Mitigating Commander’s Risk Through Expeditionary Health Partnering to Improve Health Interoperability Throughout the Crisis Continuum

Introduction: Commanders constantly assess dynamic risks to both their mission and force and seek to mitigate as much risk as possible with available resources. When medical capabilities are not available to match casualty estimates, Commanders often look to incorporate health capabilities of allies and partners to mitigate residual risk. Problem Statement: The U.S. military does not have a framework to articulate the trade-offs of incorporating partner health capabilities in a combined expeditionary health system to reduce overall composite risk. Hypothesis: The authors hypothesize that increasing the health capabilities of partners through defense health engagement and interoperability with U.S. military medical capabilities can decrease both risk-to-mission and risk-to-force. With fixed resources, however, the decision of how to focus defense health engagements to enhance partner capabilities represents trade-offs that need to match identified capability gaps. Materials and Methods: The authors applied real-world examples utilizing the Joint Risk Analysis Methodology to explore implications and opportunities to reduce risk by incorporating partner health capabilities into the expeditionary health system caring for U.S. service members. Results: Assuming limited or fixed resource allocation towards partner capacity building, the relationship between quantity and quality are often inversely related, as building health capabilities with higher levels of quality care are more resource intensive as those capabilities require greater investment per unit (such as a surgical capability), while lower levels of care (such as tactical combat casualty care at the all-service member level) require less resources, higher quantity can be delivered. A focused, balanced approach to improve both the quality of high capability care and the quantity of lower levels of care of partner health capabilities through engagements can decrease both the health risk-to-mission and health risk-to-force. Discussion: Within mission contexts, defense health engagement can deliberately mitigate Commander’s Composite Risk through a balanced engagement strategy. In a resource constrained environment, defense health engagement should focus on critical gaps of health capability that are needed to allow partners to care for their own casualties while expanding the ability to leverage those capabilities to assist in the care for U.S. service members in times of crisis. Inadequate expeditionary health capabilities increase health risks to U.S. service members and threatens mission success. Defense health engagement mitigates risk by expanding the number of partner health capabilities leveraged through partnership. Commanders may need to decide if their mission and their partners’ requirements are better served by focusing defense health engagements on improving the quality of high capability medical teams or expanding the quantity of capabilities with a low level of care. Ideally, the resulting balance between those opposing concepts would be optimized based upon the local conditions and mission requirements. Conclusion: Defense health engagement can play a significant role in mitigating health risks facing expeditionary units through building and enhancing partner health capabilities.