A Cooperative Strategy for 21st Century Sea Power: Opportunities to Renew the Public Health Service

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A Cooperative Strategy for 21st Century Sea
Power Opportunities to Renew the Public Health
Service Maritime Heritage as a Sea Service

• CAPT Arthur French MD FACEP
• USPHS (Ret.)
• Veterans Healthcare Administration

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PHS Maritime Heritage- The Past

• The Marine Hospital Service was established in
  1798
• Deployment aboard Revenue Cutter service vessels
  authorized in 1875
• Current Coast Guard health services support
• Look at the PHS officer insignia!

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Transformation- The Future

• We need to think beyond the traditional domestic
  public health missions
• Deployments will extend offshore and be more
  frequent
• Expectations amongst senior leaders, agencies,
  and officers need to be aligned
• 1 isnt sufficient (PPAC survey)

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What Are Our Missions

• Must actively seek new missions to keep us
  relevant- cant fight the Cold War
• As a uniformed service we are a national
  instrument of power projection through provision
  of health care

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Future DOD Opportunities Missions

• DOD OPTEMPO, particularly health services
  support, is high
• DOD MHS facing future shortages
• The Global War on Terrorism is the Long War
• SOFA for 58 U.S. bases in Iraq
• The DOD MHS is at a breaking point

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PHS DOD Support Precedents

• WWII Korea
• OIF-OEF
• USNS MERCY -tsunami response Pacific
  Partnership 2008
• USNS COMFORT- Partnership for Americas
• USS PELELIU

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A Cooperative Strategy for 21st Century Seapower

• October 2007- historical first unified maritime
  strategy
• US Navy, Coast Guard, Marine Corps
• Describes how seapower will be applied around the
  world to protect our interests
• Unprecedented maritime forces integration and
  cooperation with other instruments of national
  power

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The Cooperative Strategy

• Six core maritime power capabilities
• Humanitarian Assistance and Disaster Response
• Building on relationships forged in times of
  calm- proactive and in times of crisis
• Ability to conduct and sustain non-combatant
  evacuation operations
• Must properly prepare expeditionary forces for
  unique challenges

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A Fourth Maritime Partner?

• Renew PHS maritime medicine roots
• Joint Health Service Support
• Augmenting Sea-based rotations
• Humanitarian assistance
• Disaster relief
• Coast Guard international missions
• A second Great White Fleet ?

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Mural Dyslexia

• Dont miss the handwriting on the wall- there
  will be more joint DOD-PHS missions!
• We must be proactive in preparing
• Preparation essential to successful mission
  execution
• Preparation must be tailored for the unique
  maritime environment

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Challenges

• Shipboard environment
• Physical
• Physiological
• Culture
• Cultural conflicts- organization and individual
• Mission versus personal conflicts
• Different medical practice standards

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Shipboard Environment

• Physical- strength, endurance agility
• Physiological
• Heat humidity
• Sleep
• Psychosocial- we need to live up to their
  expectations
• Senior officers
• Personal danger of injury and death

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Mission Priorities

• The mission comes first (but safety always)
• Its not always about medicine
• Pre-deployment agreements
• Some USDAOs are better than others
• Operational restrictions
• Flight hours
• Vessel draft

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Mission Versus Personal Conflicts

• Feel good diplomacy vs. traditional medical
  public health support
• What to do in an emergency?
• Being an infantryman in the GWOT
• Not being in control

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Humanitarian Medical Practice Standards

• Host nation standard of care
• Limited formulary
• Limited specialty care
• Limited diagnostics
• Lab
• Imaging
• Follow up/ post-operative constraints

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Future Maritime Deployments

• White Fleet versus smaller littoral vessels
  (HSV Swift)
• Probably smaller teams with less infrastructure
  and medical support
• Steeper learning curve- higher expectations- less
  forgiveness
• Light and mobile, requiring more flexibility and
  independent operations

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Readiness is Not Optional

• Increased expectations in a more challenging
  visible environment
• Can not learn on-the-job
• Prior to deployment training and orientation is
  critical to mission success
• Train like you are going to fight
• Prior shore deployments helpful but not sufficient

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Readiness Domains

• Operational- must know the operational team and
  how it fits together i.e. shipboard ICS
• Clinical- GMO/wilderness medicine
• Physical- train for an athletic event it will
  wear you down
• Psychological-boredom, frustration, no privacy,
  sleep deprivation,

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The Navy-CG Approach

• Must prepare CC officers as well as Navy prepares
  their health services personnel
• Required pipeline pre-deployment training
• Shipboard underway orientation
• Establish professional qualifications

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The Way Ahead

• Establish required competencies
• Stand up a Professional Qualification Board?
• Publish a Maritime Deployment Professional
  Qualification Syllabus (PQS)
• Develop on-line shipboard orientation curriculum
  modules
• Use existing CG-Navy materials

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The Way Ahead

• Partner with Navy Operational Medicine Institute
  Surface Medical Officer School
• Two week resident course
• Establish underway shipboard familiarization
  program
• Leverage existing Coast Guard-PHS relationship

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The Way Ahead

• Establish a qualified cadre of maritime
  deployable CC officers
• Overlap with RDF OFRD rosters?
• Coast Guard detail participation?
• Set agency deployment expectations driven by
  readiness, not convenience
• Training deployment cycles
• 4 weeks per year

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The Way Ahead

• Assign a full-time liaison/program manager
  officer in NOMI
• Recognize those who serve
• Authorization for GWOT Service Medal and DOD
  awards
• PHS Maritime Responder Medical Badge
• AKA Navy Surface Warfare Medical Department
  Officer (SWMDO) qualification

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