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Development of regional medical team concentration in a particular country or region.182 This requires extensive knowledge and insight into that particular area (eg, tropical medicine, public health, language, climate [altitude/cold/hot/tropical/maritime/temperate], and terrain). Insight into local politics, economics, social, and demographics are essential.
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Sustained involvement. US military has provided local care to civilians ever since the Revolutionary War. However, there must be a contingency plan to provide care after the troops come home. The experience gained from the Medical Readiness Training Exercise (MEDRETE) is a notable example.177 Short-term medical teams are embedded into an area to provide basic primary care. They highlight some of the deficiencies of short-term efforts: short amount of time (usually 1–2 wks), lack of follow-up, large numbers of patients with empty promises, lack of diagnostic support, limited medications, language barriers, and unfamiliarity with local culture, diseases, and healthcare system/standards.
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Aeromedical evacuation and shipment of medial supplies. Most civilian voluntary groups are not involved in aeromedical evacuation, but a basic knowledge of flight medicine is worthwhile, especially for teams traveling long distances.178 Shipment of medical supplies for civilian humanitarian efforts is not well known. The Denton Program (http://www.dentonfunded.com/AboutDenton.htm), which is administered by USAID, allows humanitarian equipment/supplies to be shipped on military aircraft to support a variety of projects and missions to countries in need.
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Planning a medical relief mission. The logistics of planning and executing a mission is everyday language to the military. A recent military experience illustrates the type of diseases encountered.179 Highlighted is the number of orthopedic problems (>30%) encountered.
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The wartime experience of delayed wound closing, or delayed primary closure (DPC), has relevance in the austere surgical environment.180
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