By Johnson, Kraig
Journal of International Peace Operations , Vol. 8, No. 1
When medical support in theater is not enough
As of February 2012, in Afghanistan, there were over 110,000 civilian contractors, compared to approximately 90,000 US military service members, according to the Department of Defense. These civilian contractors provide many services including security, base life support (BLS), maintenance of vehicles, interpreters, and dining facilities. While the military medical components do provide life, limb and eyesight (LLE) medical care, the majority of the primary care medicine falls on the contractor.
With the limited medical resources in theater and the number of employees from different countries and various levels of routine medical care provided by their host countries, the need for employees to be transported out of theater for definitive care and evaluation poses a challenge to any contractor.
According to the Labor Department's statistics, 1,777 American contractors in Afghanistan were injured or wounded seriously enough to miss more than four days of work in 201 1 (NYT). This number alone shows the basic impact of providing services in an environment such as Afghanistan.
There are 3 types of movement that routinely occur in theater for medical purposes. They are:
Patient Movement, in theater, where an employee suffers an injury or illness that requires him/her to be moved to a facility (military or contractor operated) that has more extensive diagnostics (radiology, laboratory, etc.) or higher trained medical professionals (Physicians, PA's, etc.). An example of this would be an employee is injured at a smaller FOB and is transported to a larger FOB or base for care.
Patient Movement, out of theater, where an employee suffers an injury or illness that is beyond the scope of medical services provided in theater but is not serious enough to require utilization of the emergency medevac system. An example of this would be an employee with an orthopedic injury requiring rehabilitation or surgery.
Medevac, where an employee suffers an injury or illness that is severe enough that either the military medical personnel or the contractor civilian medical provider initiates the emergency medevac system. Examples could be an employee suffers traumatic injuries from hostile fire or has a heart attack
Most of the movements occur through coordination of care between both civilian and military medical assets. Except for the instance of an activation of the emergency medevac system of the military, most all other movements are coordinated through the contractor medical provider (Onsite OHS, for example), and the prime contractor's insurance provider.
As the medical condition is discussed with all pertinent parties (contractor medical provider, prime contractor management, prime contractor insurance provider, and civilian medical transport agency), the appropriate level of patient care is discussed and agreed upon by the providers. In the period from 2009-current, there have been very few instances that the author can recall where there has been a difference on medical opinion on the level of care to be provided to an employee who was being transferred out of theater (this will be discussed further in the Lessons Learned section).
The overall coordination needed to provide a successful medical transport from an austere environment such as Afghanistan, to tertiary medical care facilities throughout the world is a difficult task to say the least. Keep in mind that over half of the contractor employees in Afghanistan are non-US citizens. These employees come from countries such as India, Nepal and Kenya. This significantly plays into the planning and coordination of a medical movement in that there are varying levels of care provided. For example, what a US citizen might consider a lower standard of medical facility in the United States may actually be a high level of medical care in another country. This is where the communication and coordination proves to be vitally important. …