Page 139 - Journal of Special Operations Medicine - Summer 2015

RAND Metric 8: Readiness to scale up a 13% increase overall between the pre- and post-test.
To better evaluate process effectiveness, the MTT con-
Program Metric 8: The signed policy was a key indica- ducted one-on-one sessions with lower scoring students
tor of Niger’s readiness and willingness to scale up from to assess whether the issue was language based, inad-
an informal capability to a formal sustainable system of equate instruction, or a comprehension issue. Based on
national capacity. Two other notable measures of readi- the increase between the pre- and post-test, as well as
ness to scale up were the number of physicians assigned the observed skill improvement and meeting the target
to the CASEVAC team and Niger’s willingness to take of deployable teams to support Flintlock, the MTT pro-
the program on the road to the distant regions of the cess was rated as highly effective.
country. The program metric was a count of the number
of actual physicians. This metric was important because
the operational leaders had determine that a CASEVAC RAND Metric 10: Results of immediate outputs
team would consist of at least one physician. In the be- and intermediate outcomes over time
ginning, there were only three physicians participating Project Metric 10: “Overtime” is the central word here.
in the course; as of February 2014, there were six physi- The time condensed nature of this program does not
cians in the program. Pushing the capacity beyond the support a true longitudinal discussion. An anecdotal
capital city was the next metric. Niger is separated into measure of an important output was the observed in-
eight zones. The MTT charged Niger with introducing crease in team cohesion and esprit de corps as repre-
the capability to the zone commanders and civilian lead- sented by increased contact during breaks, minimal
ers of the distant zones. As of February 2014, a small complaints of extended hours, or even having to work
team including CASEVAC members and leaders from on some weekends. The intermediate outcomes were
the operational working group had introduced the ca- team members having social events and openly referring
pacity to six of the eight zones, with the other two zone to the CASEVAC crews of the program as their “family”
visits already scheduled to occur in May through June and the request of the members to be uniquely attired
2014. This metric was meant to drive the readiness to or decorated so as to single out their special function
scale up by incorporating a potential customer base and and capacity. The latter developed into the design and
foster ownership since it was the Niger military actually manufacture of an informal unit patch (Figure 6). An-
introducing the capability through a briefing, tour of the other output was the draft policy documents. Since the
aircraft, and demonstration of patient loading.
documents were unsigned, the outcome was yet uncer-
tain. The draft documents had been translated, format-
ted, and put into coordination. The draft does included
RAND Metric 9: Effectiveness and efficiency verbiage that not only established a new division but
of processes
also included language that allowed for the CASEVAC
Project Metric 9: As already noted, efficiency was not operations to be funded by private and government par-
a core goal at the execution stage. Data related to cost ties. If this remains in the actual formal document, it will
of lodging and fuel and number of flying hours were dramatically increase the possibility of the sustainability
collected to varying degrees but they did not truly drive of the capacity because it would be revenue neutral, if
decision making. The efficiency troubles of the MTT not revenue generating, in the national budget. A more
process that mattered were maximizing flying hours, objective and significant output–outcome relationship is
CASEVAC team training in the real environment of that eight missions had been launched to transport 13
flight, and the successful transfer of the knowledge and patients. The 13 patients included both military and ci-
skills to the CASEVAC team. Effectiveness was more vilians. On 21 January 2014, members of the CASEVAC
of a marker for the MTT. Several different tools and crews were tasked to provide casualty evacuation for
means were used to monitor the effectiveness of the
process. Attendance alone did not mean that a person
merited a certificate. The MTT accessed the number of
viable teams versus the number of three-person teams
that could be formed numerically. To overcome the lan-
guage barrier and initial lack of rapport, another metric Figure 6 Informal unit
for effectiveness was how well students could execute patch.
new skills when observed by MTT instructors. We then
advanced to skill sheets and mini tests that allowed the
individuals skills to be graded. Next we required them
to teach the skills to each other or uninitiated personnel
while observed by their peers. In the validation phase, we
incorporated a pre- and post-test. The students showed

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