Page 77 - JSOM Winter 2018

Evaluation of a Concept for a
Military Expedition Performance Environment

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R.R. Berendsen, MD , DiMM; B. Vieyra, MD ; G.J.W.M. Rietjens, PhD ; R.T.N. Beckers;
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R.A. van Hulst, MD, PhD ; C.E.L. Boumeester ; CDR R. Hoencamp MD, PhD, FEBVS, DMA *

ABSTRACT
To evaluate four factors essential in the preparation of high- FIGURE 1 Military Expedition Performance Environment (MEPE)
altitude expeditions and of the performance during these concept.
expeditions, the Manaslu 2016 Medical Team, as part of
the medical team of the Royal Netherlands Marine Corps
(RNLMC), developed the Military Expedition Performance
Environment (MEPE) concept. The scope of this concept is
intended to cover (1) selection of a team, (2) medical planning
and support, (3) competencies in the field (team work and hu-
man factors), and (4) and chain of command.

Keywords: Manaslu 2016 Medical Team; Royal Netherlands
Marine Corps (RNLMC); Military Expedition Performance
Environment (MEPE); teams; planning, medical; chain of
command
The primary aim of this study was to provide guidance on
possible essential pre-expedition and per-expedition factors
for successful achievement of the predefined goal. The second-
Introduction
ary aim was to assess ability to meet all key aspects proposed
“The chief work of the surgeon of a polar expedition is done in the MEPE concept
before the ship leaves England” is a quotation from Alexander
Macklin, surgeon on two of Ernest Shackleton’s expeditions. Methods
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This quotation still stands today and applies to commercial
and military expeditions. Medical preparedness to reach the This study was approved by the Ministry of Defense and the
summit of an 8,000m-high peak is one example. To evaluate Institutional Review Board of Leiden University, the Nether-
four factors essential in the preparation of high-altitude expe- lands. Twenty carefully selected military specialist climbers
ditions and of the performance during these expeditions, the (mountain leaders [MLs]/Heeres Bergführer [HBF (German:
Manaslu 2016 Medical Team, as part of the medical team of Army mountain guide)]) were involved in determining factors
the RNLMC, developed the MEPE concept. The scope of this for success and performance. Prospective data were collected
concept is intended to cover (1) selection of a team, (2) medi- during the RNLMC organized expedition with individuals
cal planning and support, (3) competencies in the field (team from Austria and the United Kingdom attached. This mil-
work and human factors), and (4) and chain of command (i.e., itary expedition distinguished itself from regular, commer-
accountability; Figure 1). cial high-altitude expeditions in two ways. First, there was a
well-defined mission objective: enabling at least one climbing
Military medicine introduced numerous practical adaptations team (two climbers) to undergo a summit attempt on Manaslu
to existing medical practices and started innovations in mod- and the imperative condition for all climbers to return safely.
ern trauma care. An important finding in the study of Shlim This should encourage the solidarity behavior that is part of
et al. is that a high mortality rate for altitude sickness, due the RNLMC values of solidarity, strength, and dedication.
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to commercially driven factors and “top fever,” is associated Second, the concept of operations combined with a military
with organized treks. The causes of this increased mortality command and control structure well embedded with the assist
rate are well described and can be applied to all organized ex- and advice of five Sherpas created shared responsibility for
peditions. With this in mind, the MEPE concept is introduced. preparation and tasks (i.e., local knowledge).
*Correspondence to CDR R. Hoencamp, MD, PhD, LUMC, Department of Surgery, K6-50, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the
Netherlands; or r.hoencamp@LUMC or r.hoencamp@mindef.nl
1 Dr Berendsen is at Department of Anesthesiology, Leiden University Medical Center, the Netherlands. LT Vieyra is at Ministry of Defense,
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Royal Netherlands Navy. Dr Rietjens is an exercise physiologist and senior researcher at TGTF Ministry of Defense, the Netherlands. 1LT
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Beckers is medical chairman, Manaslu Expedition (medic), Ministry of Defense, Royal Netherlands Marine Corps. CAPT NAVY van Hulst is at
the Ministry of Defense, Department of Anesthesiology, Academic Medical Center Amsterdam, the Netherlands. MAJ Boumeester is expedition
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leader, Manaslu Expedition. CDR Hoencamp is at the Ministry of Defense, Department of Surgery, Alrijne Medical Centre Leiderdorp, Leiden
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University Medical Centre Leiden, the Netherlands.
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