Page 89 - Journal of Special Operations Medicine - Winter 2015

Figure 1 Dengue management do’s and don’ts. medical personnel should consider what resources will
be required to prevent, diagnose, and, where applicable,
at least initially treat the broad spectrum of illnesses that
they may encounter.

Second, we realized in this setting that medical per-
sonnel outside Special Operations may not be familiar
with tropical infectious diseases and may not be aware
of what diseases are endemic to the areas of operation.
Special Operations medical personnel must remain
adequately educated in tropical infectious disease to
counter this lack of familiarity among other medical
personnel. Many US-trained physicians will never see or
treat these illnesses and may spend an entire career only
hearing about them peripherally. However, SOF medi-
cal personnel should expect to encounter tropical infec-
tious diseases in their operations around the globe. They
may, by default, be the local expert among US medical
Courtesy of Centers for Disease Control and Prevention. advice on management of tropical illness. If they are not
personnel and, as in this case, may be asked to provide

the primary treating provider, SOF medical personnel,
at the very least, should be able to provide the treat-
ing provider with a background on what illnesses are
endemic to the area of operations and should be con-
sidered in a Soldier who becomes ill during or after op-

Military Tropical Medicine course at the Uniformed Ser-
vices University, or the Operational Clinical Infectious
Source: CDC, at http://www.cdc.gov/dengue/resources/ erations in that area. Attendance at courses such as the
Disease course at the Walter Reed Army Institute of Re-
DENGUE-clinician-guide_508.pdf. search should be encouraged for all SOF medical per-
sonnel. These courses should especially be emphasized
to their area of operations but also to the prevention for SOF medics, when available, to provide a structured
of illnesses. The illness in this case very likely could period of review and education in tropical disease. Cre-
have been prevented had greater emphasis been placed dentialed SOF medical providers should remember to
on compliance with all vector-borne illness prevention include discussions of endemic tropical disease in non-
measures. Classroom exposure to tropical medicine and trauma training modules for SOF medics. This training
infectious disease during initial SOF medical training should place an emphasis on prevention and should in-
may leave some SOF medics feeling overwhelmed at clude a discussion of tropical and travel medicine re-
the possibility of someday being required to diagnose sources where country and/or region specific tropical
and treat a multitude of tropical diseases without spe- disease information can be obtained. Both civilian- and
cialty consultation. Yet this may quickly become a real- military-specific online resources exist that can provide
ity, particularly in situations where even a newly trained an introduction to expected infectious disease threats in
SOF medic may be operating relatively independently, a country. A full discussion of these resources is beyond
as is frequently the case during deployments through- the scope of this report, but a brief sampling of some of
out Asia. These same SOF medics should remember that these resources can be found at the NEPMU Unit Two
they can significantly lessen the likelihood of these in- (NEPMU-2) Threat Assessment web page (http://www
fections and make a tremendous difference in maintain- .med.navy.mil/sites/nepmu2/Pages/threat_assessment
ing the general health of their team simply by working .aspx). Additionally, review of prior unit after action
with leadership to encourage and enforce basic sanita- reports may provide similar information, and trusted
tion, hygiene, and preventive measures. Predeployment host-nation medical providers may provide a wealth of
medical planning should always include a thorough knowledge of disease patterns among the populace.
study of the area of operations, including of expected
endemic disease. The National Center for Medical In- In summary, the management of this case reminded us
telligence (NCMI) and Navy Environmental and Pre- of the necessity to maintain competence in nontrauma
ventive Medicine (NEPMU) also offer consultation and medicine even in wartime, and specifically in tropical
advice. Likewise, when packing for these missions, SOF infectious disease. We think SOF medical personnel will

Tropical Disease Case Study: Fever and Thrombocytopenia 77