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CHAPTER 69: International Deployment

Gerard DeMers; Gary M. Vilke

INTRODUCTION

Emergency medicine service (EMS) personnel have opportunities to deploy in a variety of settings from urban international disaster response to sustained humanitarian missions for developing areas of the world. Types of deployments are listed in Table 69-1. Terms to describe these missions vary but generally offer some combination of direct clinical care to refugees, displaced persons or host country citizens, medical education information exchange, including consulting and training, establishing public health programs, health care team development, building or rebuilding health care infrastructure, and medical support to other deploying professionals. Missions may be short in duration, require multiple rotations over time, or require months to years of direct sustained medical support. Medical operations are usually conducted as a component of multidisciplinary teams or organizations, and other services offered may include food and water distribution or civil engineering programs. Each stage of response may need medical support, and personnel responsibilities may be well defined or fluid depending on needs. Clinical or administrative medical roles may be necessary depending on the circumstances. There are multiple ways for EMS personnel to participate in international deployments.

TABLE 69-1

Medical Mission Types

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TABLE 69-1

Medical Mission Types
Mission Types Etiologies Rotation Duration Security Concerns Associated Factors
Environmental disasters Earthquakes, hurricanes, floods, drought, etc Short to long Potential risk

  • Disrupted infrastructure

  • Local health capabilities may be compromised
Man-made disasters Terrorism, industrial accidents, aircraft crash, etc Short High security risk

  • May be prone to secondary attacks or incidents
Complex humanitarian disasters response Conflicts (political, religious, land, and/or ethnic disputes) often associated with environmental disasters Short to long High security risk

  • Political vacuum

  • Displaced population

  • High morbidity and mortality

  • 50% of the affected population are children

  • Disrupted infrastructure
Medical information exchange/education/mentoring Educator shortage Short Lower risk

  • Cultural or language barriers impact delivery
Clinical care delivery (direct patient care) Provider shortage Short to long Lower risk

  • Sustainability

  • Standard versus sufficiency of care
Public health programs No organized public health infrastructure Short to long Lower risk

  • Immunization programs

  • Water and sanitation

  • Vector control

  • Disease surveillance and outbreak control

OBJECTIVES

  • Describe types of need prompting international deployment.

  • Describe different ways to participate in international deployments.

  • Describe planning for readiness to deploy to international venues.

  • Discuss how to determine what supplies may be available locally, when planning insertion into locations that are difficult to access.

  • Describe health risks and other potential hazards inherent to international deployment to a disaster area.

  • Discuss cultural, legal, and other nonmedical operational concerns that must be addressed in the predeployment planning and during deployment operations.

  • Describe unique medical conditions related to disasters in international venues.

INTERNATIONAL DEPLOYMENT OPPORTUNITIES

Involvement in international missions may be on an individual basis. Alternatively, personnel may participate through private/not-for-profit groups, EMS agency team, hospital team, government or nongovernment organizations (NGOs), or through interagency operations. Becoming ...

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