Page 128 - Journal of Special Operations Medicine - Summer 2016

and educate personnel at the senior Air Force, Health, security, and cooperation among our partners and will
and Defense Department levels in addition to the em- only continue to grow in demand. As we consider future
bassy team. However, the support of these individuals GHE operations, we should strive for PN ownership and
is critical to overall endorsement, PN ownership, and sustainability that actually improves PN capacity and in-
program sustainability. frastructure. During the Niger-led CASEVAC course, I
clearly remember a key conversation with one of the in-
Importance of basic concepts and people structors. “Hey Doc, this is how we are going to do our
It cannot be overstated that humans and the basic con- final training scenario for tomorrow.” He proceeded
cepts taught and practiced are more important than to outline all of the steps required for teaching and ac-
fancy equipment and training. Teaching a PN and pro- complishing the objectives for the students. I smiled and
viding equipment or training outside of their supported gave the thumbs up with nothing more to add. The un-
health-care infrastructure is often fruitless and yet this derdog was now running the show.
occurs frequently across GHE operations. Upgraded
medical equipment for training may be appropriate but Disclaimer
usually requires a bolstered infrastructure to support it.
If the infrastructure cannot be influenced, it probably The views expressed are those of the authors and do not
should not be provided. Our experience in Niger rein- reflect the official policy or position of the US Air Force,
forced the importance of simple and mobile CASEVAC the Department of Defense, or the US Government.
supplies and equipment based on Tactical Combat Ca-
sualty Care principles. More practice repetitions with Disclosure
simple equipment is preferred to minimal practice with
complicated equipment. The author declares no conflicts of interest.

Empowering the PN References
In Niger, it did not take long for the PN to see the im-
mediate benefit of a CASEVAC system once they were 1. United Nations Development Program. Human development
able to move casualties off the battlefield in an expe- reports: international human development indicators. 2015.
http://hdr.undp.org/en/countries. Accessed 1 January 2016.
dited fashion. Their motivation, compassion, and desire 2. Givens M, Verlo A. MEDCAN-GRO: medical capacity for Af-
to learn provided the tipping point for full ownership of rican Nations—growing regional operability. A case study in
this process. In addition, this capability bolstered troop Special Operations Forces capacity building. J Spec Oper Med.
morale when countering VEOs and had rapid support 2015;15;1:105–112.
from the PN ground forces. This is an important point 3. Scott A, Hogan R. A case study of MEDCANGRO relative to
and should be accessed early on when planning GHE RAND conceptual framework. J Spec Oper Med. 2015;15;2:
123–131.
activities. If the motivation and compassion are lacking
early in the process, it is highly unlikely a PN will own
and sustain a program.
Maj Flatau, USAF, MC is the Deputy Surgeon for the Air
Through our frequent visits and ongoing relationship Force Special Operations Air Warfare Center (AFSOAWC) at
development, we were able to encourage and provide Duke Field, Florida. He is board certified in Family Medicine
ongoing support to key CASEVAC leaders and decision with a fellowship in Wilderness Medicine and serves opera-
makers. Reiterating and emphasizing the importance of tionally as an AFSOC Flight Surgeon and Combat Aviation
improving mortality and morbidity along with review- Advisor. The AFSOAWC Medical Operations Division leads
ing PN lessons learned helped facilitate ongoing PN mo- AFSOC GHE/IHS activities and provides medical support to
tivation, empowerment, and capacity improvement. all AFSOAWC IW/AvFID operations globally.
E-mail: s8pflatau@gmail.com.

Conclusion
The Niger CASEVAC program offers key lessons for
GHE/IHS leaders throughout the military and inter-
agency communities. Effective and sustainable GHE pro-
grams remain critical for improving regional stability,

114 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016