Page 118 - Journal of Special Operations Medicine - Spring 2015

care and assisted coordination of regional assets. In­ communications, logistics, and operational planning with
struction is applicable to all levels of providers (layman, command and control, should be conducted to establish
medic, nurses, physicians, and other support personnel) common operating procedures and subsequent interop­
with a focus on common language and training to op­ erability. Mastery of tactical level application of medical
timize continuity of care within the healthcare system. and public health skills opens the door for more sophis­
“Train the trainer” courses are integral to the pathway ticated healthcare networks that require more complex
for partner nations to establish and maintain their own communication and logistic systems to support opera­
training in the absence of a US presence. Resources for tions. The adjunct training modules of the MEDCAN–
instruction can be scaled to be congruent to host­nation GRO model tie the foundational components together
capabilities, with modified packing lists for individual to support a robust prehospital system capable of in­
first aid kits (IFAKs), combat lifesaver bags, medic bags, corporating a mobile Role 2 with a strong public health
aid station sets, and configuration of Role 2. underpinning (Table 3).

The second foundational pathway focuses on force health Realization of such a robust training model would best
protection and basic public health measures (Table 2). be facilitated by a Regional Training Center of Excellence
Individual responsibility for hygiene and for food and to bring representatives from multiple nations together
water safety is the building block on which team/family to train collaboratively and share lessons learned unique
environmental science principles are taught, with devel­ to their region. By regionalizing education and train­
opment of more mature community­ and region­based ing, scarce resources can be shared with a focus on op­
sanitation efforts. Minimal expenditure of resources timizing use of valuable equipment and personnel. US
for education and development of hygiene, water, and personnel can benefit by having a collaborative nucleus
waste management can have profound impacts on the within a diverse healthcare network from which infor­
health of individuals and communities in developing na­ mation can be exchanged and assistance efforts targeted
tions. Such efforts are often complementary to critical in the most appropriate manner.
infrastructure development by other agencies with more
robust resources and longevity in a region. Reinforce­ MEDCAN–GRO Case Studies
ment of basic public health measures pays dividends for
all stakeholders in a region. Special Operations Command Africa (SOCAFRICA)
has used the MEDCAN–GRO model in two separate
For linkages to occur between units and their counter­ regions, with tangible positive outcomes and a pathway
parts, training adjuncts in support systems, to include for future development. These case studies highlight how

Table 2 Environmental Health Training
Phase EHS Training Objectives Resources Contact Time
I Disease transmission Individual, family unit, and community 1–2 trainers per 20–40 4 hours
education on fecal­oral and vector disease students
transmission, hand­washing procedures, and (ESEO/PM tech/18D/IDC)
hygiene awareness
II Water, waste, and vector Family unit/team water supply quality 1–2 trainers per 10 family/ 18 hours
management (team/family) and protection; wastewater and excreta team leaders
management; vector control; safe food (ESEO/PM tech/18D/IDC)
handling, preparation, and storage; basic field
sanitation team concepts
III Water, waste, and vector Community or area water supply quality 1 trainer and assistant per 10 18–24 hours
management, disease and protection, wastewater and excreta community or unit ES leaders
surveillance (unit/ management, vector control, basic principles (ESEO and PM tech/18D/IDC)
community), deployment of base camp and ISB establishment
environmental health
IV Regional sanitation and Government or regional agencies 1 trainer (ESEO) and one 24–36 hours
public health policies, implementing sanitation policies that facilitate interagency facilitator with
QA/QC and evaluation, improved municipal services, development of representation of key host­
deployment environmental regional water supply management, QA/QC nation pertinent agency
health and evaluation of sanitation systems, routine leadership
site assessments, and health risk evaluation at
deployed locations
Notes: 18D, Special Operations medic; ES, environmental science; ESEO, environmental science education officer*; IDC, independent duty
corpsman; ISB, intermediate staging base; PM tech, preventive medicine technician; QA, quality assurance; QC, quality control.
*Environmental or civil engineer, entomologist, or public health officer may substitute.

108 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015