Page 127 - Journal of Special Operations Medicine - Summer 2016

Figure 4 A Nigerien instructor teaches during the Figure 6 Nigerien CASEVAC team receives a real-world
first-ever Nigerien-led CASEVAC course (provided by CASEVAC from a forward operating base (provided by
Maj Philip Flatau). Maj Philip Flatau).

Figure 5 Final CASEVAC exercise. Instructor monitors
students preparing to load patient onto a Cessna 208 used for recognized as we consider best practices approaches to
CASEVAC (provided by Maj Philip Flatau). GHE and IHS activities.

Relationship- and time-intensive model
Nine missions were dedicated to developing this ca-
pability in Niger over 3 years. A relationship-driven,
time-intensive approach is often needed to develop any
long-term sustainable program. This should come as no
surprise but is a good reminder as we plan and execute
strategic GHEs. Too often, we have failed our PN col-
leagues by planning and executing short-term and short-
sighted engagements that often leave the country with
little to no benefit.

PN policy and ownership
Our model was based on PN-owned and -developed
CASEVAC policies and SOPs that work within their in-
frastructure and constraints, not ours. Our experience
the African continent and a key sustainability marker has taught us that if you do not have something formally
(Figures 4 and 5). In addition, the PN continues to fly in writing that is endorsed by senior-level PN leaders
multiple, real-world CASEVAC missions in support of and applicable to all parties, then the program does not
ongoing combat operations providing basic, yet life- exist and will not last going forward. In essence, it will
saving, care en route to higher-level medical care (Fig- be of little value to provide training and equipment to
ure 6). Finally, an Air Forces Africa IHS representative a country that does not have a foundational policy that
was able to witness this care and motivation as SO- validates and officially recognizes the skills and ability
CAFR transitions this program to conventional assets. of the trained personnel. Policy and SOP development
This face-to-face, in-country handoff provided a criti- also provide critical benchmarks of success in which to
cal link to ensure ongoing sustainable support to the progress into the next phase.
PN and should be considered as a template for future
operations. Decision-maker influence
Who are the key leaders and decision makers within a
country for the program desired? Within many countries
Lessons Learned
throughout the world, command and decision-making
The CASEVAC program stands out among African authority are rarely delegated, leaving a GHE team with
countries as successful for a variety of reasons. As the the need to educate or influence multiple key personnel.
program evolved, resulting in Nigerien-led operations, Understanding the culture is key. This was our experi-
key lessons were learned that should be reviewed and ence in Niger. It took time to build these relationships

Niger’s CASEVAC Success 113