NATO Special Operations Forces Medical Engagements and Partnering Course: Initial Curriculum Recommendations from the NSHQ SOFMEP Committee.

Military partnering operations and military engagements with host nation civil infrastructure are fundamental missions for NATO Special Operations Forces (SOF) conducting military assistance operations. Unit medical advisors are frequently called upon to support partnering operations and execute medical engagements with host nation health systems. As a primary point of NATO SOF medical capability development and coordination, the NATO Special Operations Headquarters (NSHQ) sought to create a practical training opportunity in which medical advisors are taught how to prepare for, plan, and execute these complex military assistance operations. An international committee of SOF medical advisors, planners and teachers was assembled to research and develop the curriculum for the first NSHQ SOF Medical Engagement and Partnering (SOFMEP) course. The committee found no other venues offering the necessary training. Furthermore, a lack of a common operating language and inadequate outcome metrics were identified as sources of knowledge deficits that create confusion and inhibit process improvement. These findings provided the foundation of this committee?s curricular recommendations. The committee constructed operational definitions to improve understanding and promote dialogue between medical advisors and commanders. Active learning principles were used to construct a curriculum that engages learners and enhances retention of new material. This article presents the initial curriculum recommendations for the SOFMEP course, which is currently scheduled for October 2012.

Advanced Medical Technology Capacity Building and the Medical Mentoring Event: A Unique Application of SOF Counterinsurgency Medical Engagement Strategies.

Background The Medical Civic Assistance Program (MEDCAP) is a military commander?s tool developed during the Vietnam War to gain access to and positively influence an indigenous population through the provision of direct medical care provided by military medical personnel, particularly in Counter Insurgency Operations (COIN). An alternative to MEDCAPs is the medical seminar (MEDSEM). The MEDSEM uses a Commander?s military medical assets to share culturally appropriate medical information with a defined indigenous population in order to create a sustainable training resource for the local population?s health system. At the heart of the MEDSEM is the ?train the trainer? concept whereby medical information is passed to indigenous trainers who then pass that information to an indigenous population. The MEDSEM achieves the Commander?s objectives of increasing access and influence with the population through a medical training venue rather than direct patient care. Previous MEDSEMS conducted in Afghanistan by military forces focused on improvement of rural healthcare through creation of Village Health Care Workers. This model can also be used to engage host nation (HN) medical personnel and improve medical treatment capabilities in population centers. The authors describe a modification of the MEDSEM, a Medical Mentorship (MM), conducted in November 2010 in Kabul, Afghanistan, at the Afghan National Army (ANA) National Medical Hospital. This training was designed to improve intubation skills in Afghan National Army Hospitals by ANA medical providers, leave residual training capability, and build relationships within the institution that not only assist the institution, but can also be leveraged to foster Commanders? objectives, such as health and reconstruction initiatives and medical partnering for indigenous corps and medical forces described below. Methods We, the authors, developed a culturally appropriate endotracheal intubation training package including a Dari and Pashto instruction manual, Dari video training program, video laryngoscope and difficult airway training mannequin to be used by indigenous medical personnel to train other indigenous medical personnel in the skill of endotracheal intubation. Utilizing Special Operations medical personnel, University of Nebraska medical personnel and local Afghan medical instructors, we coordinated with local authorities and ISAF medical authorities. We trained approximately 100 ANA physician assistant (PA) students and ten ANA intensive care unit (ICU) and Anesthesia medical staff in endotracheal intubation. The video laryngoscope was used as a training aid to guide each student?s direct intubation technique. Results We validated the Medical Mentorship (MM) concept as a means to engage an indigenous population?s medical personnel. The indigenous medical training facilities capability was augmented by use of the video laryngoscope as a training aid. This improvement was sustained over the observable period. Relationships were developed and enhanced for medical support of coalition partner forces supporting SOF operations. Introducing the video laryngoscope to the ICU increased direct care capabilities within the medical institution. Conclusions The MEDSEM is a viable option for military commanders to leverage medical assets to positively engage an indigenous population during COIN operations. MEDSEMs leave residual sustainable medical capabilities, in contrast to MEDCAP models. This report describes a modification of the MEDSEM concept?Medical Mentoring Event (MME)?a short term focused intervention designed to insert medical technology or techniques into an indigenous medical facility that creates sustainable, tangible benefits to patient care while fostering a SOF Commanders objectives. Follow up with embedded NATO trainers at National Military Hospital (NMH) shows that the video laryngoscope continues to be used successfully in airway management training and in difficult intubations, enhanced the teaching impact of imbedded NATO medical mentors, left a residual training capability for Afghan medical instructors and created relationships between SOF medical providers and the host institution that can facilitate healthcare for SOF partner forces.

Telementoring for airway management between a far forward special operations location to a major medical center using inexpensive telemedicine solutions.

Critically ill patients in remote settings have limited access to specialized care. Telemedicine/telementoring can improve access to quality care, although VTC equipment is costly. This study showed that an inexpensive internet telecom software program can be effectively employed in the intubation training of a remote trainee.

Using the Battlefield Telemedicine System (BTS) to train deployed medical personnel in complicated medical tasks - a proof of concept.

This work describes the use of Adobe Connect software along with algorithm software to provide the necessary audio visual communication platform for telementoring a complex medical procedure to novice providers located at a distant site.

Utilization of a civilian academic center as a force multiplier in support of NATO special operations medicine - a pilot demonstration.

This work describes a NATO-university telemedicine collaboration established to perform a teleneurosurgery consult to assist a deployed soldier with a spinal cord injury.