Page 132 - Journal of Special Operations Medicine - Winter 2015

2. Upson S. Jordan’s radioactive water problem. IEEE Spectrum. Figure 2 US Servicemembers stand in line to have their
http://spectrum.ieee.org/energy/environment/jordans-radioactive temperature checked as they exit the KC-130.
-water-problem.

Initial Preventive Medicine Response
to Operation United Assistance
Paul Lang, MS, MPH, REHS/RS

“Force Health Protection — Measures to
promote, improve, or conserve the behavioral
and physical well-being of Service members to
enable a healthy and fit force, prevent injury
and illness, and protect the force from health
hazard.”—JP 1-02

Introduction
The need for Force Health Protection (FHP) is arguably United Assistance (JFC-UA) was able to operate safely
greatest while conducting theater opening operations. and effectively which led to a successful transition to the
The Army Operating Concept (AOC) lists setting the 101 Division (Airborne) Headquarters.
st
theater as a core competency the Army must be able to
accomplish as part of a Joint Force. The medical sup-
1
port is accomplished through the two distinct portions Health Risks to the Force in an Immature Theater
of the Army Health System (AHS): Health Service Sup- “Good doctors are of no use without good
port (HSS) and Force Health Protection. The primary re- discipline. More than half the battle against
sponsibility of FHP is to conserve the fighting strength of disease is not fought by doctors, but by
the force. Specifically, this includes providing timely FHP regimental officers.”
information and recommendations to the commander in —Lieutenant General William Slim
a manner that supports his/her decision cycle. Planning (1891–1970), Burma Campaign, 1943
and executing the FHP plan for Operation United As-
sistance (OUA) was a successful endeavor due, in large Contrary to public opinion, the number one infectious
part, to the command influence and time spent support- disease risk for Servicemembers deployed in support of
ing prevention methods. The National Center for Medi- OUA is malaria. As of this writing, no Servicemember
cal Intelligence (NCMI) rates Liberia as a very high risk supporting OUA has been diagnosed with malaria. Com-
country for infectious disease. The first US forces for paratively, in 2003, 80 of the 200 US Marines deployed
OUA touched down in Liberia in mid-September, includ- to Liberia contracted malaria within 10 days of being
ing the US Army Africa Commander, Major General on the ground. Key differences were command influence
2
Darryl Williams, and select members of his primary staff, and strict adherence to prevention principles. The JFC-
including the Command Surgeon. United States Army Af- UA Commander and Command Sergeant Major under-
rica (USARAF), the Army Service Component Command stood the malaria risk and made daily direction of the
(ASCC) to US Africa Command (AFRICOM), served as importance of prevention protocols through JFC wide
the initial Joint Force Command headquarters element video teleconferences, meetings, and through leadership
for Operation United Assistance (OUA). Within the first channels. Leadership, at every echelon, understood the
45 days, the population at risk (PAR) for infectious dis- highest risk to JFC-UA was malaria, and they enforced
ease totaled over 500 people. Although it is too early to multiple programs to ensure compliance with FHP pro-
see disease and injury (D&I) trends, the early observed tocols. These measures included observed compliance of
rate of common illnesses affecting Servicemembers in an malaria chemoprophylaxis, use of bed nets, application
austere environment was markedly diminished (Figure 2). of insect repellants on the skin, and the use of perme-
thrin-treated uniforms. Upon arrival into theater, each
Challenges highlighted in this article stem from both Servicemember received a briefing that included simple
conducting a large military operation in Western Af- tools to prevent disease, injury, and illness (Figure 3).
rica and a slightly atrophied ability of the US Army to
conduct theater setting activities in an austere environ- Another high risk to the deployed force is eating food and
ment. The intent of this article is to show that despite drinking water from unapproved sources. Prior to the ar-
conducting operations in one of the highest risk areas of rival of JFC-UA, the US Marines maintained a constant
the globe for infectious disease, Joint Force Command– presence of around 40 personnel in Liberia for Operation

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