Page 134 - Journal of Special Operations Medicine - Summer 2015

personnel and providing limited direct care to the indig- Figure 1 Maj Niewoonder observing students performing en
enous population in order to make a strategic difference route care skills on Cessna 208.
in the health security of a vulnerable location/region.

By layering in actual experience, we provide greater
context to the framework and enhance the construct
presented within the findings and recommendations of
the RAND report. A brief vignette of the AFSOC divi-
sion charged to carry out BPC-H is the starting point.
Next, we give the background of the development of a
BPC-H mission to Niger. Then, there is reporting of ac-
tual activities during the mission through the lens of the
four-phase framework proposed by the RAND report.
Last, we analyze the findings and recommendations of
the RAND report to aid planners and others to better
execute BPC-H missions.

Background
Lt Col Melissa Givens) was given the formidable task to
The AFSOC Surgeon (then Brig Gen Bart Iddins) created plan for medical evacuation of US personnel from Af-
a division on his headquarter staff to design and develop rica. From main cities with large airports and plenty of
policy as well as tactics, techniques, and procedures for support services (medical and nonmedical) and absent
AFSOC medical personnel that would conduct what any hostilities being involved, medical evacuation is an
was then termed “medical stability operations” and easy task due to the TRICARE contract with ISOS. The
later evolved into “global health engagements.” The SOCAF Surgeon’s tasks include extraction from for-
name of the unit was Irregular Warfare/Medical Stabil- ward operating locations, possibly during hostilities, at
ity Operations Division, AFSOC/SGK (referred to here locations with minimal support services. During course
as SGK). Like all military organizations, SGK had to of action (COA) development, the SOCAF Surgeon
deal with changes in leadership and priorities. Brig Gen consulted various experts on the civilian and military
Iddins transitioned leadership before the RAND report sides. Based on the sheer size of Africa, the key factor
was published. SGK was left in the hands of Lt Col John was determined to be the availability of fixed and rotary
Crowe, who valiantly struggled to keep the unit and wing airframes. It was deemed insurmountable to plan
mission true to the original intent. The unit was com- for coverage of all of Africa. Even reducing the area to
posed of individuals who brought with them years of merely potential operational areas was still cost prohibi-
experience in AFSOC, operational expertise from work- tive. The SOCAF Surgeon pitched several options to the
ing with other Special Forces, operational experiences SOCAF Commander but led the discussion toward an
in austere semi-premise environments, and tactical skills approach that included options for contracting for sup-
working with and through foreign cultures. The team port and partnering with host nations to develop their
included two USAF international health specialists with capability to meet their needs and mitigate some of the
language capability and professional, seasoned veterans risks and cost for the United States. With vision and in-
from the clinical, trauma medicine, public health, and tent, the building partner capacity mission was taking
contingency planning aspects of AFSOC medical func- form. However, before it could be tasked out, several
tions (Figure 1). At the writing of this article, SGK no other factors had to be worked out to determine the lo-
longer exists as a separate division on the AFSOC Sur- cation and scope of the program that would combine
geon staff. The success of SGK in the building capac- several engagements over a projected time frame.
ity mission combined with the RAND report provides
a marker for subsequent evolutions of BPC-H missions. The RAND report details a four-phase framework for
conducting HPC-H missions:
Vision and leadership are keys to building partner ca-
pacity. The RAND report clearly states that the vision 1. Consult, plan, and prepare for start-up.
and leadership must reside with the theater command, 2. Launch activities.
which must prioritize and select BPC-H missions that 3. Conduct full-scale implementation.
result in mutually beneficial outcomes. Special Opera- 4. Draw down, transition, and (possibly) withdraw.
tions Command Africa (SOCAF) was the Theater Spe-
cial Operations Command (TSOC) to task AFSOC for The RAND report describes each phase and the vari-
the BPC-H mission to Niger. The SOCAF Surgeon (then ous metrics in great detail. The report even includes a

124 Journal of Special Operations Medicine Volume 15, Edition 2/Summer 2015