer", "The Apostles' Creed" and "The Prayer for the sick and Wounded" with the Soldier.The Lord's Prayer. "Our Father, Who art in heaven, hallowed be Thy name. Thy kingdom come, Thy will be done, on earth as it is in heaven. Give us this day our daily bread. And forgive us our trespasses, as we forgive those who trespass against us. And lead us not into temptation, but deliver us from

evil. For Thine is Kingdom, and the power, and the power, ,and the glory forever, Amen."The Apostles' Creed. "I believe in God, the Father almighty, maker of heaven and earth; and in Jesus Christ, his only Son our Lord, who was conceived of the Holy Spirit, born of the Virgin Mary, suffered under Pontius Pilate, was crucified, died, and was buried. He descended into Hell; the third day He rose again from the dead. He ascended into heaven and sitteth at right hand of God the Father,almighty. From thence He shall come to Judge the living and the dead. I believe in the Holy Spirit, the holy- Catholic church, the communion of Saints, the forgiveness of sins, the resurrection of the body, and the life everlasting, Amen."Prayer for the sick and wounded: " O Lord, in your mercy behold, is it , and relieve your servant. Give him comfort in the knowledge of your love and sure confidence in your care. Defend him from the danger of the enemy and keep him in spiritual peace and safety; through our Lord Jesus Christ. Amen." In the event of the death of a Protestant Soldier, the following prayer may be said: "Depart, dear brother (sister), out of this world in the name of the Father who created thee, in the name of the Son who redeemed thee, and in the name of the Spirit who made thee whole. Amen."

Eastern Orthodox Christian Soldiers:

If a dying Eastern Orthodox Christian Soldier desires religious support and a chaplain is unavailable, the chaplain assistant, commanding officer, platoon leader, or another soldier may voluntarily repeat with the soldier the following prayers:* "Holy God! Holy Mighty! Holy Immortal! Have mercy on us!" (Repeat this phrase three times.)“Glory to the Father, and to the Son, and to the Holy Spirit, now and ever and unto ages of ages. Amen."

"O Most Holy Trinity, have mercy on us. O Lord, cleanse us from our sins. O master, pardon our transgressions. O Holy One, visit and heal our infirmities for Thy name's sake. Amen."

"Lord have mercy!" (Repeat this phrase three times)

"Our Father who art in heaven, hallowed be Thy name. Thy kingdom come, Thy will be done, on Earth as it is in heaven. Give us this day our daily bread. And forgive us our trespasses as we forgive those who trespass against us. And lead us not into temptation, but deliver us from the evil one. Amen."

"The Father is my hope, the Son is my refuge, the Holy Spirit is my protector; O Holy Trinity, glory to Thee!"

"Beneath your compassion we take refuge, O Virgin Theotokos. Despise not our prayer in our adversity, but deliver us from harm, O only pure and blessed one."

The following brief prayer may be substituted for the above, in support of a dying Eastern Orthodox Christian soldier:"With the saints give rest, O Christ, to the soul of thy servant, where there is neither sickness nor sorrow, and no more sighing, but life everlasting. Amen."

In the event of the death of an Eastern Orthodox Christian soldier, the following prayer may be said: "O God of spirits, and of all flesh, who hast trampled down death and overthrown the Devil and given life to Thy world; do Thou, the same Lord, give rest to the soul(s) of Thy departed servant(s) (state Soldier's name), in a place of brightness, a place of refreshment, a place of repose where all sickness, sighing, and sorrow have fled away. Pardon every transgression which he (she) (they) has (have) committed, whether by word or deed or thought. For Thou art a good God and lovest mankind;

because there is no man who lives yet does not sin; for Thou alone art without sin; Thy righteousness is to all eternity; and Thy word is truth. For Thou art the Resurrection, the Life, and the Repose of Thy servant(s) (state Soldier's name) who has (have) fallen asleep, O Christ our God, and unto Thee we ascribe, glory, together with Thy Father who is from everlasting and Thine all-holy good, and life-creating Spirit, now and ever and unto ages of ages. Amen."

Jewish Soldier:

If a dying Jewish Soldier desires religious support and a chaplain is unavailable, the chaplain assistant, commanding officer, platoon leader, or another Soldier may voluntarily repeat with the Soldier the following prayers:

The Shema: "Hear, O Israel: the Lord our God, the Lord is One."

The Confession for the critically ill: "Lord my God, God of my fathers; before Thee I confess that in Thy hand alone rests my healing or my death. If it be thy will, grant me a perfecthealing. Yet if my death fully determined by thee, I will in love accept it at thy hand. Then may my death be an atonement for all sins, transgressions, and for all the wrong which I have committed before Thee, Amen."

The 23rd Psalm-A Psalm of David: "The Lord is my shepherd, I shall not want. He maketh me to lie down in green pastures; he leadeth me beside the still waters. He restoreth my soul. He leadeth me in the paths of righteousness for His name's sake. Yea, though I walk through the valley of the shadow of death, I will fear no evil: for Thou art with me: Thy rod and Thy staff they comfort me. Thou preparest a table before me in the presence of mine enemies; Thou anointest my head with oil; my cup runneth over. Surely goodness and mercy shall follow me all the days of my life, and I shall dwell in the house of the Lord forever."

In the event of the death of a Jewish Soldier, the following prayer may be said: "Your sun shall no more go down, neither shall your moon withdraw itself; for the Lord shall be your everlasting light, and the days of your mourning shall be ended. Amen."

Muslim Soldiers:

In the event of the death of a Muslim Soldier, the following prayers may be said: (The person who leads in prayer should stand and face toward Mecca, if possible.)

"Allah is Great!" (Repeat this phrase four times.) "There is no God but Allah and Mohammed is his prophet." "Glory be to Thee, O Allah, and praise. Thy praise is glorified, and there is no God other than Thee." "O Allah! Have mercy on Muhammad, just as Thou hadst mercy and Thou sendst peace and blessing and hadst compassion on Abraham. Surely Thou art Praiseworthy, the Great!" "O Allah! Forgive those of us who are still living and those who are dead' those of us who are present and those who are absent, and our minors and our elders. O Allah! Let the one whom Thou keepest alive from among us live his life according to Islam, and let the one whom Thou causest to die from among us, die as a believer." "Peace and Allah's mercy be upon you. Amen."

In the event of the death of a Muslim Soldier, the following prayers may be said: (The person who leads in prayer should stand and face toward Mecca, if possible.) "Allah is Great!" (Repeat this phrase four times.) "There is no God but Allah and Mohammed is his prophet." "Glory be to Thee, O Allah, and praise. Thy praise is glorified, and there is no God other than Thee." "O Allah! Have mercy on Muhammad, just as Thou hadst mercy and Thou sendst peace and blessing and hadst compassion on Abraham. Surely Thou art Praiseworthy, the Great!" "O Allah! Forgive those of us who are still living and those who are dead' those of us who are present and those who are absent, and our minors and our elders. O Allah! Let the one whom Thou keepest alive from among us live his life according to Islam, and let the one whom Thou causest to die from among us, die as a believer." "Peace and Allah's mercy be upon you. Amen.

DD Form 1380

Indicate patient’s religious preference and religious ministrations performed