U.S. Medical Support in a Developing World Health System - a Partnership Made in Africa for a "New Normal" Strategy.

Abstract

The United States Government (USG) is deeply interested in political stability and economic prosperity within each of the sovereign states of Africa. Part of the “whole-ofgovernment approach,” the Department of Defense (DoD) is responsible for lines of effort that place uniformed service members and U.S. Embassy officials at risk. Current USG missions on the African continent typically involve small travelling contact teams, special operators, and diplomatic missions without robust medical support. Beyond Self Aid and Buddy Care (SABC) and unit medics, there is no capacity to support U.S. assets during the golden hour of trauma. Civilian and military assets are integrated with variable success on an ad hoc basis (e.g., Theater Patient Movement Requirement Center coordinates with International SOS, as needed, to arrange medical evacuation by the most effective means possible, usually a civilian aircraft). Those unstable for evacuation are transported to the nearest medical facility where service members and diplomats receive the best care available, which may be different from the standard of care available in other countries. Despite historical precedence and known risks, the USG does not have a robust response capability for medical crisis that involves USG representatives on the African continent. Many proposals exist to push specific medical capabilities closer to U.S. personnel in Africa, but few use evidencebased tactics aligned to strategic end-state objectives. The tactical capabilities proven to save lives and reduce the burden of disease are clear: personnel protective equipment (e.g., body armor and tourniquets), SABC, tactical combat casualty care, casualty evacuation, forward access to trauma surgery, reliable blood bank and laboratory support, evidencebased critical care, and robust medical evacuation. We propose a strategy to assist development of African regional training institutions to teach, train, evaluate, and maintain these specific evidence-based tactical medical capabilities. In this strategy, host nation (HN) training institutions selected based on willingness, regional consensus, and funding legitimacy would draw medics from the region to complete standardized training at a center of excellence, staffed and led by HN medics to serve both the health security objectives of the USG, the training requirements of all partners, and the health care objectives of the HN. The end-state objective directly supports U.S. Africa Command Lines of Effort and a whole-of-government approach to Global Health Engagement. Measurable outcomes based upon this strategy must directly support desired end states, and should include: HN medics graduated from mandatory training, HN medic performance during training exercises, time-distance from U.S. Embassy to accessible Role 2 care, reliable access to accredited blood bank, sustainable information technologies to support unimpeded access to medical subspecialist consultation, incorporation of Millennium Development Goals or the future Sustainable Development Goals, access to 5,000-foot runway and helipad, flexible and integrated AE routes, and HN certified as United Nation/African Union interoperable combat medics with civilian health care credentials. In the initial effort of this Global Health Engagement strategy, HN personnel assigned to military or civilian units responsible for disaster response will receive tactical training based on HN and partner requirements. One training source is the Defense Institute for Medical Operations with extant courses categorized as Health Systems Management, Disaster Management and Consequence Management, Public Health and Force Health Protection, and Patient Transport and Evacuation. Unique courses offer by DoD include the following: SABC, Combat Casualty Care Course, and tactical combat casualty care. Department of State, DoD, and U.S. Agency for International Development (USAID) have the capacity to train Basic Life Support, Advanced Cardiac Life Support, Pre-Hospital Trauma Life Support, Advanced Trauma Life Support, and Advanced Life Support in Obstetrics. Indeed, such training is currently happening in African nations with train-the-trainer follow-up with external instructors. However, African International Health Specialist Team USAFE/AFAFRICA SGXD Unit 3050, Box 170 Ramstein, APO AE 09094-0170. The views expressed are those of the authors and do not reflect the official policy or position of the U.S. Africa Command, the U.S. Air Force, the Department of Defense, or the U.S. Government. doi: 10.7205/MILMED-D-15-00413