Medical Readiness Training Exercises Research Articles

The U.S. Must Embrace Partner-led Global Health Engagement.

Direct-care Medical Readiness Training Exercises (MEDRETEs) are a popular method for conducting global health engagement. Unfortunately, direct-care MEDRETEs build partnerships without building partner nation capacity. This article proposes that global health engagement should instead focus on partner-led health engagements to accomplish both of these goals.

Improving Care of Cleft-Related Velopharyngeal Incompetence on Humanitarian Missions Using a Multidisciplinary Team Approach.

Proper evaluation and analysis of speech surgery outcomes for cleft-related velopharyngeal incompetence in children and young adults performed on humanitarian missions is poorly characterized. The aim of this study is to examine the effect of using a multidisciplinary team on cleft-related humanitarian missions. The effect on patient selection, velopharyngeal mechanism imaging, and speech outcomes after surgery will be highlighted. A review of the Medical Readiness Training Exercise database for craniofacial missions to the Dominican Republic from 2009 to 2011 was performed. A speech pathologist and a craniofacial surgeon evaluated all patients with a diagnosis of cleft palate and speech abnormalities. Patients were screened using speech analysis and selective nasal endoscopy. Data collected included sex, age, diagnosis, speech scores, date, and type of surgical procedure-that is, pharyngeal flap (PF) versus sphincter pharyngoplasty (SP), morbidity, and mortality. One hundred twenty-six patients with cleft palate were screened during the study period by a craniofacial surgeon and secondarily by a speech pathologist. Twenty-eight patients were identified with nasal quality speech of whom 12 patients (12/126 = 9.5% of total surgical cases) underwent PF/SP surgery after previous primary repair of a cleft palate defect. The 16 remaining patients (16/28 = 57%) with nonsurgical speech abnormalities were determined that surgery was not going to be beneficial and they were spared unnecessary surgery after speech pathology evaluation and nasal endoscopy. Eight patients were female and 4 patients were male; average age was 13.3 years (range 4-27 years). Seven pharyngeal flaps (58%) and 5 (42%) sphincter pharyngoplasty procedures were performed. The average presurgical speech score was 11.4 (range 6-24). There was a significant decrease in postsurgical speech scores with the average postsurgical speech score of 5.2 (range 0-21, P value = 0.0028). Follow-up evaluation averaged 18 months (range 6-24). Average hospital stay was 2 days for PF/SP surgery. Two patients, both with developmental delay, retained speech scores greater than 6. There were no major complications or reoperations. Pharyngeal flap/sphincter pharyngoplasty surgery in young adults resulted in improved speech scores and comprehensibility after speech surgery on Medical Readiness Training Exercise military humanitarian missions. Speech surgery in older patients in relatively austere environments is safe and effective. After comprehensive multidisciplinary team evaluation, 43% of the patients who were screened to have velopharyngeal incompetence were identified as surgical candidates. Fifty-seven percent of patients evaluated by speech pathologist were recommend nonsurgical solution toward improving speech scores sparing them unnecessary surgery. The incorporation of a speech pathologist to the humanitarian mission resulted in identifying surgical candidates who would benefit the most from intervention and improved speech surgery outcomes.

The Importance of Medical Readiness Training Exercises: Maintaining Medical Readiness in a Low-Volume Combat Casualty Flow Era.

Ringed external fixation has demonstrated promising results in the management of severe combat-related extremity injuries. The purpose of this study was to identify and compare rates of wartime-related surgical cases at times of high and low casualty time periods, and then compare these case numbers with those performed during a 2-week Medical Readiness Training Exercise (MEDRETE) in Honduras. A retrospective review was performed of patients treated at a single Military Treatment Facility with definitive ringed external fixators during a 2-year period of high-volume combat casualty flow (January 2009-December 2010) and a subsequent 2-year period of low-volume combat casualty flow (January 2013-December 2014). These data were then compared with cases performed over a 2-week period during a MEDRETE in 2011 to Honduras. Sixty-one cases were identified as having definitive treatment using ringed external fixation at the Military Treatment Facility during the high- and low-volume eras. During the high-volume era, 47 ringed external fixators were used as a definitive treatment. During the low-volume era, only 14 of the definitive ringed external fixation were identified. Of the 32 total cases performed during the 2-week MEDRETE to Honduras, 11 cases of definitive ringed external fixator placement were performed. This accounted for 34.4% of all cases performed during this 2-week period. Appropriately planned MEDRETEs can provide a concentrated case volume to allow maintenance of complex surgical skills related to the management of severe combat-related extremity injuries. These training exercises will be vital to maintain surgical skills during a low-volume combat casualty flow era.

Kitona 2013: A Medical Readiness Training Exercise in the Democratic Republic of the Congo Leading to Lion Rouge.

Health initiatives support regional stability and are a priority for US and African partners. We present data and experience from the Democratic Republic of Congo (DRC), a strategically and epidemiologically ideal location for collaborative medical engagement (CME). Our objectives included relationship building, exposure of US military medical personnel to uncommon tropical diseases, bolstering a referral hospital, and updating Congolese physicians on new treatment or preventive standards of care. We conducted a CME-styled medical readiness training exercise (MEDRETE) at the Military Referral Hospital of Kitona in June 2013. US and Congolese healthcare providers presented 20 lectures and evaluated 158 patients collaboratively; 132 for infections. The CME led to Lion Rouge, the first joint military, multidisciplinary engagement between the respective militaries. Equally noteworthy is that some of the same participants returned to the same location for the follow-on exercise, providing continuity. These outcomes suggest the MEDRETE and CME approaches were successful.

The complicated life of a physician-soldier: Medical readiness training exercises & the problem of dual loyalties

While physicians are generally understood as owing moral obligation to the health and well being of their individual patients, military health professionals can face ethical tensions between responsibilities to individual patients and responsibilities to the military mission. The conflicting obligations of the two roles held by the physician-soldier are often referred to as the problem of dual loyalties and have long been a topic of debate. This paper seeks to enrich the dualloyalties debate by examining the embedded case study of medical civilian assistance programs. These programs represent the use of medicine within the military for strategic goals. Thus, a physician is expected to meet his obligation to his role as a soldier while also practicing medicine. These programs involve obligations inherent in both roles of the physician-soldier and thusly they serve as excellent exemplars for the problem of dual loyalties at an institutional level. This paper focuses on Medical Readiness Training Exercises (MEDRETEs). These programs are short-term, generally taking place in low-income nations in order to accomplish strategic goals including training opportunities for military medical professionals that are not possible on the home front. This form of temporary program raises ethical concerns regarding the exploitation of vulnerable populations and the value of what is termed “parachute medicine”. The short-term nature of these interventions makes long-term treatment and follow-up impossible, begging the question as to whether this peak and trough approach to foreign civilian aid is of any use. Physicians are generally understood as having obligations towards the well being of the patient, which these programs do not necessarily prioritize. Rather, the programmatic intent is military, with political and strategic aims of furthering international relations, increasing US military global presence and providing austere and tropical training opportunities for military healthcare providers. This can be morally problematic for the physician-soldier.

Recommendations for Diarrhea Management During Medical Stability Operations

Training and planning for medical stability operations, to include humanitarian assistance, disaster relief, and medical readiness training exercises, has taken on new importance for today's military forces. Deployed medical forces providing care to local populations are presented with the challenge of limited resources and complex public health needs. In this paper, we review the epidemiology of diarrhea as one of the leading causes of mortality in these settings and provide an evidence based-approach for management within the framework of military medical stability operations.

Lessons Learned from a Successful MEDRETE in E1 Salvador

Medical readiness education and training exercises are short-term exercises designed to provide health care and preventive medicine education to underserved civilian populations overseas. These high profile missions provide superb training opportunities, build democracies, and can be a powerful incentive to retain soldiers in the Reserves. Despite this, the literature offers little guidance in terms of how to best conduct a MEDRETE, particularly with a unit that has not been recently deployed. A U.S. Army Reserve unit was deployed to El Salvador following two devastating earthquakes and treated 20,890 patients in 10 days. This patient volume was achieved by a close cooperative effort among an experienced Mission Coordinator and Reservists and superb host nation support. Lessons learned regarding predeployment, deployment, patient management, and safety issues are presented to assist future units in conducting successful medical readiness education and training exercises.

Urology/Urogynecology Medical Readiness Training Exercise: Experience for the Military Surgeon

A medical readiness training exercise was conducted in conjunction with Task Force Bravo in Honduras during July and August 2000. Surgical teams from Madigan Army Medical Center performed 46 major pelvic reconstructive surgical procedures and treated more than 300 patients. The mission was an exceptional training opportunity for Army Medical Department personnel, who performed complex surgical procedures with limited logistical support under austere surgical conditions. Team members gained invaluable experience in mobilization preparedness and tested their predeployment training and resourcefulness while providing needed services to the people of the host nation.

Medical Readiness Training Exercise in El Salvador, Central America, 1996

Medical Readiness Training Exercises (MEDRETEs) can be a valuable training tool for U.S. Army personnel in remote areas of deployment. We report our experience of the MEDRETE in El Salvador in 1996. Working with foreign physicians of the host country was a positive experience in which we learned local customs and mutual cooperation. Evaluation and treatment of nearly 6,000 patients increased goodwill in the community and provided an opportunity for teamwork for Army Reserve medical units, including increased discussions of public health issues. We also report on the field applicability of the advanced laboratory and pharmacy equipment we included in our training.

The Practice of Obstetrics in Mongolia

Sponsored by the US Department of State and the US Army Pacific as part of a Medical Readiness Training Exercise, 17 physicians from Tripler Army Medical Center traveled to Outer Mongolia during September 1995 to examine the practice of medicine in the country. The obstetrical care observed was delivered at Third Women's Hospital in Ulanbataar. Prenatal care in Mongolia is provided mainly by family physicians, with the family doctor visiting each pregnant patient every month for the first 5 months, increasing to weekly visits at 7 months. The patient is taken to an obstetrical or women's and children's hospital when she reaches term or goes into labor. The staff at Third Women's Hospital deliver approximately 2000 babies annually and perform approximately 1000 pregnancy terminations through sharp curettage. The cesarean section rate is reported to be 10%. The hospital has no laboratory or X-ray capability, but can send out for such tests on rare occasions. During labor, patients are fully ambulatory on an as-needed basis. Fetal monitoring is not routinely available, except for occasional auscultation, patients in labor were not given IV fluid, delivery rooms were bleak and with only antiquated equipment, lighting was poor, and gloves were reused until they were too tattered for reuse. The authors discuss their experience with 3 cesarean sections and 1 ectopic pregnancy performed while in the country.

Eyeglass MEDRETE: Practical Considerations (A User's Guide)

This article presents the experiences of two independent practitioners who participated in eyeglass-dispensing medical readiness training exercises (MEDRETEs) in Central America. It explains the importance of defining personnel policies, having the proper equipment, utilizing the retinoscopists optimally, and having an adequate supply of eyeglasses with plus lens power for indigenous persons in this geographic area. To maximize the effectiveness of a MEDRETE, a dispensing optician and two teams of translators are needed. Triage of patients will permit the optimal number of refractions and distribution of corrective lenses to those most in need. Fitting indigenous patients with corrective lenses in one of the more tangible and lasting effects of a MEDRETE. It contributes not only to patient satisfaction but possibly to improved relationships with the host nation.

The Maturing of MEDRETEs

The Medical Readiness Training Exercise (MEDRETE) is generally regarded as an effective tool for enhancement of U.S. foreign policy in developing nations. However, if MEDRETEs are evaluated with parameters other than emotion, there is found to be little durable effect and virtually no improvement in the health status of the host nation. The classic MEDRETE is ineffective, costly, and provides only an evanescent benefit to the served population. It should be replaced by PMRETEs (Preventive Medicine Readiness Training Exercises) targeting preventive medicine concerns which would provide low-cost, durable contributions to the health status of growing nations.

Use of Lightweight X-Ray Machine and Processor during Riverine Medical Readiness Training Exercise on the Amazon River

A small lightweight X-ray machine and processor are needed for use in military medicine for humanitarian service missions, training exercises, and even tactical situations. Size and weight have frequently been a limiting factor for the use of X-ray equipment in military medicine. The large size and great weight of X-ray equipment often limit its use and make this diagnostic modality unsuitable. I believe that a smaller X-ray machine, combined with the new improved lightweight Polaroid processor and film, can provide adequate X-ray exams in a high percentage of patients.

Medical Readiness Education and Training Exercises by United States Army Medical Personnel in Kenya

Medical Readiness Education and Training Exercises (MEDRETEs) enable United States military medical personnel to sharpen their skills in diagnosis and treatment of common illnesses in rural third world populations. We report our experiences on MEDRETEs conducted during recent exercises in the Republic of Kenya involving United States and Kenyan forces. Respiratory, musculoskeletal, and eyes, ears, nose, and throat conditions comprised 55% of cases. In 73% of cases, the final diagnosis and the chief complaint were in the same diagnostic category. In asymptomatic patients, 17% had physical findings suggestive of significant disease. Anecdotal experiences demonstrated the importance of the local environment and social customs in the genesis of certain illnesses and symptoms.

The Medical Care System and Medical Readiness Training Exercises (MEDRETEs) in Honduras

Honduras is the second largest and one of the least urbanized of the six Central American countries. Beginning with Big Pine II Military maneuvers in August 1983, U.S. military medical personnel based in Palmerola, Honduras, have been involved with a civic action-type training activity termed the Medical Readiness Training Exercise (MEDRETE). Medical officer and enlisted medics from the three services have had the opportunity to receive military medicine training in a Third World environment. The planning, preparation, and initiation of these training missions and the benefits to the participants and recipients are discussed.

Cold Injury Complicating Trauma in the Subfreezing Environment

During the Winter Medical Readiness Training exercise in Maine, simulated victims developed early hypothermia while in the subfreezing environment prior to medical attention. The early changes of hypothermia were aggravated by wet, cold clothing sustained during an associated fire fighting exercise. A literature search has revealed that the use of polyethylene envelopes to protect individuals from the effects of wind and cold while awaiting medical attention can significantly retard the development of cold injury especially in the injured patient with exposed cold, wet flesh. A proposal for polyethylene envelope use along with available low temperature reading thermometers is made as a result of this experience and subsequent literature review.