Abstract
This chapter deals with the modalities of the actions to be taken prior to the deployment of a field hospital to a foreign country in a disaster. It specifically examines the necessity and role of a recce mission, which should deploy before thefield hospital does. It covers the issues that the recce mission will face on arrival in a foreign country and the actions it should take to tackle these. It also deals with the specific duties of a recce mission in terms of establishing liaison with the host government and the coordination structures established at the disaster site. Actions that need to be taken for the smooth entry of the field hospital into the country and its deployment to the site are covered in detail from site selection for the field hospital to immigration and customs issues. It also covers the handing over of responsibility from the recce mission to the main body of the field hospital. The chapter includes numerous references to handbooks and articles that deal with international deployment and ends in some “take-home” conclusions for a team.
In this chapter, we offer medical leaders and planners in charge of launching field hospitals guidelines and lessons learned from previous missions regarding mission initiation and international coordination:
Mission Initiation
The initiating body may be a local government requesting medical assistance following a disaster, a government offering assistance, a nongovernmental organization (NGO) that decides to send a field hospital, or even a group of individuals. A call on behalf of a local government requesting aid (whether specific to a country or organization, or a general call for help following a disaster) would assist in smoothing the approval process and in assuring access to the affected area.
Under international law, the national government is responsible for disaster response in its own territory[1]. Diplomacy plays a significant role in the preparation phase of a mission and should never be underestimated. Regardless of whether this is the initiative of the local government or of the organization offering help, establishing contact at the international (diplomatic) level is essential. Diplomatic involvement will help to not only approve the delegations’ entry but also establish government to government (or NGO to government) contacts: crucial for the next step in approving and planning the mission. Obviously, the lack of an official approval by the accepting country will technically preclude launching the mission. Furthermore, until such approval is granted, most dispatching organizations will halt preparations, thus emphasizing the importance of swift and assertive diplomatic actions.
Procedural considerations should also be addressed. In tandem with the diplomatic activity, professional contacts (both official and informal) with colleagues in the destination country should be established. These would not only assist in estimating the local needs and ease the work of the recce team but also could assist with establishing contact with health-care professionals and officials, as well as with legal issues like approvals to practice medicine in the foreign country. This important issue is best addressed by a collaborative effort on behalf of the launching organization team, as well as with officials from the deploying country’s Ministry of Health (MoH) and diplomats. Practicing medicine requires a license, even during a disaster, and, when involving a foreign country, the requirements vary. A waiver by the local government should be issued (or an official recognition in the one issued in the home country) to allow those doctors, nurses, pharmacists, and so on to practice while deployed. Discussions should also cover areas such as medications (as there could be differences between the countries), as well as establishing a policy regarding nonurgent and chronic cases who may come to the field hospital for help, and more. On the receiving country’s side, the official approval given at the government level should be “translated” into a working order for the health officials in the field to try to lower resistance for foreign involvement, should it exist. A mechanism for ongoing collaborations and consultations between the local and the deployed medical professionals should be established, allowing for most of these issues to be addressed as they present. As said, the approval and the licensing issues should be addressed. Detailed guidelines on these issues have been issued by the World Health Organization (WHO) in their emergency medical teams (EMTs) initiative and should be read by the recce team. WHO classified the Israel Defense Forces’ (IDF) field hospital in November 2016 as a type 3 team[2].
International Coordination
Normally, if a disaster situation is of such magnitude that foreign field hospitals have to be deployed, there will invariably be many more responders on site. These responders would be international governmental, NGO, and private responders. Conditions that the recce team is likely to find on the ground at the disaster site have been clearly described[3]. On ground, wherever there is a functioning government, there will normally be some sort of coordination center established on site to coordinate both local and international resources. “The quality of disaster response and its coordination is dependent on the experience and administrative and organizational ability of the government of the affected country[3].”
In major disasters, the UN will assist the local government in coordinating international assistance by deploying a UN disaster assessment and coordination (UNDAC) team[4]. The UNDAC team supports the government’s on-site coordination by establishing an onsite operations coordination center (OSOCC) to assist in coordination of international assistance[5]. It is mandatory this is established in the event of a major earthquake as specified in the International Search and Rescue Group (INSARAG) Guidelines[6]. The recce team should look out for the OSOCC and obtain a briefing from them. If no OSOCC has been established, it should contact the government coordination center and be briefed by them. There are likely to be many other governmental or NGOs on the ground quite early into the disaster. Most are quite willing to share knowledge and contacts with new arrivals. The recce team should contact such entities. (On-the-ground collaboration will be discussed elsewhere.)
By nature, mobilizing and deploying a field hospital is an organizational and logistical challenge. Whether to another country or within one’s own borders, if involving a full-scale field hospital or a smaller medical component, government, or NGO-operated treatment facilities, efforts to match the means to the end are imperative, as the capability is, by definition, deployed at times of various needs (and uncertainty). Predeployment planning is crucial to allow taking advantage of these facilities’ most prominent feature of being flexible and adjustable, and to allow for tailoring the capabilities, structure, and staffing to better meet the expected needs, as well as to shorten the time before opening the gates of the hospital and actually receiving patients. It is important to realize that an “ideal” configuration of the about-to-be-launched hospital may not exist under these conditions, and protracted attempts to “improve” the capability before launching a deployment should be generally avoided, as this may cause delays and cost lives at the destination. Nevertheless, thoughtful but practical professional planning and predeployment preparations could prove vital in assuring the mission’s success and avoiding many of the obstacles ahead. One of the most useful instruments in ensuring a smooth deployment is the rapid dispatch of a small advance, reconnaissance team (called recce mission or team) prior to the deployment of the main field hospital.
The Recce or Assessment Mission
Rationale
A field hospital is a large entity with a significant amount of staff and equipment, making it a major effort to move it. It should also be operational at the disaster site as soon as possible without wasting time finding out the situation and needs. Therefore, it is advantageous that a small recce team be deployed in advance to, firstly, confirm the necessity to deploy the field hospital, and, secondly, carry out all the preparatory work necessary on the ground to ensure the field hospital, when deployed, goes smoothly and rapidly to its designated site and is functional without wasting time. The situation in the early hours of a major disaster is quite chaotic and fluid. It is therefore one of the more necessary functions of a recce team to keep the home base informed in real time of the conditions on the ground so adjustments can be made to the staffing and equipment of the hospital prior to deployment to make it more capable of dealing with the requirements at the site.
Purpose of the Recce Team
There may be a need to send a recce or assessment mission to the affected country prior to deployment decisions being taken, or while the main delegation is preparing to deploy. While the purpose of the recce team could somewhat vary depending on the scenario and timing (should a mission be launched versus which team or what capabilities), the principles are the same, as well as the urgency involved. The team should conduct a rapid initial assessment comprising situation analysis, resource, and needs assessment, and would be intended to determine the type of immediate relief response needed. The mission should be clear on what questions need to be answered for decisions to be taken and what type and size the team should be. Coordination with the destination government and/or officials is crucial to assure access for the team and hopefully contribute to the team’s safety and success.
The recce team should gather information about:
the needs, possible intervention strategies, and resource requirements
local resources, the level of response by the affected country, its internal capacity to cope with the situation, and the level of response from the international community
the most vulnerable segments of the population that need to be targeted for assistance, particularly pediatric and/or geriatric patients
professional challenges expected: common mechanisms of injuries (e.g., burns, crush), endemic diseases, congenital defects, the need for obstetric capabilities, and so on
existing coordination mechanisms in the country
significant political, cultural, and logistical constraints
weather, climatic conditions, and season
in-country logistics; for example, functioning airports or seaports, means of transport, and communication
mission support: food, medical, and so on
the presence of any other international relief teams
any prevailing endemic medical situations (e.g., prevalence of HIV/AIDS, rabies, and so on)
the need for country-specific prophylaxis (e.g., malaria)
unusual or site-specific medical conditions and appropriate precautions (e.g., vectors)
local health and medical infrastructure (including veterinary facilities)
Related posts:
Chapter 3 – Definitions, Needs, Scenarios, Functional Concept, and Modes of Deployment
Chapter 2 – Caring for Weapon Wounded
Chapter 7 – Personnel
Chapter 15 – Pediatrics in a Field Hospital
Chapter 18 – Orthopedics in a Field Hospital
Chapter 25 – Infectious Diseases and Public Health in a Field Hospital
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