The U.S. military has been performing humanitarian missions since the end of the Cold War, sometimes in a support role to other agencies, often as the lead agency. Medical missions are typically, short-term, occur outside of the continental United States and involve the U.S. military providing care to large numbers of patients.
These missions are an integral part of national security. They serve as a deterrent to conflict because a forward military presence enhances peaceful cooperation and contributes to regional stability.
Department of Defense Directive 3000.05, "Military Support for Stability, Security, Transition, and Reconstruction (SSTR) Operations," states that stability operations have a priority status comparable to combat operations. It also mandates that we develop measures of effectiveness that evaluate progress in achieving the mission's goals.
But despite the large number of missions over the past decade, there is a dearth of information in the literature regarding patient encounters. The few publications that are available show that data collection techniques vary widely and are laced with problems.
In 2007, USNS Comfort (T-AH 20) completed a four-month humanitarian assistance deployment as part of the President's policy on "Advancing the Cause of Social Justice in the Western Hemisphere." This narrative will provide historical background, describe the method used by the crew to document patient encounters and discuss lessons learned.
Accurate clinical documentation is imperative to monitor and evaluate patient care and assess effectiveness. We welcome help from the technology community to develop tools to aid in this effort.
In a "Descriptive analysis of patient encounter data from the Fleet Hospital FIVE humanitarian relief mission in Haiti," from the Naval Health Research Center (NHRC), San Diego, researchers describe using paper free-text forms and pencil to document the diagnosis and treatment of patients during a 1997 deployment to Haiti. The report outlines the limitations in this method, including illegible handwriting, lack of conformity of language and many form areas left blank.
For a later study from 2001, researchers collected patient encounter data from Naval Medical Center San Diego (NMCSD) physicians who traveled with a nongovernmental organization (NGO), HELPS International, on a humanitarian assistance mission to Guatemala. The completed forms were entered into an electronic database and analyzed by NHRC San Diego.
Although the study, "Documenting Patient encounters during a humanitarian assistance mission to Guatemala," showed that a revised, forced-choice patient encounter form alleviated the problems of illegibility and nonstandard language often found in free-text forms, there were still problems because this method did not successfully link diagnostic data with treatment and prescription information, and often diagnoses were miscoded. Data were collected on diagnoses, treatments, medications, surgeries and type of provider specialty.
In the experience of the 48th Combat Support Hospital's 2003 deployment to Afghanistan, an eponymous report revealed similar findings. Data were collected using a paper and pencil method. Demographics were collected at the nursing triage station. The medical care providers documented the chief complaint, examination, diagnosis and treatment on the reverse side of the same form after each encounter.
Data were later compiled, and the results entered by hand into an electronic database. Limitations included incomplete forms, subjective analyses of patient conditions and small sample size.
In January 2005, West Coast-based USNS Mercy (T-AH 19) sailed to the Philippines and Indonesia where care was provided to 100,000 victims of the catastrophic tsunami. Various tools were used to capture patient