A Grassroots Approach to Building National Resilience for Comprehensive Defense, Deterrence and Crisis Response

The foundation of comprehensive defense and deterrence is a trained populace who are willing and able to respond during times of crisis.

Efforts by external, intervening entities should initially focus on enabling and empowering the people of the partner nation to support themselves.

External intervention without strategy is medical tourism at best and may be detrimental to defined initiatives.

Comprehensive defense demands participation and inclusion from all socioeconomic backgrounds in a society.

If still in the stages of preparation, there is an opportunity to build and organize communities to come together in times of need, and meaningfully improve the national emergency medical response posture. 

A population resilient to the effects of disasters and crises may increase the deterrent effect they have on potential aggressors. 

Deterrence begins and ends with an empowered population that has the will to resist. Because sacrifice is synonymous with resistance, the resolve of the citizen to self-govern and allow governance by the nation must be greater than that of the acceptance of subjugation. And while resolve and the will to fight are paramount, the population must also have the means in which to do so. This begins with a national identity resolute in their chosen way of life and a tendency toward action. A resistance is made up of people willing to sacrifice for a cause. Sacrifices should only be made with meaning, minimizing wasteful and needless suffering due to ignorance of proven techniques and skills and the lack of inexpensive supplies. Medicine and medical preparedness are absolute necessities of a resistance and are non-threatening with a low barrier of entry to the common citizen of all demographics. 

The International Stop the Bleed Day was started, and later expanded to the entire month of May, in order to bring awareness of the issue of needless trauma death. The goal was to globally expand awareness and training in the appropriate use of tourniquets and wound packing techniques approved by the  American College of Surgeons (ACS) Stop-the-Bleed classes.Training may also have the desired effect of sensitizing bystanders toward an attitude of action and intervention versus one of spectation and ineptitude. Small group training classes should be used to discuss how and when to intervene.  Proper, tested and recommended equipment should be available for demonstration and practice, along with how to identify dangerous, cheap Chinese counterfeit tourniquets that are seen spreading across Europe, and through Amazon in the US.  These fakes have a higher propensity of breaking once tightened, when needed most at exactly the wrong moment. Likewise, emergency improvisation techniques can be shown along with common techniques that are prone to failure. 

Small training group classes can be used to identify those who have inherent interest and skill in emergency medicine to be further trained as instructors and technicians. Once identified, they can receive additional training in Tactical Combat Casualty Care (TCCC) and Tactical Emergency Casualty Care (TECC) adapted by law enforcement and first responders not in the military. This cadre of trained bystanders and first responders can then be integrated into a national trauma system with the goals of stopping bleeding within minutes, administering blood transfusions within 30 minutes and delivering live patients with the best chances of survival to a trauma surgical team within 1 hour.  The principles of prolonged field care can also be demonstrated to medical technicians, rescue crews and medics in the national guard and armed services when those treatment and evacuation goals cannot be met, and patients must be managed for extended periods of time. One such program already available internationally is the Austere Emergency Care certificate course offered by Specialized Medical Standards and Ragged Edge Solutions.  

These efforts are perfect for global health engagement and medical security cooperation initiatives to identify and train a core cadre of host nation trainers to ensure that a sense of ownership and pride are maintained and promulgated among a population.  This must be done in the spirit of candidly sharing all lessons learned and not from a place of superiority and should include both successes, and failures. Both were on display for the world as seen in the responses to the Las Vegas concert shooting and Boston Marathon Bombing, as well as the failures seen during the domestic responses to the large-scale destruction seen from hurricanes here in the US, or the Bataclan concert shooting in France. The simultaneous goals of improving the national trauma system from the bystander up, while also influencing an accountable and self-reliant citizenry to build the backbone of national resilience may be achieved in this manner. The attitude of preparedness and self-reliance is likely to spill over into other aspects such as communications, food storage, hunting, self-defense, etc… All of which are vital for a resistance to flourish under oppression or for a community to come together during a large natural disaster. The most important of all of these second order effects is that of building tighter communal bonds in a time of increasing self-imposed isolation before a crisis occurs and not after.  

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