**3. Methods**

This article synthesizes ten medical relief operations in disaster settings, carried out during the last three decades in the form of deployed FFH, in a particular pattern designed and executed by the IDF Medical Corps. We interviewed over period of four years (2011–2015) physicians who actively participated in the IDF disaster relief missions from 1988 until 2015, as chief medical officers and other personnel who have vast experience in the logistics, policy, and health ministry aspects involved in this humanitarian domain from their service in the Israel Home Front Command. Several of them were also highly ranked in United Nations Disaster Assessment and Coordination [UNDAC] and the Department of Peacekeeping Operations at the United Nations Headquarters in New York. Therefore, they have expert-knowledge about the administrative aspects of collaboration between countries during relief missions. Each interview lasted about 2 h and was recorded and transcribed with permission from key informant. Interview questionnaire guide can be provided as appendix. After conduction exhaustive literature review of principal medical and auxiliary publications, we integrated information detailing the assembly of the missions, (manpower selection and training), their operative modes (supplies and equipment, medical data storage and handling, communication systems), capacity (number of beds, collaboration with other delegations), and termination protocol in order to ensure continuity of care by local medical staff their operative modes and outcome.

**61**

*Healthcare Military Logistics at Disaster Regions around the World: Insights from Ten Field…*

A body of knowledge was accumulated over the years by the IDF Medical Corps from deploying numerous relief missions to both natural (earthquake, typhoon, and tsunami), and man-made disasters, occurring at nine countries in different regions of the globe (Africa, Asia, Caribbean, Europe, and Middle East). Longitudinal studies of this sort which juxtapose different humanitarian missions can be helpful in learning and making better decisions in the case of future disasters. Indeed, our study shows an evolutionary pattern with improvements implemented from one mission to the other, with special adaptations to address specific requirements and to accommodate to language and national culture barriers [13]. An important trait of the Israeli FFH pertains to the medical staff selection and training: the staff of the FFH (physicians, nurses, pharmacists, etc.) is recruited in a very selective process [14]. It is composed from mixture of reservists and actual duty soldiers drafted for the voluntary mission. Knowledge of local languages at the disaster area (Russian, French, etc.) is an important criterion for staff selection. Missions to war regions such as Goma, Zaire, were complemented by armed soldiers that also served as stretcher carriers. Additional personnel included laboratory, logistic and communication technicians. For risk assessment two members of Israel national committee for nuclear energy joined the mission to Japan, equipped with

Importantly, the chosen personnel are composed roughly 2/3 of people who participated in past missions and 1/3 new recruits, in order to transfer knowledge gathered between missions and to create an organizational body of experience pertaining to humanitarian aid. This experience has often been enriched by previous practice gained in military medical units in combat regions, unfortunately

Based on IDF experience at Adapazari, Turkey, it is recommended, a (nurse):(physician) ratio of (1–1.5):(1), as opposed to a (2.5–3):1 ratio in regular civilian hospitals because paramedics and medics are available for active assistance [16]. These nurses have to be specialized, work longer and more intensive shifts than in a regular hospital. Consequently, physicians need to assist in classic

Adjustments in hospital structure were made during missions. Thus, IDF FFHs functions ranged from primary care and first aid clinics as in the Kosovo and Japan missions, to regional first echelon for patients released from ruins in Turkey, to municipal hospitals, as happened in India or Armenia, and to a medical referral center, as happened in Haiti, Nepal and the Rwandan disasters. In this last example, the operative mode and structure changed over time, in parallel with needs. This mission served initially as a regional cholera camp, but with the recognition of its capabilities, it became a referral center for trauma and other surgical cases, for patients with meningitis and other complicated medical conditions, as well as for

The functional structure of the FFHs changed accordingly. In Rwanda, a triage and rehydration facility changed into adult and pediatric wards, with a latter addition of expanding departments for surgical/orthopedic/obstetric patients and for those with non-diarrheal critical infections, such as meningitis [17, 18]. The FFH in India was setup in a fully self-sufficient tent encampment. It provided variety of surgical and diagnostic procedures such as: orthopedics (soft tissues, amputations, fracture reduction, external fixation), plastic surgery, skin grafts, debridement/ reconstruction, appendectomy, caesarian section, pediatric neonatal intensive care unit, and deliveries. The FFH in Adapazari, Turkey (1999) served for few days as a first level facility for injured population rescued from wreckage, principally providing surgical and orthopedic surgical facilities and managing patients with crush syndrome and associated renal failure [19]. At later stage, beyond the salvageable

*DOI: http://dx.doi.org/10.5772/intechopen.88214*

dosimeters for continuous monitoring of irradiation [15].

prevalent in Israel and surrounding countries.

critically ill babies requiring intensive care settings.

nursing issues.

#### *Healthcare Military Logistics at Disaster Regions around the World: Insights from Ten Field… DOI: http://dx.doi.org/10.5772/intechopen.88214*

A body of knowledge was accumulated over the years by the IDF Medical Corps from deploying numerous relief missions to both natural (earthquake, typhoon, and tsunami), and man-made disasters, occurring at nine countries in different regions of the globe (Africa, Asia, Caribbean, Europe, and Middle East). Longitudinal studies of this sort which juxtapose different humanitarian missions can be helpful in learning and making better decisions in the case of future disasters. Indeed, our study shows an evolutionary pattern with improvements implemented from one mission to the other, with special adaptations to address specific requirements and to accommodate to language and national culture barriers [13].

An important trait of the Israeli FFH pertains to the medical staff selection and training: the staff of the FFH (physicians, nurses, pharmacists, etc.) is recruited in a very selective process [14]. It is composed from mixture of reservists and actual duty soldiers drafted for the voluntary mission. Knowledge of local languages at the disaster area (Russian, French, etc.) is an important criterion for staff selection. Missions to war regions such as Goma, Zaire, were complemented by armed soldiers that also served as stretcher carriers. Additional personnel included laboratory, logistic and communication technicians. For risk assessment two members of Israel national committee for nuclear energy joined the mission to Japan, equipped with dosimeters for continuous monitoring of irradiation [15].

Importantly, the chosen personnel are composed roughly 2/3 of people who participated in past missions and 1/3 new recruits, in order to transfer knowledge gathered between missions and to create an organizational body of experience pertaining to humanitarian aid. This experience has often been enriched by previous practice gained in military medical units in combat regions, unfortunately prevalent in Israel and surrounding countries.

Based on IDF experience at Adapazari, Turkey, it is recommended, a (nurse):(physician) ratio of (1–1.5):(1), as opposed to a (2.5–3):1 ratio in regular civilian hospitals because paramedics and medics are available for active assistance [16]. These nurses have to be specialized, work longer and more intensive shifts than in a regular hospital. Consequently, physicians need to assist in classic nursing issues.

Adjustments in hospital structure were made during missions. Thus, IDF FFHs functions ranged from primary care and first aid clinics as in the Kosovo and Japan missions, to regional first echelon for patients released from ruins in Turkey, to municipal hospitals, as happened in India or Armenia, and to a medical referral center, as happened in Haiti, Nepal and the Rwandan disasters. In this last example, the operative mode and structure changed over time, in parallel with needs. This mission served initially as a regional cholera camp, but with the recognition of its capabilities, it became a referral center for trauma and other surgical cases, for patients with meningitis and other complicated medical conditions, as well as for critically ill babies requiring intensive care settings.

The functional structure of the FFHs changed accordingly. In Rwanda, a triage and rehydration facility changed into adult and pediatric wards, with a latter addition of expanding departments for surgical/orthopedic/obstetric patients and for those with non-diarrheal critical infections, such as meningitis [17, 18]. The FFH in India was setup in a fully self-sufficient tent encampment. It provided variety of surgical and diagnostic procedures such as: orthopedics (soft tissues, amputations, fracture reduction, external fixation), plastic surgery, skin grafts, debridement/ reconstruction, appendectomy, caesarian section, pediatric neonatal intensive care unit, and deliveries. The FFH in Adapazari, Turkey (1999) served for few days as a first level facility for injured population rescued from wreckage, principally providing surgical and orthopedic surgical facilities and managing patients with crush syndrome and associated renal failure [19]. At later stage, beyond the salvageable

*Military Engineering*

mass casualty events [12].

**3. Methods**

inmarsat) enabled Wi-Fi communication [6].

**2.4 Electronic medical data storage and handling**

between the hospital and the sleeping quarters. In 1999, at Adapazri, Turkey, short wave communication (telephone and Internet) relied on a high frequency (HF) radio transceiver in the range of 3–30 MHz; in 2010 at Port-Au-Prince, Haiti, a direct satellite channel was established with an 8 GB bandwidth; and in 2011, at Minanisanriku, Japan, broadband global area satellite internet network (BGAN

A computerized hospital administration information system has capability to gather rapidly information, analyze it, and present it to medical team. It can also give pharmacist in charge data control over release of medical supplies and provide alerts regarding need to replenish developing shortages of critical items. The IDF designed and used in Haiti such an information system which included: identification and demographic information, photo album, admission notes and status, survey of injuries by body system, laboratory and imaging studies, surgical reports, diagnoses, and discharge summary [10]. The usage of such an electronic medical record in mega-disaster scenario ensures medical accuracy, and lowers risk of losing information in chaotic environment when patients are transferred between FFHs from different countries, or when delegation returns back to home country and give control over FFH facility to local healthcare authorities as occurred in most missions. For instance, in Haiti, bar-code readers were used to facilitate patient's registration upon entry to a specific department within FFH and to minimize manual data entry errors. The database of passport-like photographs was useful for family members to locate their relatives and it was suggested for future designing customized radio frequency identification (RFID) technology in order to track patients in disaster area [11]. Such technologies are developed in Israel as part of a national system for disseminating information on victims during

This article synthesizes ten medical relief operations in disaster settings, carried out during the last three decades in the form of deployed FFH, in a particular pattern designed and executed by the IDF Medical Corps. We interviewed over period of four years (2011–2015) physicians who actively participated in the IDF disaster relief missions from 1988 until 2015, as chief medical officers and other personnel who have vast experience in the logistics, policy, and health ministry aspects involved in this humanitarian domain from their service in the Israel Home Front Command. Several of them were also highly ranked in United Nations Disaster Assessment and Coordination [UNDAC] and the Department of Peacekeeping Operations at the United Nations Headquarters in New York. Therefore, they have expert-knowledge about the administrative aspects of collaboration between countries during relief missions. Each interview lasted about 2 h and was recorded and transcribed with permission from key informant. Interview questionnaire guide can be provided as appendix. After conduction exhaustive literature review of principal medical and auxiliary publications, we integrated information detailing the assembly of the missions, (manpower selection and training), their operative modes (supplies and equipment, medical data storage and handling, communication systems), capacity (number of beds, collaboration with other delegations), and termination protocol in order to ensure continuity of care by local medical staff

**60**

their operative modes and outcome.

rescue period, the hospital principally provided first aid and primary care for the nearby population, as the number of patients with acute and chronic medical, pediatric and neonatal conditions exceeded that of traumatic cases [20]. The heterogeneous mixture of medical staff enabled the transformations that took place in the operative mode of the FFH.

In the same way, the Haiti mission coped in the first days with injuries caused directly by the earthquake, with very busy orthopedic and surgical units, doubling the surgical capacity by cross-over mixed teams concomitantly addressing needs for various surgical disciplines. A few days later, when patients with less urgent medical needs arrived, staff assignments, organization of unites, and hospitalization policy were readjusted.
