Page 130 - Journal of Special Operations Medicine - Winter 2015

talking with an ambitious junior 18D on one of these in Hua Hin, Thailand, the primary vector-borne disease
upcoming JCETs, he expressed frustration with the lack of concern is dengue fever, which one must rely solely on
of available medical intelligence stating “We’ve had five the DOD Insect Repellent System to prevent, while the
JCETs to this camp in the past 7 years . . . I don’t un- primary foodborne disease is typhoid fever, prevented
derstand why the most current medical information is by vaccines, drinking approved bottled water, and mak-
from 2003.” Both of these situations identified the need ing risk-assessed food choices.
to develop a simple, yet effective medical intelligence 5. What are the not-so prevalent illnesses that may
program for 1SFG (A) to alleviate the valid operational emerge? One cannot prepare for all possible diseases in
concerns by the Battalion Commander and the frustra- the region, which is why one should primarily prepare
tions by the junior 18D. for those with a high probability. However, the opera-
tional medical team must maintain a high level of situ-
After collaborating with other USASOC FHP officers, ational awareness of the location-specific diseases that
the following list of questions were developed for an are a low probability, yet have a high severity (e.g., criti-
18D to answer prior to any OCONUS exercise or op- cal, catastrophic). An example of a low- probability, yet
eration; the MIPOE “Top Eight”: catastrophic level severity disease that resulted in the fa-
tality of a US Soldier in Afghanistan in 2009 is Crimean-
1. Where/when are we going (specifics)? This first Congo hemorrhagic fever. Early identification and
1
question generates the requirements for the remaining subsequent treatment is paramount for certain diseases;
seven and is very important to protect from location- mission preparation should include basic research on
specific, not just countrywide, disease threats, and to de- low probability, high severity pathogens for the region.
termine evacuation and treatment capabilities. Seasonal 6. Where/what is my unit going to eat/drink? Waste
variations also play a significant role in disease rates and disposal? As the lead medical authority for an ODA, the
evacuation options; a road that is 15km from potential 18D is responsible to approve food and water sources
point of injury (POI) to the nearest Medical Treatment for his team; thorough research and subsequent on the
Facility (MTF) can be easily accessible in September, but ground assessments will increase the confidence of these
not in the monsoon season in May when the JCET is approvals, and ultimately keep the ODA healthy to
scheduled. complete the mission. Recommend 18Ds are included
2. Who has gone there before? Contact them. As on all mission Pre-Deployment Site Surveys (PDSSs)
with user generated restaurant and hotel review web- to conduct Food Water Risk Assessments (FWRAs) to
sites (e.g., Yelp , Trip Advisor , etc ) the most current identify the risks associated with the locations which the
®
®
and usually the best information is from honest reports ODA will eat. This will allow the 18D to work with
2,3
of recent patrons. When planning for a mission, it is the ESEO and/or 68S (Preventive Medicine NCO) to
highly unlikely your team is the first ever to conduct develop preventive countermeasures for the actual mis-
a mission at the site; almost certainly another DoD or sion. Waste disposal is often under considered during
Department of State (e.g., US Agency for International mission preparation, yet improper methods of disposal
Development) organization has provided recent support can result in significantly high disease incident rates.
to the region. One of the most valuable resources for Human, solid, and wastewater disposal practices identi-
mission planning are the trip reports [i.e., After Action fied during the PDSS by the 18D can mitigate disease
Reports (AARs) and Special Operations Debrief and Re- impacts during the mission.
trieval System (SODDARS)], which will include point of 7. If/when a team member gets sick/injured/
contact information. Another option is to contact the wounded, what is the primary, secondary, and tertiary
country’s Defense Attaché Offices through the respec- evacuation and treatment plans? Despite all the disease
tive Theater Special Operations Command (TSOC). prevention efforts by a competent and aggressive 18D,
Utilize those with previous experiences at the location someone on the ODA is likely to require some sort of
to prepare for future missions; intelligence websites are medical care during a mission. Prior to the PDSS, an 18D
valuable, but firsthand knowledge from a trusted source should conduct thorough research on the available MTFs
is priceless. in the area from potential POI to increased roles of care,
3. What are the environmental threats? Basic, but and their ground evacuation routes. This research can be
very important—heat, cold, altitude. Learn the threats validated during the PDSS. Also, ensure everyone on the
to make sure the team is prepared for the elements. team memorizes the local “911” (in English, if available)
4. What are the prevalent diseases? What are the and has the International SOS contact information on-
TM
prevention methods? The location-specific diseases that hand for the PDSS and mission. These plans should be
are at a high rate of probability (with variable rates of printed and shared with all members of the ODA and
severity) to encounter on upcoming missions will be in- not kept only with the 18D; likely Murphy’s Law will
cluded on this list, along with their associated preven- be in full effect and it will be the 18D that needs to be
tion methods. For example, when planning for a JCET evacuated and treated.

118 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015