Kiger Michelle E, Hickey Patrick W, Hammond Caitlin E, Knickerbocker Kara J, Wolf Lauren J, Lara Sebastian
Department of Pediatrics, Uniformed Services University, Bethesda, MD 20814, USA.
Wright-Patterson Medical Center, Dayton, OH 45433, USA.
Mil Med. 2025 Jan 16;190(1-2):366-373. doi: 10.1093/milmed/usae106.
Stability operations, including humanitarian assistance and disaster relief missions, are key functions of U.S. Military medicine and the Military Medical Humanitarian Assistance Course (MMHAC) is a 2-day course widely used to prepare military medical personnel for such missions. It focuses on caring for those most vulnerable in the wake of disasters, particularly children. The large-scale humanitarian deployment of military medical providers in support of Operation Allies Welcome/Operation Allies Refuge (OAW/OAR) presents an opportunity to evaluate the preparedness of these providers to care for the needs of the Afghan travelers, so we explored the experiences of military medical providers deployed in support of OAW/OAR to inform improvements in the MMHAC.
We conducted a qualitative study of military medical providers who were deployed in support of OAW/OAR using a series of three virtual focus groups. Focus group questions were structured around the main topics covered in the MMHAC (patient care, ethical considerations, logistical concerns, and preventive and public health) and explicitly asked about adaptive leadership challenges faced and strategies used to overcome them. We analyzed transcripts using inductive thematic analysis within a constructivist paradigm, with adaptive leadership as a sensitizing concept. The study was approved by the Institutional Review Board of Uniformed Services University.
We constructed 4 themes from participant responses, each addressing challenges that medical providers faced during their mission: (1) Medical providers navigated tension between medical and public health priorities and military mission priorities; (2) Chronic and complex care needs posed unique challenges for medical personnel; (3) Challenges in patient care were compounded by logistical and system-based barriers; and (4) Cultural barriers led to ethical dilemmas that physicians felt inadequately prepared to handle, most notably with respect to gender-related concerns. Within each theme, participants described which aspects of MMHAC training were most helpful and which areas were inadequate.
Physicians found the OAR/OAW mission meaningful but also identified challenges related to medical care provision, public health, logistics, and ethical dilemmas that hindered their ability to carry out their medical mission. Lessons learned from OAW/OAR highlight several areas in which the MMHAC training could be augmented and improved to further mitigate these challenges.
稳定行动，包括人道主义援助和救灾任务，是美国军事医学的关键职能，而军事医疗人道主义援助课程（MMHAC）是一门为期两天的课程，广泛用于让军事医疗人员为这类任务做好准备。它侧重于照顾灾难后最脆弱的人群，尤其是儿童。军事医疗人员大规模人道主义部署以支持“欢迎盟友行动/盟友避难行动”（OAW/OAR），为评估这些人员满足阿富汗旅行者需求的准备情况提供了一个机会，因此我们探讨了部署支持OAW/OAR的军事医疗人员的经历，以为改进MMHAC提供参考。
我们对部署支持OAW/OAR的军事医疗人员进行了一项定性研究，采用了一系列三个虚拟焦点小组。焦点小组问题围绕MMHAC涵盖的主要主题（患者护理、伦理考量、后勤问题以及预防和公共卫生）构建，并明确询问了所面临的适应性领导挑战以及用于克服这些挑战的策略。我们在建构主义范式内使用归纳主题分析对文字记录进行分析，将适应性领导作为一个敏感概念。该研究得到了军事卫生服务大学机构审查委员会的批准。
我们从参与者的回答中构建了4个主题，每个主题都涉及医疗人员在任务期间面临的挑战：（1）医疗人员在医疗和公共卫生优先事项与军事任务优先事项之间周旋；（2）慢性和复杂护理需求给医务人员带来了独特挑战；（3）后勤和基于系统的障碍使患者护理方面的挑战更加复杂；（4）文化障碍导致了医生认为准备不足应对的伦理困境，尤其是在与性别相关的问题上。在每个主题中，参与者描述了MMHAC培训最有帮助的方面以及哪些领域存在不足。
医生们认为OAR/OAW任务有意义，但也指出了与医疗服务提供、公共卫生、后勤以及伦理困境相关的挑战，这些挑战阻碍了他们执行医疗任务的能力。从OAW/OAR吸取的经验教训突出了MMHAC培训可以在哪些方面得到加强和改进，以进一步缓解这些挑战。
