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US veterinary support to standardization of food and water safety and animal care and use within NATO.

The North Atlantic Treaty Organization (NATO) Standardization Agency was established in 1951 as the Military Standardization Agency upon the recognition that NATO military effectiveness and efficiency could be greatly enhanced through increased standardization and interoperability of the Allied forces (specific NATO definitions of terms are provided in the inset below). (1) Through improved standardization, NATO militaries and partner forces can optimize their available resources by leveraging and utilizing the capabilities of other alliance militaries with the stated assurance that common policies, procedures, and equipment will be used. A key component of this assurance is the development and ratification of standardization agreements within which NATO member nations agree to implement a common standard, either in whole or in part. Within NATO, the Committee of the Chiefs of Military Medical Services (COMEDS) has the authority to develop and maintain medically-related standardization agreements. It is assisted by the Military Committee Medical Standardization Board which coordinates the efforts of multiple working groups and expert panels dealing with military medical structures, operations and procedures, military medical healthcare, force health protection, medical standardization, and medical issues related to chemical, biological, radiological, and nuclear threats (displayed in the Figure). One of these expert panels is the Food and Water Safety and Veterinary Support Expert Panel (FWSVS), which is charged with "initiating and developing common principles, policies, doctrines, concepts, procedures, programs and techniques for advice to COMEDS and for standardization and coordination in order to enhance interoperability within food and water safety, environmental health, and for veterinary medicine aspects, in the operational environment." (2) The FWSVS, which reports to the Force Health Protection Working Group, is comprised of military veterinary officers (or their designated representatives) from the NATO member nations, as well as representatives from NATO Partnership for Peace countries.

The FWSVS has primary responsibility for 8 standardization agreements as shown in the Table. In compliance with NATO Standardization Agency requirements, all standardization agreements and the associated Allied Medical Publications are reviewed every 3 years to ensure the principles, policies, procedures, and techniques included in the agreements are consistent with current medical standards and technologies and in compliance with the doctrine and capabilities of NATO military partners. In addition to these 8 primary standardization agreements, the FWSVS also provides expert consultation on veterinary and food and water safety related issues in several additional standardization agreements which are the responsibility of other working groups and expert panels within COMEDS and the greater NATO Standardization Agency community, such as the recently formed expert panel for the use of military working dogs (MWD) in counter-improvised explosive device (C-IED) operations.


The past 18 months have been a time of significant change for agreements covering military animal medical care and welfare. Military animals are critical assets and injured working animals are expected to receive a high level of care during military service. National systems of military veterinary medical support are well-established, but recent reviews by the FWSVS led to the merging of Standardization Agreements 2534 and 2538 and a major rewrite of Allied Medical Publication 19: Animal Care and Welfare and Veterinary Support During All Phases of Military Deployments. (4) The new document retains a phased approach and updates some health certificate and medical data, but the posture of the comments has changed from implicit instructions for veterinarians to improved education and guidance for commanders and staff. New definitions for veterinary roles of care were also added in order to maximize communication of veterinary medical capabilities and foster greater interoperability of medical assets on deployment.

In support of the NATO C-IED Action Plan, the Allied Command Transformation C-IED Integrated Product Team leader from the Unites States organized 2 NATO C-IED MWD workshops which were conducted at the Defense Animal Centre (Melton Mowbray, United Kingdom) in May 2011 and the Defense MWD School (Madrid, Spain) in January 2012. Both workshops focused on 6 priority areas designed to optimize use of MWDs to support defeating the device, countering threat networks, and harmonizing MWD activities as a C-IED enabler in NATO C-IED strategy. The participating nations and C-IED organizations came to consensus on terms of reference for the expert panel which were approved by the Military Committee Land Standardization Board, C-IED Working Group, officially creating an expert panel in May 2012 (shown in the Figure). The inaugural meeting for the new NATO Expert Panel on MWDs for C-IED was hosted by Italy at the Military Veterinary Centre in Grosseto, Italy, in June 2012. The Expert Panel chairman from the United Kingdom led 43 participants in work on developing NATO MWD certification standards, measures of performance and effectiveness, and capability matrix and terminology. Although interoperability of MWD capabilities must consider the personnel and organizational differences across a wide group of NATO stakeholders, outstanding advance work conducted by the Nordic Defense Cooperation MWD Working Group led to agreement on a matrix defining 5 primary MWD C-IED capabilities within NATO. Other international products that improve command and staff awareness and understanding regarding the operational use of MWDs are under review, which may result in quick advancement of NATO objectives. Additional interests include improved common operational pictures for in-theater MWD capabilities and veterinary medical support locations; use of MWD advisory teams and program managers in mission planning and deployments; and combining mutually independent methods of detecting items of interest with MWD capabilities to find personnel and materials to exploit and strengthen the intelligence cycle. Future standardization agreement and concept of employment considerations regarding operational interoperability, synergy, and unified efforts of all NATO and partner countries are ongoing.


Drinking water must be readily available and consumed in adequate quantities to prevent dehydration. It must be potable or otherwise it may have adverse health effects on the consumers. It must also be palatable so personnel will be willing to drink it in adequate quantities. Standardization Agreement 2136 implements Allied Medical Publication 18: Minimum Standards of Water Potability during Field Operations and in Emergency Situations (AMedP-18), (4) and provides procedures and water quality standards for field water that is shared among nations during NATO operations. The documents have undergone many improvements over more than a decade, as nations have worked together to ensure the Warriors of each nation receive water that is safe and acceptable for drinking. The aims or purposes of Standardization Agreement 2136 and AMedP-18 include standardizing the approach for ensuring the quality of drinking water provided to the troops during field operations; establishing the minimum requirements for potable drinking water provided to troops in a theatre of operations during emergency situations; and establishing the minimum water quality testing capabilities required in the field.

All nations do not have the same water treatment and testing capabilities, and may not be able to meet all of the standards in AMedP-18. A caveat has been included in the document to ensure all participating nations have the ability to share drinking water with other nations. A nation that produces water which does not comply with all the requirements of the Allied Medical Publication (AMedP) must maintain a document detailing what procedures or parameters of the AMedP are not met, and provide a copy to the nation or nations who would receive the water. The receiving nations can then decide to accept the water as is, accept it and provide additional treatment and monitoring, or decline to use that nation's water.

AMedP-18 provides agreed-upon definitions of all salient water supply terms and phrases used in the publication (from "approved sources" to "water treatment"), to ensure that all nations that use the document interpret it the same way. It describes the desirable qualities of raw water sources, and methods to assess the quality and determine the type of treatment necessary to obtain levels required for emergency, short-term, or long-term use. All participating nations agree to the following:

* The provision of safe drinking water in the field is an operational necessity.

* All health-related risks will be assessed in setting criteria for the quality of drinking water during operations.

* The minimum criteria for the quality of drinking water based on performance-related risks will only be applied in emergency situations.

* To follow the procedures of risk management described within the document.

AMedP-18 contains a list of emergency water quality standards with maximum allowable concentration levels (MCLs) and indicators. Water that contains contaminants at the indicated levels is only to be used for drinking water for 7 days or less. If either the MCLs or the usage period is exceeded, the capabilities of some Soldiers to complete their missions could be compromised by performance degradation. These standards were developed in the 1980s through a comprehensive study (5) by Lawrence Livermore National Laboratories, and are still applicable today.

The operational and long-term standards in the current AMedP-18 (edition 5) were selected in the early 2000s by the executive committee members and included MCLs from the European Union Standards, the US Triservice Field Water Standards, and the former US Army Center for Health Promotion and Preventive Medicine. In order to simplify the defense of the long-term standards to all participating nations, the draft of edition 6 of AMedP-18 proposes to replace the current standards with primarily standards copied from the World Health Organization's Guidelines for Drinking-water Quality, (6) with some additional aesthetic standards from the current Army Technical Bulletin MED 577. (7)

AMedP-18 gives guidance for storage and handling procedures for both commercially bottled and packaged field water that will protect them from the weather, sunlight, and potential adversaries, while maximizing their shelf life. Commercially bottled and packaged field water are generally considered food products and are handled, stored, and inspected by Quartermaster personnel, augmented by veterinary and preventive medicine personnel in a manner similar to other purchased packaged food products. This guidance differs somewhat from the very robust surveillance system the US Army has for its surveillance program, but is considered adequate, and the next edition of Technical Bulletin MED 577 will be more in line with the standardization agreement procedures.

AMedP-18 also addresses the situation in which a nation's bulk water may be taken from a local municipal water supply or produced by a commercial contractor. It requires that water produced by either source must meet all the criteria described for military-produced water, and that the chemicals, materials, and ultraviolet disinfection systems (if used) be tested and certified to meet the applicable NSF International(r) (Ann Arbor, MI) standards. The water purveyors must also provide documentation that they meet these requirements together with water quality test results to all nations that use the water.


Much of the early work of the FWSVS focused on operational rations, ensuring that rations were prepared and stored in a manner to maximize safety and usability by NATO forces. This effort continues today, with the most recent draft of Standardization Agreement 2937 and AMedP-60: Survival, Emergency and Individual Combat Rations-Nutritional Values and Packaging, (4) to ensure nutritional equivalency so combat rations may be shared with other NATO countries.

When combat operations continue beyond the initial entry phase, most nations quickly transition from combat rations to catered meals prepared in dining facilities. These catering operations have evolved over the past decade from primarily individual national catering operations to multinational NATO catering operations. The NATO Support Agency (NSPA) provides logistic support to NATO operations, much like the Defense Logistics Agency does for US forces. In Afghanistan, NSPA is the contracting agency that provides most of the meals for US and allied forces. This has created a demand for a standardization agreement covering all aspects of catering operations from the facility infrastructure to food storage, processing, and service. The current Standardization Agreement 2541 and AMedP-20: Audit Principles and Risk Assessment of Food Processors and Distributors Associated With Military Deployments, (4) incorporates many of the requirements within the US Military Standard 3006, (8) and standardizes the auditing of commercial food and water facilities by NATO forces.

A revised draft of Standardization Agreement 2541, which should be promulgated for ratification this year [2012], covers all aspects of the food chain from the audit of the food processing establishment to the inspection of the catering operation on the battlefield. The new Standardization Agreement 2556 will replace Standardization Agreements 2541 and 2550, and will cover AMedP-25: Food Safety, Defense, and Production Standards in Deployed Operations, (4) and another AMedP which has not yet received a numerical designator, "Inspection of Food Services Catering Facilities on Deployed Operations," in addition to AMedP-20. These new documents will standardize the requirements for operation of military and commercial dining facilities during NATO operations, and also provide guidance for inspection of these facilities. Ratification of these new documents will help close an existing critical gap in food and water safety during NATO military operations, resulting in improved force health protection.


Standardization Agreement 2557 implementing AMedP-26: Veterinary Guidelines on Major Transmissible Animal Diseases and Preventing Their Transfer Summary, (4) the newest standardization agreement produced by the FWSVS, was ratified and implemented in February 2011. A driving force behind its development is the realization that NATO forces may be exposed to zoonotic and transboundary animal diseases during combat, foreign humanitarian assistance, or other military operations. These diseases may have significant negative effects on military readiness and force health protection in situations involving highly pathogenic avian influenza, rift valley fever, and other zoonoses. Further, some transboundary animal diseases could have significant economic effects if they are inadvertently transported and introduced into a NATO country's domestic animal population during redeployment of personnel and equipment.

In order to address the health threat posed by these animal diseases, AMedP-26 provides NATO personnel with a list of important animal diseases, as determined by the World Organization for Animal Health, as well as the risk factors associated with their transmission and recommendations for controlling or preventing transmission through disinfection of personnel and equipment. Included with these recommendations and guidance are document templates to rapidly develop notices which can be disseminated to military personnel, caterers, or transportation personnel to inform them of imminent health threats and reduce the likelihood of inadvertent disease transmission.

Although Standardization Agreement 2557, implemented in 2011, is less than 3 years old, the FWSVS panel is already working on revisions to improve future versions. One proposed improvement is additional guidance for preventing transmission to or by military personnel through avoidance and the use of personal protective measures such as gloves or disposable outer garments. Another important change is the reporting of confirmed or suspected diseases not only to NATO preventive medicine staff officers, but also the host nation's chief veterinary authority. This latter report is especially important as each nation's chief veterinary authority is responsible for reporting new occurrences of domestic transboundary animal diseases to the World Organization for Animal Health so that neighboring countries and trading partners can be informed in a timely manner and take necessary precautions to prevent the introduction of the disease into their own countries. The revised version of Standardization Agreement 2557 and AMedP-26 should be available for review in 2013, with ratification potentially in 2014.


NATO requires all standardization agreements and Allied Medical Publications to be reviewed at least once every 3 years to ensure they reflect current technologies and national military policies and procedures. This is particularly applicable with regard to veterinary medicine and food and water safety where advances in scientific knowledge and practices may result in documents quickly becoming obsolete. Such is the case with the 8 standardization agreements for which the FWSVS has responsibility; all are currently undergoing major revisions. With each revision, national representatives, including US veterinary and preventive medicine personnel, must review the documents to ensure there are no significant issues which would prevent ratification and implementation. This improves standardization and enhances interoperability between NATO partners to minimize duplication. This is accomplished by leveraging other national military capabilities, while maintaining confidence that the food, water, and veterinary support provided to their Warriors, support personnel, and animals in the field is safe and high in quality. Adherence to such standards is a major factor in maintaining the operational readiness of all alliance armed forces.

Definitions of NATO Standardization Agency Terms

Interoperability: The ability to act together coherently, effectively and efficiently to achieve Allied tactical, operational and strategic objectives.

Standardization: The development and implementation of concepts, doctrines, procedures and designs in order to achieve and maintain the compatibility, interchangeability or commonality which are necessary to attain the required level of interoperability, or to optimize the use of resources, in the fields of operations, materiel and administration.

Standardization Agreement: A standardization agreement is a normative document recording an agreement among several or all NATO member nations, which has been ratified at the authorized national level, to implement a standard, in whole or in part, with or without reservation.

Source: NATO Standardization Organization (1)


(1.) NATO Standardization Organization. Brussels, Belgium: NATO Standardization Agency; 2012. Available at: /NSO_BOOKLET_A4.pdf. Accessed August 2, 2012.

(2.) Terms of Reference for the Food and Water Safety and Veterinary Support Expert Panel. Brussels, Belgium: Military Medical Steering Group, Committee of the Chiefs of Military Medical Services in NATO; 2009:1.

(3.) Official Minutes of the 32nd Meeting of the Food and Water and Veterinary Support Expert Panel [NATO Standardization Agency]. 18-20 September 2012. Ieper, Belgium.

(4.) STANAG/AMedP Index. NATO Standardization Agency Website. Available at: protected/nsdd/_CommonList.html [restricted access].

(5.) Daniels JI, Gallegos GM, eds. Evaluation of Military Field-Water Quality. Livermore, CA: Lawrence Livermore National Laboratories; 1990.

(6.) Guidelines for Drinking-water Quality. 4th ed. Geneva, Switzerland: World Health Organization; 2011. Available at: tation_health/publications/2011/dwq_guidelines/ en/. Accessed October 26, 2012.

(7.) Technical Bulletin MED 577: Sanitary Control and Surveillance of Field Water Supplies. Aberdeen Proving Ground, MD: US Army Public Health Command; May 1, 2010. Available at: http:// tbmed577.pdf. Accessed October 26, 2012.

(8.) MIL-STD-3006: Sanitation Requirements for Food Establishments. Washington, DC: Office of The Surgeon General, US Dept of the Army; June 1, 2008 [revision C].

MAJ Ronald L. Burke, VC, USA

COL Kelly A. Mann, VC, USA

Steven Richards, PhD, PE, BCEE

COL Timothy H. Stevenson, VC, USA

MAJ Burke is Assistant Director, Division of GEIS Operations, Armed Forces Health Surveillance Center, Silver Spring, Maryland. He is the current Secretary for the NATO Food and Water Safety and Veterinary Support Expert Panel.

COL Mann is Director, Department of Defense Military Working Dog Veterinary Service, LTC Daniel E. Holland Military Working Dog Hospital, Lackland Air Force Base, Texas. He is a member of the NATO Food and Water Safety and Veterinary Support Expert Panel and the Expert Panel on the use of Military Working Dogs for Countering Improvised Explosive Devices.

Dr Richards is the Field Water Section Chief, Water Supply Management Program, Army Institute of Public Health, US Army Public Health Command, Aberdeen Proving, Ground, Maryland. He is a retired Colonel of the Army Medical Service Corps.

COL Stevenson is Commander, Public Health Command Region-South, Fort Sam Houston, Texas. He is the current Chairman of the NATO Food and Water Safety and Veterinary Support Expert Panel.

Current NATO Standardization Agreements of Responsibility for the
Food and Water Safety and Veterinary Support Expert

Panel. Source: NATO Standardization Document Database

Standardization   Title and Associated Allied Medical     Custodian
Agreement         Publication (AMedP)                      Nation

2136              Minimum Standards of Water             Netherlands
                  Potability During Field Operations
                  and in Emergency Situations

2534 (a)          Welfare, Care and Veterinary          United States
                  Support for Deployed Military
                  Working Animals

2538              Animal Care and Welfare and              France
                  Veterinary Support During All
                  Phases of Military Deployments

2541              Audit Principles and Risk                Belgium
                  Assessment of Food Processors and
                  Distributors Associated With
                  Military Deployments (AMedP-20)

2550              Minimum Standards of Food Safety         United
                  and Hygiene on Operations                Kingdom

2556 (b)          Food Safety in the Provision of          Canada
                  Food and Catering Services Support
                  to Deployed Operations (AMedP-25)

2557              Preventing the Transfer of Animal        Greece
                  Or Plant Diseases and Pests to
                  Nonindigenous Areas (AMedP-26)

2937              Survival, Emergency, Individual          Germany
                  Combat and Group Rations
                  Nutritional Values and Packaging

(a) Standardization Agreement 2534 is merging with AMedP-19 into
a single consolidated document. (3)

(b) Standardization Agreement 2556 will cover AMedP-20, AMedP-25,
and AMedP-XZ in the future. (3)
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Title Annotation:North Atlantic Treaty Organization
Author:Burke, Ronald L.; Mann, Kelly A.; Richards, Steven; Stevenson, Timothy H.
Publication:U.S. Army Medical Department Journal
Geographic Code:1USA
Date:Jan 1, 2013
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