The contingency medical force: chronic challenge, new solution.

To keep pace with the changing requirements of the U.S. Army's combat doctrine, the U.S. Army Medical Department continually modifies its combat health support doctrine and unit organizations. This includes creating more capable, deployable, and mobile units. Unfortunately, as units become more capable, they become less mobile and deployable. As a result, striking a proper balance between capability, mobility, and deployability poses a significant challenge. In 1998, the 212th Mobile Army Surgical Hospital designed a rapidly deployable, air transportable medical module capable of supporting a brigade-sized contingency force (approximately 3,000 personnel) with level or echelon I to III medical care in an austere and ambiguous environment. This module, known as the contingency medical force (CMF), also provides command and control capabilities for this initial medical force and the transition to a more robust health care structure. Conducted over an 8-month period, the design process began with a staff exercise using the deliberate planning process model and culminated in a validation exercise monitored by external observers/controllers at the Combat Maneuver Training Center in Germany. This article describes the planning process, development, and initial deployment of the CMF. The CMF was then deployed on short notice to Albania in support of Task Force Hawk, the Army component of Joint Task Force Noble Anvil.

Responsibilities of a veterinary augmentation package in support of a contingency operation.

A veterinary augmentation package (VAP) was assigned to the 212th Medical Treatment Facility supporting Task Force Hawk outside Tirana, Albania, from April 15 to July 4, 1999. The VAP's mission was to provide level I and II veterinary care, including emergency treatment, stabilization, and evacuation of military working dogs, and to ensure food safety and public health. This mission allowed the VAP to act as a force multiplier and to play an integral role in force protection. In the first 30 days of the operation, the VAP was confronted with animal issues concerning housing of the military working dogs, no access to emergency equipment, antiquated sets, kits, and outfits, and stray animal control. The food safety mission initially entailed inspections of operational rations and inspection of local sources for food procurement. Operational rations were replaced by A-rations, which required a central ration breakdown point to facilitate disbursement of food. The final step was to initiate the prime vendor program so that food was delivered directly to the dining facilities. Inspections of the port at which the food was arriving and a close association with preventive medicine personnel ensured a successful prime vendor operation. Veterinarians on future deployments should be prepared to supplement sets, kits, and outfits, pack an aid bag, and work closely with preventive medicine personnel, all while possibly living under the austere conditions of a combat zone.

Delayed onset arterial gas embolism.

Numerous civilian and military personnel are involved in SCUBA diving activities. In this day of rapid air travel it is important that all physicians, not just those living near the coast or dive centers, be familiar with the basics of diagnosing and treating diving-related injuries. One of the more serious complications of dysbarism is Arterial Gas Embolism (AGE). This case history involves an atypical presentation of delayed onset AGE in a military diver trainee, and its treatment. This article then reviews the incidence, etiology, pathophysiology, "classic" presentation and current treatment of this disease. Systemic pathophysiology secondary to the effects of intravascular air of AGE is also discussed.

The Special Forces medic: unique training for a unique mission.

The U.S. Army Special Forces Medic, Military Occupational Specialty 18D, is a unique, enlisted, medical asset. The training of the 18D is demanding, lengthy, and selective. The 18D is trained to independently assess, and provide acute and long-term medical care for, a variety of medical conditions in support of the Special Forces mission. This article briefly discusses the general missions of U.S. Army Special Operations and Special Forces. This is followed by an in-depth discussion of the 55-week selection and training program of the 18D.

Operational medical support of an aviation brigade deployed during Operation Desert Shield.

This is a brief report on the medical support provided to an aviation brigade from September 1, 1990 to November 1, 1990, deployed during Operation Desert Shield. The aviation brigade consisted of 1,400 personnel including attachments. Medical support was provided by 3 physicians, a physician's assistant, and 24 enlisted personnel. Daily patient load was 2.5% of the unit strength.