Commander of the U.S. Air Force Medical Support Agency provides operational insight and reveals future investment opportunities

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Brigadier General James McClain is Commander of the U.S. Air Force Medical Support Agency (AFMSA), which is responsible for overseeing the execution of the Air Force Surgeon General’s policies and programmes. AFMSA provides leadership for the entire medical service supporting the activities of more than 44,000 personnel serving 2.6 million beneficiaries through 76 military treatment facilities worldwide with a budget of $6.1 billion. Defence IQ asked Gen. McClain where some of that budget would be allocated in terms of technology and strategic investment.

“A lot of our efforts and future investment are being directed to the concept of anti-access/area denial (A2/AD),” said Gen. McClain. “We might have to operate in areas where we won’t have the same access that we have had previously.”

He explained that having to operate in austere and contested environments “is really our biggest challenge … we may not have the protection that we often enjoyed in the past.”

To address that challenge AFMSA is working on several initiatives focused around MODE – Medical Operations in Denied Environments – including research analysis and utilising some of its industry partners to determine how best to operate in denied environments.

“We need to look at all of our medical operations – not just combat but also disaster and humanitarian response – to look at how we can minimise the risk to our healthcare givers and support staff.”

Gen. McClain explained that there are two key areas for investment, the first of which is to strategically shift a number of health advisors globally to help them develop strategies and build relationships with local communities and organisations.


The other priority area for investment is communications systems and other related technologies. Gen. McClain said that AFMSA would be increasing the volume and sophistication of its communications systems to better interact with partners and other stakeholders. He said they would also use electronic media, such as telemedicine, to support these efforts in the future.      

“We have a desire to increase our telecommunication platforms to raise awareness and understanding of our global partners.

“The whole point of utilising telemedicine technologies for combat operations is to allow medical operations to have access to high level expertise and skills without having those capabilities put at risk in a combat environment … We’re looking to leverage that more than we have in the past.” 

Communication and collaboration

This plays into a wider – and far more important – issue for McClain: Improving collaboration between the military and civilian organisations.

“I’ll be the first person to tell you that as we look towards the future and our international environment – the complexities, vulnerabilities, uncertainties – there is no question that collaboration and building quality partnerships and coalitions is the key to success,” said Gen. McClain.

“Engaging with our partners across the globe is what we all have to do. I really believe the most important thing we can work towards is having a better understanding among all of the global health stakeholders of knowing each other’s interests, capabilities, resources, and limitations, so that when we do form partnerships and coalitions we can appreciate what each partner brings to the table.”

AFMSA is putting together a ‘Field Guide to Global Health and Disaster Medicine’ to help its partners work together more effectively. Due for release in 2017, the Guide will act as a “baseline” for government organisations, militaries, non-governmental organisations (NGOs), charities and other stakeholders to facilitate future partnerships. Over the last few years AFMSA has established a global health working group, which has done much to increase awareness about working with US agencies and provide a framework for ad hoc crisis response.

“A lot is being done to develop collaboration between military, civilian, domestic and international partners because we know that is the future key to success,” said Gen. McClain. “It’s something we can’t ignore.”

While improving inter-agency and multi-national collaboration is an enduring challenge, this was underscored during the 2014 Ebola outbreak in West Africa.

“Ebola was a watershed in many ways, not least in terms of interacting with partners across the spectrum,” said Gen. McClain.

“It was a watershed because it was an opportunity for us to interact with NGO partners that we had not had as much opportunity to work with in the past. For example we worked with Doctors Without Borders for the first time to help us develop some culturally appropriate training resources for lay healthcare volunteers in West Africa.”

Whenever you look at any type of humanitarian or disaster relief response it’s typically a very complex and changeable scenario; the one thing you can guarantee is their complexity. One of the biggest challenges during these crises that Gen. McClain was keen to again stress was the ability to maintain a good quality and consistent flow of communication, from the highest levels of authority right down to the level of execution.

“It may seem a simple concept but actually it’s amazingly complex,” Gen. McClain continued. “You deal with ambiguity of rules and regulations and responsibilities; you have cultural differences and language barriers. It presents an extraordinary challenge.”