Appendix 2 – Sacrifice Medal (SM) - Additional guidelines
The following guidelines are provided as an amplification of the criteria and examples available at Annex J, Appendixes 3and 4 and shall be read in conjunction with them.
While the posthumous aspect of the Sacrifice Medal (SM) includes all service-related deaths, the living aspect of the medal, recognizing wounds which are the direct result of a hostile action, or an action that was intended for a hostile force (meaning friendly fire), is a combat award, like its predecessor the Wound Stripe. This means that, for living nominee’s only those wounds sustained in combat with an armed enemy in a warlike situation within an active theatre of operations will be considered with the exception of acts of terrorism which can be eligible regardless of location in accordance with the regulations.
Physical and psychological wounds are considered equal and must therefore meet the same criteria: be the direct result of a hostile action, be grievous, and be duly recorded. An Operational Stress Injury (OSI) or PTSD diagnosis does not on its own constitute eligibility unless the aforementioned criteria are fully met.
The following interpretations apply:
“Hostile” means the act is perpetrated either by a uniformed armed force or armed terrorists, armed mutineers, armed rebels, armed rioters and armed pirates. A random act of violence or criminal action not corresponding with the aforementioned description does not meet the intent of the award;
“Action” means that an actual hostile act must have occurred. The threat, fear, potential or perception that a hostile force might be present or might undertake an action is not sufficient; and
“Direct” means that:
The nominee must be physically present at the moment the act is perpetrated, within a reasonable range from the act itself. The range may vary depending on the weapon used. An indiscriminate attack using imprecise weapons on a large target creates a larger range while an attack on a specific site using more precise weapons reduces the range. Any person arriving at the scene after the act has been completed, witnessing the act remotely (through UAV or other video footage) or seeing or dealing with the aftermath of such an act (including medical personnel arriving on site to treat victims, investigators, vehicle recuperation teams, hospital and morgue personnel, etc.) is excluded from eligibility;
The nominee must be directly part of the intended target of the act. Witnessing a random act of violence in a troubled situation does not constitute eligibility;
The nominee must be the victim or target of the direct hostile act and not the perpetrator; and
The reactivation, aggravation or exacerbation of a pre-existing wound or condition does not qualify unless the action would likely have caused significant injury even in the absence of a pre-existing condition.
To meet the intent of the Medal, the wounds must be sufficiently severe to qualify.
For a physical wound this means the wound must require immediate treatment. The wound generally requires multiple treatments over time and/or results in disability. Normally, the lack of treatment would have serious health consequences and put life and/or limb at risk. Any minor wound which is not noticed or treated until after the fact or can be remedied by the application of basic first aid or the intervention of a platoon medic does not meet the criteria.
For a psychological wound, it is recognized that the development of the wound may not manifest itself until months or even years later. However, the requirement to have recurring or ongoing medical treatment, the presence of a significant period of disability, and the likelihood of significant negative health consequences in the absence of treatment are indicators of wound severity that should also be considered in assessing the eligibility of psychological wounds.
Several eligible wounds (either physical or psychological or a combination thereof) caused by one incident will result in one award. Eligible wounds suffered in separate incidents may result in multiple awards (medal and bar(s)). In the case of psychological wounds, it is possible for one diagnosis to be related to several qualifying incidents: this diagnosis will result in one award. If there are multiple diagnoses, each linked to separate incidents, there may be multiple awards.
The application form, DND 2479, shall include a detailed description of the operational incident including date, place, type of hostile action, weapons used, number of casualties and nominee’s involvement but shall not include any details of the actual wound(s) sustained to protect medical confidentiality. The signature of the CO confirms the incident was related to a direct hostile action while the signature of the MO attests that the wound(s) sustained appear to be the result of the actions described, the wounds were severe and the treatment was duly recorded in the medical records. Both signatures constitute a recommendation but an application does not guarantee an award. DH&R will review the operational info while CFHS, at the Regional Surgeon level and, where necessary at the CFHS HQ level, will review the medical component to confirm eligibility.
Any case where there is insufficient information to confirm either the operational criteria with regards to the nature of the incident or the medical criteria regarding the diagnosis and/or treatment, the application will be rejected. If further or new information is provided, a previously rejected application may be reviewed.
It is improper for the chain of command to interfere with the review of the medical component. Once SM applications are submitted to DH&R any questions related to such applications shall be directed through the chain of command to DH&R who will link with CFHS as necessary.
