Page 127 - Journal of Special Operations Medicine - Fall 2015

This article will review three of the major types of as- familiar with healthcare facilities can conduct this as-
sessments conducted in Africa, their benefits, who can sessment. A healthcare facility assessment does not au-
perform them, estimated time of completion, and what tomatically approve the facility for direct TRICARE
their purposes and limitations are. reimbursement nor can it approve procurement of sup-
plies and services from that facility outside of emergen-
Occupational and Environmental Health Site cies. For instance, a hospital that can generate oxygen
Assessment (OEHSA) cannot be used to refill US portable oxygen containers
An OEHSA is a comprehensive baseline assessment of without an additional evaluation and approval. It will
occupational and environmental health threats related familiarize the deployed medical provider with the ca-
to a location and the associated activities and missions. pabilities of the nearest facility that can be used as a
Ideally, OEHSAs are initiated prior to occupation of medical contingency. It can foster relationships with the
a site and reassessments are conducted periodically as medical providers and staff to expedite the use of the
required to identify, document, and provide mitigation facility in an emergency and also open opportunities for
for health threat exposure pathways. Army Techniques medical engagements. A health facility survey generally
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Publication 4-02.82 guides the multiphased OEHSA takes a few hours to complete, but even a 1-hour visit
process. It outlines activities and objectives from pre- will provide a few pieces of valuable information.
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deployment through the completion of the site assess-
ment and sampling analysis, and contains an example Food and Water Risk Assessment
report. OEHSAs are primarily conducted by preventive Food and water risk assessments (FWRAs) are com-
medicine personnel (service equivalents of Army envi- pleted in areas where approved sources are not avail-
ronmental science and engineering officers or preven- able or where a veterinary-approved source audit would
tive medicine technicians), but any medical provider be impractical, and when US government funds will be
can conduct an OEHSA commensurate with their level used to procure food or water. FWRAs are not required
of expertise. The OEHSA process was designed to be if personnel are on per diem and personally procuring
iterative, so any amount of information or updates food. This is the case for many temporary duty person-
that can be obtained on a location is valuable. Preven- nel staying at hotels, or when teams hire a local cook
tive medicine personnel can use basic information ob- or deploy a cook with the team and buy food from the
tained by providers as a way to prioritize robust site local market. At the time of publication, there are only
assessments and environmental sampling. An OEHSA 18 approved food or water sources in Africa. FWRAs
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is not intended to document deployment-related, pop- can be conducted by all SOF medical personnel who
ulation-based exposures in individual medical records. have received the requisite training. FWRAs will allow
Specific incidents can be documented with individual a commander to use government funds to procure food
patient encounters. A periodic occupational and envi- and water from local sources, but they do not approve
ronmental monitoring summary (POEMS) is the offi- the source. They are limited to the particular exercise,
cial multi- Service-approved document that summarizes deployment, unit, or event being supported, and should
Department of Defense (DoD) medical interpretation be repeated every 6 months. FWRAs are also not in-
of occupational and environmental health exposure in- tended for bottled-water plants. They are often used
formation and data for deployed sites. They use a wide in conjunction with in-depth bottled-water sampling
range of data, including sample results and OEHSAs, to analysis, as there is not a mechanism to inspect bottled-
describe exposure hazards, summarize information, and water plants for short-term use outside of an approved
assess the significance of acute and long-term health ef- source audit. Given fiscal limitations in Africa, many
fects. A full OEHSA can take as little as a day or up to facilities do not have the infrastructure or equipment re-
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a couple of days to complete, depending on the size and quired to pass an audit, so an FWRA is the best tool the
complexity of the deployed location. commander has. Local contracting offices will have dif-
ferent FWRA documentation requirements. Depending
Health Facility Survey on the size of the facility and the complexity, an FWRA
The Special Operations Command (SOCOM) Health can take between a few hours and a day to complete.
Facility Survey Sheet is the required format to be used to
conduct a capabilities assessment of local clinics, hospi- These are the primary kinds of assessments and many
tals, laboratories, or other healthcare-related activities. of the common FHP or preventive medicine core tasks
Surveys of local health facilities can be crucial in iden- are components of these larger products. For instance, it
tifying local medical expertise or equipment capabili- is not uncommon for a unit to request FHP to conduct
ties that could be used in an emergency. Many medical a dining facility inspection without knowing what they
facilities in Africa are well below Western standards, require is actually an FWRA. Generally, it is most ben-
and things like sterile tools, clean running water, and eficial if individuals going to Africa to conduct an FHP
consistent electricity are often unavailable. Any person assessment or task initiate or update the OEHSA and

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