Page 140 - Journal of Special Operations Medicine - Summer 2015

two civilian men who had ran over a mine in a city ap- by saving citizens’ lives, projecting an image of concern
proximately 650 miles from the capital in Niamey. One and effectiveness to several underserved populations on
patient’s foot was partially amputated and he was losing the frontline of the border and undergoverned space,
blood rapidly. During the flight, a CASEVAC-trained while aiding directly in the perceived legitimacy of the
crew member observed that bleeding was not under government. The working group noted that they expect
control and applied a field tourniquet as instructed in an improvement in individual Niger servicemember mo-
the courses. The surgeon who received the patients and rale as they realize their country is willing to support
performed the emergency surgery to complete the ampu- them by sending a CASEVAC mission if needed any-
tation credited the man being alive to the actions of the where in the country or region. If the capacity becomes
crew member to stop the bleeding and the rapid trans- revenue generating, that will be another metric of suc-
port via a Cessna 208. cess. For Niger, the distinction of saving an American
or any other foreign citizen’s life would be huge in the
political domain. For the United States, the benefit of
RAND Metric 11: Impact on US military an American life being saved would validate why the
training and access
DoD and OSD are willing to invest in BPC-H programs.
Project Metric 11: The immediate impact on US mili- American military, state department, or private citizens
tary training is that there is another option for support benefit in having a reliable “local” option that will
as they operate in more forward locations. US forces reach locations that some commercial patient evacua-
working with partner nation personnel have a higher risk tion companies would not go, extending access to all.
threshold due to the fact that access to medical care can The best program metric would be a count toward how
be expedited via a formal system of casualty evacuation. many nations in the region request assistance with creat-
The metric is the count of how many times US military or ing similar programs. Another metric might reflect prog-
Niger’s forces request CASEVAC support or coverage of a ress toward regionalizing the capacity and developing
real world or training events. As of February 2014, there multinational centers.
had been two requests for support (Flintlock and another
field training exercise on the border). The implications Conclusion
are operational and fiscal for Niger and US goverments.
The RAND conceptual framework does aid in keeping
a program on track and providing appropriate decision
RAND Metric 12: Readiness for hand-over
point metrics that will lead to successful BPC-H missions
Program Metric 12: The process for handing over the and programs. The Niger CASEVAC program was a suc-
program was systematic and incremental. The MTT cess because even in a severely constricted time frame,
began by having the Niger CASEVAC crews lead and the approach was systematic and deliberate toward the
oversee skill stations and drills. Next, the Niger mem- objective of creating a proficient, reliable, sustainable
bers were tasked with scheduling flights and setting up system that was owned and effectively operated by the
training scenarios. An objective measure of readiness for partner nation. Different agencies for different reasons
hand-over was that individuals had completed the pro- might find a need to adjust the phasing and metrics.
gram and the MTT had records of skills performance The experience from Niger was that six phases would
and attendance. The desired indicator on the US side be more ideal and pragmatic. The scheme of metrics is
was a signed policy document. But, the enthusiasm and a function of the mission dynamics and creativity of the
independence demonstrated during the final phase vali- team. The RAND framework aids planners, trainers,
dated that the CASEVAC crews had assumed ownership and Operators in structuring engagements and missions
and were dedicated to professionalizing the capability. in the near and long term. Great strides continue in the
The Niger CASEVAC team leadership planned and or- Niger CASEVAC program. Since March 2014, the end of
ganized activities and resources for the deployment of Flintlock, the country has launched eight additional mis-
the capability to two separate locations. Without any sions. SOCAF and Niger have agreed to jointly develop a
US guidance, the team conducted their own hotwash center of excellence to teach and aid other regional part-
of activities during CASEVAC Flintlock and completed ners to develop similar capacity. Niger will host a confer-
and submitted an independent after action report with ence on patient movement in advance of Flintlock 2015.
lessons learned to the operational working group. And, finally, not only has the Niger government signed
the documents to codify their program, but they have
already expanded it by incorporating a course in their
RAND Metric 13: Level of benefit to the basic training for new recruits that teaches many of the
partner nation and the United States
lifesaving steps learned during this program. In accord
Program Metric 13: In this early stage, the program has with the RAND report, this mission was successful as
demonstrated unmeasurable benefit to the host country measured in efficiency and effectiveness. The long-term

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