Fellowship Outline Global Emergency Preparedness & Disaster Response Health Specialist Naval Medical Center Emergency Medicine Department

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1 Introduction: As International Medicine, Disaster Medicine, Infectious Disease, Public Global Health and their implications on National Security become a global entity, Military Medical training must keep pace with this ever dynamic and exciting phenomenon. These issues grow more relevant with recent concerns for international pandemics, the requests and desires for the United States to participate in international and domestic disaster relief response, and provide Public Health expertise worldwide. Military physicians are requested to spearhead these relief efforts as our training and ability to care for all populations in challenging settings make this specialty ideal for these circumstances. The United States Navy is a leader in this field because of its ability to quickly stand up personnel in any environment. Currently, humanitarian missions have become a focus for nation building in Iraq, Afghanistan, Haiti and elsewhere in the world, where urgent humanitarian assistance is required and represent a Key Judgment in the Intelligence Community s Strategic Implications of Global Health (National Intelligence Council, 2008). As stated in A Cooperative Strategy for 21 st Century Seapower (CNO), a core concept is Humanitarian Assistance and Disaster Response. Building on relationships forged in time of calm, we will continue to mitigate human suffering as the vanguard of interagency and multinational efforts, both deliberate, proactive fashion and in response to crises. Human suffering moves us to act, and the expeditionary character of maritime forces uniquely positions them to provide assistance. Our ability to conduct rapid and sustained non-combatant evacuation operations is critical to relieving the plight of our citizens and others when their safety is in jeopardy. In accordance with National Security Presidential Directive 21, paragraph 14, the Nation must collectively support and facilitate the establishment of a discipline of disaster health. Formalized Global Emergency Preparedness & Disaster Response medical training in a controlled, safe, and friendly working environment prepares our future international medical leaders in the skills that are needed to quickly and effectively manage this type of operation. This response training requires a focused, sensitive, and respectful approach to the populations it touches. An educated and experienced approach can do great things for those whom it touches and the individuals and nation it represents. Naval Medical Center Portsmouth s Emergency Medicine Department and the Navy and Marine Corps Public Health Center in Portsmouth, Virginia, as well as the United States Navy, have recognized this challenge and not only intend to keep pace, but to lead from the front. The Global Emergency Preparedness & Disaster Response Fellowship curriculum described in this manuscript and the training it provides allow formalization of this leadership role. Program Outline:

2 The following is a proposal for a core curriculum for a Fellowship position in Global Emergency Preparedness & Disaster Response (GEPADR) at the Naval Medical Center Portsmouth (NMCP). The core coordinators for this curriculum would include, but not be limited to Global Emergency Preparedness & Disaster Response Director, Naval Medical Center s Department Head of the candidate s respective department, and various field faculty preceptors. All field experiences must be prearranged and/or reviewed by the Global Emergency Preparedness & Disaster Response Director and endorsed by the individual s respective specialty designee. Since training in GEPADR encompasses a wide variety of curriculum options or paths, each trainee will have the opportunity to tailor his or her curriculum to meet those individual desired goals in conjunction with the current needs of the United States Navy. The field experience elements are considered to be essential components of the program; however, the individual will be expected to fulfill the additional components noted below. This Fellowship curriculum in Global Emergency Preparedness & Disaster Response is intended to be available to a residency trained physician whose prior training and or operational experiences complements the goal of the program and needs of the Navy. As such, the physician will be expected to perform regular clinical duties within his or her department to maintain clinic skills during this approximately yearlong program. Global Emergency Preparedness & Disaster Response Program Outline: I. Clinical Practice a. Domestic Clinical practice in respective field i. Further development of respective skills in candidates specialty adequate to maintain clinical skills to be determined by appropriate department head and IM Coordinator b. International Clinical Practice i. International clinical medicine in an urban setting ii. Practice in rural health care and community health abroad iii. Practice in an operational setting c. International health systems evaluation i. Exposure to health systems in various stages of development ii. Assessment of existing health systems data iii. Evaluation and prioritization of health needs d. Instruction and training to NMCP residency programs in international medicine concepts II. Educational Programs a. Domestic educational agenda i. Tropical medicine course work or assigned readings in: 1. Tropical infectious disease

3 2. Health care in developing settings ii. Masters level understanding of: 1. Epidemiology and statistical analysis 2. Community health and public health 3. Immunizations 4. Hygiene and preventive medicine 5. Health information systems 6. May pursue MPH degree simultaneous to curriculum iii. Travel health training iv. Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) studies v. Domestic Emergency Preparedness and Response b. International educational agenda i. Assessment of educational needs in an international setting ii. Plan international educational objectives iii. Implement international educational programs iv. Assess and document cultural differences in thought, action, and communication v. Assess and develop plans and training that aligns with military operational conditions vi. Evaluation of Emergency Medical Services (EMS) in an international setting c. Tri-service curriculum i. Target IM relevant programs provided by the United States Army and Air Force ii. Coordination of planning and triage within the Services III. Research a. Knowledge of International Health literature i. Journal clubs and readings b. Participate in ongoing research i. International faculty in respective specialty ii. International Public Health policy or initiatives iii. Measures of effectiveness (impact measures) iv. Research in additional areas of interest c. Develop research project in international medicine i. Preparation and presentation of an abstract ii. Research project suitable for publication IV. Additional International Curriculum a. Develop an additional field of expertise i. Refugee health ii. International EMS and prehospital care iii. Disaster relief and complex humanitarian emergencies iv. Advanced tropical medicine training V. Faculty Development

4 a. Education and training for disaster response b. Capacity building in emergency preparedness c. Peer training i. Medical students, interns, residents ii. Stakeholders and medical response personnel Suggested Schedule: (Approximately 52 week curriculum + 52 weeks MPH) The following schedule can be adjusted according to the candidate s individual goals and prior experiences in collaboration with the International Medicine Director and Specialty Leader. Some Global Emergency Preparedness and Disaster Response Fellowship Goals and Objectives and Core Content can be obtained simultaneously. Therefore, the following does not exactly add up to 52 weeks and can easily be adjusted according the trainees goals, past experiences, and current needs of the United States Navy. The Masters in Public Health will be a one year program that preferable will be completed during the first year of the program at the Uniformed Services University of Health Sciences in Bethesda, Maryland. I. Continued training and practice in respective field of expertise * : 8 weeks Minimum international experience 4-8 weeks Operational Military experience (may be combined with international experience) 4-8 weeks Public Health 8 weeks- Military Medical Planning & Leadership Courses 4-8 weeks International Humanitarian Medical Courses 4-6 weeks Military Tropical Medicine 4-8 weeks Elective or individual focused study 2-4 weeks - Research 2-4 weeks Emergency Medical Services 1-2 weeks Travel Medicine Clinic 2 weeks CBRNE 1-2 weeks PHEO training 1 week CME TAD 2 weeks Leave * Detailed recommended schedule attached II. Masters in Public Health Uniformed Services University of Health Sciences:

5 52 weeks MPH degree preferably to be completed the 1 st year. Must apply and be accepted per USUHS application policy and procedures separately from Fellowship Program for July enrollment. Fellowship Curriculum Goals and Objectives: 1. Develop the ability to assess international health systems and identify pertinent international and operational health issues pertinent to the needs of the United States Navy. a. Establish contacts and develop relationships with local health officials b. Acquire knowledge of prominent endemic illnesses and co-morbid factors c. Evaluate available health resources, including current emergency services d. List and prioritize health needs e. Use available data for system evaluation f. Integrate International Medicine concepts into an operational setting 2. Design international health programs that address identified needs: a. Design programs that integrate needs assessment with available resources b. Develop skills in organization and implementation of international objectives c. Develop a proposal that addresses health goals, desired outcomes, funding, resources, and available implementing partners d. Develop educational skills and presentation techniques e. Design programs addressing military humanitarian and disaster response 3. Develop the skills necessary to implement domestic, international, and operational programs at home and abroad and integrate them into existing health systems. a. Develop cooperative relationships with existing medical, public health, military, and political organizations. b. Establish working relationships with other health providers c. Integrate emergency medical and EMS programs into existing infrastructures. d. Set up education and funding mechanisms to promote program sustainability. 4. Evaluate the effectiveness of international and domestic health programs. a. Design an evaluation tool during the planning phase of a project to form a usable database. b. Develop systems of data collection for program evaluation c. Maintain quality assurance indicators d. Contribute to the body of literature in international health.

6 Global Emergency Preparedness & Disaster Response Fellowship Core Content: 1.0 Emergency Preparedness and Response Section Goal: In accordance with National Security Presidential Directive 21, paragraph 14, the Nation must collectively support and facilitate the establishment of a discipline of disaster health. The specialty of emergency medicine evolved as a result of the recognition of the special considerations in emergency patient care, and similarly the recognition of the unique principles in disaster-related public health and medicine merit the establishment of their own formal discipline. Such a discipline will provide a foundation for doctrine, education, training, and research and will integrate preparedness into the public health and medical communities. Knowledge best obtained by: A combination of didactic course work sponsored by stakeholders in Emergency Preparedness and Response to include, but not limited to Defense Security Cooperation Agency (DSCA), online Incident Command System (ICS), Public Health Officer (PHO) related training and curriculum, Hospital Incident Command Systems (HICS), and respective military services curriculums. Additionally, the trainee would be encouraged to actively engage in local and regional planning projects and attending meetings of disaster response teams such as Disaster Medical Assistance Team (DMAT) and Metropolitan Medical Response System (MMRS). Suggested Field Experience: Actively participate in disaster and emergency response planning and meetings with DMAT and MMRS. Engage and participate in hospital, local, regional, state, and national emergency preparedness planning and training activities. Participate in EMS and hospital protocol development for a variety of disaster scenarios. 2.0 Military Humanitarian Aid and Disaster Relief Section Goal: To become experienced in directing, managing, and treating patients during humanitarian and disaster relief situation in the best interest of the United States Navy. Knowledge best obtained by: A combination of field experiences and didactic participation. This knowledge may be obtained by, but not limited to, participating in ongoing humanitarian efforts such as those directed by the USS Comfort or Mercy or other ongoing mission sponsored by the United States Navy and NMCPHC. Other efforts sponsored by the United Sates Army, Air Force, Marines, or Coast Guard would be acceptable with prior approval. The candidate may also have the opportunity to work with federal Disaster Medical Assistant Teams under ASPR, NATO relief efforts, USAID, Civil Affairs Command, Department of State, etc Suggested Field Experience: Actively participate in a sponsored humanitarian

7 or disaster mission such as those on the USS Comfort or Mercy or other United States military, NGO, or Department of State service mission. Additionally, the candidate may choose to arrange and organize his or her own humanitarian effort approved the IM faculty and United States Navy. The candidate would also attend Disaster Medical Assistance Team (DMAT) meetings to gain knowledge in the various federal management schemes. 3.0 International Health Administration Section Goal: To learn how to coordinate the delivery of military emergency medical relief in the context of a refugee setting, field hospital, natural disaster, military operations, and complex humanitarian events. Knowledge best obtained by: A combination of field experiences and Public Health coursework specific to refugee care and health systems management in developing nations. The three-week course such as Health Emergencies in Large Populations (H.E.L.P.) or equivalent military experience would be an example of such an experience. This course is offered by the WHO and International Committee of the Red Cross (ICRC). Times and dates of this course offering are listed on the website: Suggested Field Experience: Through the Faculty Development supervising committee, arrangements may be made to assist and aid group, work with a concurrent military humanitarian aid mission, or respond to a Complex Humanitarian Emergency (CHE). 4.0 International Relief and Development Organizations Section Goal: To become familiar with the types of military operations and governmental and non-governmental organizations (NGO s) working in relief and development. Additionally, the candidate would be expected to develop relationships and understand the interactions with these organizations working internationally. Suggested Field Experience: Working with a particular Relief and Development organization in a developing country. This could be a coordinated effort with an ongoing collaborative effort with the United States Navy or other Uniformed Services operation. Experiences with as many different aid organizations as possible will be encouraged. The candidate may also attend WHO, NGO, and United States military Health Coordination meetings. 5.0 Public Health Curriculum Section Goal: The goal of formal public health training is to gain rapid exposure to as many pertinent public health concepts. These concepts are to include, but not be limited to, health care administration, epidemiology, and

8 statistical analysis. Suggested training that provides a background in public health includes the following recommended principles if the candidate does not already have a Master s or other formal training in Public Health. 3.1 Principles in Epidemiology 3.2 Biostatistics 3.3 Management in Public Health 3.4 Public Health Concepts and Practice 3.5 Principles in Environmental Health 3.6 Behavioral Science in Public Health 3.7 International Epidemiology and study design 3.8 International Nutrition for Public Health Professionals 3.9 Maternal and Child Health 3.10 Community Assessment in Maternal and Child Health 3.11 International Health 3.12 Community Health Sciences 3.13 Environmental Health Sciences 3.14 Water and Sanitation Management 3.15 Occupational Health in Developing Nations 3.16 Quality Management in Public Health Knowledge best obtained by: Public Health Course Work, assigned independent study, or prior certification training in Public Health. The Navy and Marine Corps Public Health Center based in Portsmouth, Virginia on NMCP s campus will be available as a resource ( The candidate would be expected to utilize this resource and be an active participant in the duties related to international public heath within the command in order to best integrate Public Health policy, initiatives, and goals of the United States Navy and Marine Corps into IM concepts. Additionally, the candidate may pursue a MPH during his or her training. Suggested Field Experience: Coordinated efforts with United States Navy and Marine Corps Public Health Center in Portsmouth, Virginia in a humanitarian effort, independent research, or self-directed study. 6.0 Disaster Assessment and Response Section Goal: To be able to assume a leadership role in organizing an effective medical response in an international and domestic setting. Knowledge best obtained by: A combination of didactic lectures and field experiences. Disaster response has become a major humanitarian focus for the United States Navy. As such, many aspects of Disaster Medicine are relevant to the fellowship experience. The candidate will become aware of national disaster response by having the opportunity to participate in monthly training sessions of the federal DMAT teams as well as online IRCT training. The 2 week Global Medicine Course led by the Air Force Institute for Occupational Health (AFIOSH) in San Antonio, Texas provides instruction in some of these concepts as well as

9 operational medicine topics for deploying physicians ( x). However, secondary to limited resources, the international response will be uniquely different in an international setting. These unique aspects are best learned by didactic coursework, assigned readings, and/or field experiences. Suggested Field Experience: The candidate should work with and an aid group responding to a disaster, administrating a refugee camp, or dealing with a Complex Humanitarian Emergency (CHE). Additionally, the candidate may work with an organization such as the CDC doing pre-disaster Preparedness Assessment, whereby a Hospital and Public Disaster Plans are reviewed. Finally, if the opportunity lends itself, the candidate may participate in similar planning within the ranks of the United States Navy via USNS Comfort or Mercy response or planning at OPNAV and/or BUMED. 7.0 CBRNE Section Goal: Assume a leadership role in mitigating the existing gaps in support of an operational Weapons of Mass Destruction (WMD) event Knowledge best obtained by: Individual studies, collaboration with United States Military experts in CBRNE casualty care, and operational and hospital planner for WMD events. The United States Army Medical Research Institute of Chemical Defense (USAMRICD), the United States Army Medical Research Institute of Infectious Disease (USAMRID), and the Armed Forces Radiology Research Institute (AFRRI) sponsor a course annually in Hospital Management of Chemical, Biological, Radiological, Nuclear & Explosive Incidents (HM-CBRNE). Suggested Field Experience: Attend the annual course provided by USARMRICD in Maryland Collaboration with United States Military CBRNE experts in hospital or operational WMD planning. 8.0 International Health Curriculum Section Goal: To gain exposure and knowledge of critical health issues unique to the international setting. Knowledge best obtained by: A combination of didactic lectures in a formal course of study and/or assigned independent study and field experiences. Suggested Field Experience: The candidate should participate as a health care provider in a refugee setting, during an acute disaster, or in a developing country with few resources. 9.0 Tropical Medicine and Infectious Disease

10 Section Goal: To become experienced in diagnosing, treating, and preventing tropical and infectious diseases relevant to United States Navy deployments and global presence. Knowledge best obtained by: A combination of field experiences and didactic lectures. This knowledge may be obtained by participating in a certified Tropical Medicine program. The trainee will be expected to attend the Military Tropical Medicine Course in Bethesda, Maryland during his/her training, as this program is traditionally held in July of each year. If the candidate has already completed the program he/she may pursue an alternative certification in conjunction with the needs of the United States Navy. The American Society of Tropical Medicine and Hygiene (ASTMH) accredits a number of these programs. These programs allow those who pass to sit for a Certification Exam of ASTMH. Further information on these courses can be obtained from the website at under Certification Programs Community Health Section Goal: To understand the effective application of Public Health principles in developing nations. Knowledge best obtained by: A combination of Public Health coursework (or assigned independent study) and field experiences. This will be coordinated with the Navy and Marine Corps Public Health Center according to current operational needs of the United States Navy. Suggested Field Experience: The candidate should participate in a public health project in a developing nation such as National Immunization Day, training of Rural Health Workers, or performing a nutritional survey Travel Health Section Goal: To obtain knowledge of disease prevention and military medical readiness for International missions and travels. Knowledge best obtained by: Travel health is frequently covered in Tropical Medicine certification courses as well as the Military Tropical Medicine curriculum. Individual preparation for international experiences will provide the candidate with Travel Health exposure. Additionally, the candidate will have the opportunity to work in NMCP s Travel Clinic and consult with the respective staff on a routine basis. Suggested Field Experience: Travel to both hemispheres and/or different regions of the globe that require different preparatory efforts. Travel to both rural and urban environments is strongly encouraged.

11 12.0 Environmental Health Section Goal: To understand the central importance of water and sanitation in maintaining health and to gain knowledge in how to set up effective water and sanitation projects. Knowledge best obtained by: A combination of Public Health coursework and/or independent study and field experiences. Suggested Field Experience: The candidate should visit a water purification plant in the United States, one in a developing country, and portable systems used by the United States Navy Seabees. During the international experience, he or she should inspect open wells, hand pumps, defecation ponds, latrines, and open sewers Emergency Medical Services (EMS) Development Section Goal: To be able to act as a consultant in the establishment of an effective EMS system in a developing nation and for pandemic planning. Knowledge best obtained by: A combination of Public Health coursework or assigned independent study and field experiences. As this is not intended to substitute for an EMS (Emergency Medical Service) fellowship, the IM candidate should be exposed to the basic elements of EMS design and implementation. There will be the expectation of assigned reading outside the typical public health curriculum. Additionally, he or she will be expected to work directly with NMCP s EMS director to gain experience in domestic EMS implementation and management at the local, regional, and Navy Medicine West/Navy Medicine East/National Capital Area (NMW/NME/NCA) level. The candidate will need to recognize that U.S. and military models may require appropriate adaptations for a developing country. Suggested Field Experience: Participate in EMS management with NMCP s EMS director. The candidate should also participate in a field experience that allows for close evaluation of pre-hospital services in a developing country. An option would include a foreign ride-along or foreign Emergency Department clinical experience. Additionally, the candidate could participate in the teaching of ACLS, ATLS, and/or PALS in a developing nation to pre-hospital or emergency personnel. It would greatly benefit the candidate to be certified as an ACLS, ATLS, and/or PALS instructor Organizational Structure of Department of Defense and Navy Humanitarian & Disaster Planning Process Section Goal: The candidate is to gain a fundamental understanding of the planning and organizational process of a federal and NGO coordinated response. Knowledge best obtained by: Active involvement and participation in DOD and Navy Humanitarian and Disaster planning process. Suggested Field Experience: The candidate may participate in Joint Task Force (JTF) organization and management of an actual or planned humanitarian or disaster response. The goal would be to interface with other domestic and

12 international federal agencies and NGO s and gain knowledge of whom and why specific units are activated. This would include an overview of the Rules of Engagement (ROE) and engagement policies, limitations of humanitarian missions, and a discussion of National Response capabilities and Inside the Continental United States (INCONUS) response within the National Disaster Medical System (NDMS) system International & Domestic Health Systems Section Goal: To learn the critical components of Emergency Medical Services response, academic design in a developing nation, and how to adapt a US-based system to a developing country. Knowledge best obtained by: Active involvement and participation in NMCP s EMS protocols and academic programs. General knowledge of these fundamental aspects should have been obtained during the candidate s residency. Independent study may be assigned. Suggested Field Experience: The candidate may assist in the design of an Immunization or Health Clinic, Emergency Department, or EMS System; assist in the establishment of a residency or other medical training program; assist in the coordination of a humanitarian or disaster response; or take part in the creation or operation of a regional or national medical Society in a developing nation Educational Topics in International Health Section Goal: To become familiar with the sources of information dealing with current trends in International Health. Additionally, to make a contribution to the general body of International Health literature. Knowledge best obtained by: Creation of an International Health research project or public health program in a developing nation. Presentation of these findings at an International meeting or submission for publication in an International Health related journal. Due to the inherent limitations presented in a one -year program, this goal may be obtained via development of paper that would be acceptable for publication. The program directors would act as mentors for such a project. Suggested Field Experience: Participate in a community educational project in a developing nation Program Resources and Funding Section Goal: To learn how various Relief and Development programs are funded. To be able to write proposals and grants in a format acceptable to international donors. Knowledge best obtained by: Assisting and reviewing grant proposals while working with an international relief organization.

13 Suggested Field Experience: Administrative work that involves the development and/or review of proposals and grants during an experience with an international relief organization Language and Cultural Studies Section Goal: To gain basic language skills and a cultural understanding and respect of a particular region of interest so that the trainee can conduct basic day to day functions in a respectful and professional manner. Knowledge best obtained by: The candidate would ideally have had some basic language education from prior secondary or university experiences. He or she would be expected to perform additional independent study or formal course training in language and cultural concepts in an area of interest or according to the current needs of the United States Navy. Suggested Field Experience: Actively participate in foreign language coursework whether by independent study or local schools or universities. Although courses may range from weeks in length, the candidate may even coordinate intensive language training with the Defense Language Institute Foreign Language Center (DLIFLC). Participation in DLIFLC would most likely require additional time designation and would need to be coordinated with the International Medicine Development Committee and conducted in a manner that would be advantageous to the current needs of the Navy and Armed Forces and future billeting Military Focused Disaster & Humanitarian Medicine and Public Health Section Goal: The goal of formal military disaster response, military centric humanitarian relief, and military public health training is to gain exposure to the relevant and unique aspects of these respective disciplines in the military setting. These concepts are to include, but not be limited to, deploying and organizing military disaster and humanitarian response; recognizing the unique environments presented in military public health management, concepts, and epidemiology; and applying those elements into the international setting on behalf of the United States Armed Forces. Knowledge best obtained by: Public Health Course Work; assigned independent study; and/or a military focused disaster response, humanitarian effort, or public health project in collaboration with the respective Centers based at the Uniformed Services University of Health Sciences (USUHS). The Uniformed Services University of Health Sciences based in Bethesda, Maryland will be available as a resource. The candidate would be expected to utilize this resource and be an active participant in the duties related to military international disaster relief & humanitarian medicine and public heath within the command in order to best integrate Disaster & Humanitarian Medicine and Public Health policy, initiatives, and goals of the United States Navy and Marine Corps into global health concepts.

14 Additionally, the candidate will be encouraged to lecture and teach these concepts to students training at the facility. Suggested Field Experience: Coordinated efforts with The Uniformed Services University of Health Sciences in Bethesda, Maryland in a disaster response, humanitarian effort, public health, independent research, and/or self-directed study Medical Homeland Defense & Civil Support / Medical Stability Operations Section Goal: The trainee is to establish his or herself as an expert source in Global Emergency Preparedness and Disaster Response such that he or she would be expected to provide expertise in Medical Homeland Defense & Civil Support / Medical Stability Operations. The trainee would be expected to be a resource and source of information that could provide assistance, expertise, resources, and contacts for homeland disaster preparedness and emergency response for military, government, and civilian preparation, planning, response, and mitigation. Knowledge best obtained by: The trainee would be expected to participate in discussions, drills, planning, etc. with the instillation s Emergency Management Working Group. Additionally, he or she would attend the Public Health Emergency Management training sponsored by the Defense Medical Readiness Training Institute and be familiar with the roles of or even qualify as a Public Health Emergency Officer or Medical Emergency Manager. Engage with the National Center for Disaster Medicine & Public Health (NCDMPH). Suggested Field Experience: Participation in planning, training, and response with the respective instillations Emergency Management Working Group. Gaining additional exposure in national and regional response efforts by attending meetings or trainings sponsored by local EMS, Metropolitan Medical Response Teams (MMRT), Disaster Medical Response Teams (DMAT), National Medical Response Teams (NMRT), and/or other local, regional, or national emergency response organizations 21.0 Faculty Development Section Goal: Once the trainee has established his or herself as an expert source in Global Emergency Preparedness and Disaster Response, he or she would be expected to train stakeholders involved in such activities. The trainee would be expected to be a resource and source of information that could provide educational opportunities in the form of lectures, simulations, drills, and other didactic activities. Knowledge best obtained by: The trainee would be expected to perform duties as a student as well as an educator during his or her training. He or she would be expected to familiarize themselves educational models and adult learning concepts.

15 Suggested Field Experience: Providing lectures, simulations, drills, and other didactics on Global Emergency Preparedness and Disaster Response to all levels of trainee and expertise. Individual and directed study in learning models and adult learning concepts. Candidate Selection: The minimum requirements for candidate selection include a residency trained physician with a passion for Military Global Medicine. The candidate will ideally have some operational experience that includes some international and public health exposure. The ideal candidate should have at least a 4 year minimum remaining obligation and/or intend to serve in an active duty status for a period of time in which the candidate can implement his or her skills productively into the international goals of the United States Navy and United States Armed Services. The candidate should exhibit strong leadership skills, a comfort with austere environments, training to manage a broad spectrum of patient populations and complaints in high volumes, an ability to work with a variety of branches within the military as well as NGO s, and motivation to self direct educational experiences according to his or her goals and current needs of the Navy. The selection committee would include but not necessarily be limited to the Global Emergency Preparedness and Disaster Response Director, respective specialty department head, and Specialty Leader. Anticipated Role United States Navy and United States Armed Services Upon completion of the curriculum, the individual will fill a void in the United States Navy s goals in international relief and humanitarian assistance according to A Cooperative Strategy for 21 st Century Seapower (CNO). The candidate will be expected to lead, train, and have the ability to coordinate multiple military and civilian assets during a humanitarian or disaster response in an efficient and effective manner in conflict or peacetime. As the number and need of trained individuals increase, they will be integrated with various forward deployed assets such that individual can participate in international regional preventive measures, promote medical diplomacy, and provide and lead an immediate humanitarian and disaster response in a coordinated and effective manner. This individual is to become the United States Navy s face of international medicine and humanitarian and relief response.

16 References 1. Lis J, VanRooyen MJ, Dey CC, et al. Suggested Core Content for Fellowship Training in International Emergency Medicine. Center for International Emergency, Disaster and Refugee Studies, The John Hopkins Hospital. Center for International Emergency Medicine, Penn State University. Center for International Emergency Medicine, Loma Linda University. Center for International Emergency Medicine, Harvard University School of Medicine (unpublished manuscript). 2. Monaghan K. Strategic Implications of Global Health. National Intelligence Council. December VanRooyen MJ, Clem KJ, Holliman CJ, et al. Proposed Fellowship Training Program in International Emergency Medicine. Academic Emergency Medicine 1999, 6: Holliman CJ, Kirsch TD, Green GB, et al. Guidelines for Evaluation of International Emergency Medicine Assistance and Development Projects. Annals of Emergency Medicine 1997, 30: Holliman CJ, VanRooyen MJ, Green GB, et al. Planning Recommendations for International Emergency Medicine and Out-of-hospital Care System Development. Academic Emergency Medicine 2000, 7(8): Holliman CJ, Green GB, VanRooyen MJ, et al. Proposed Curriculum for an Observational International Emergency Medicine Fellowship Program. Academic Emergency Medicine 2000, 7(4): Weiner SG, Kelly SP, Rosen P, Ban KM. The Eight Cs: A Guide to Success in an International Emergency Medicine Educational Collaboration. Academic Emergency Medicine 2008, 15(7): Welling DR, Ryan JM, Burris DG, Norman RM. Seven Sins of Humanitarian Medicine. World J Surg 2010, 34(3):