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Dedicated to the Military Medical & VA Community

Leadership Insight :


Health Care Collaborator Lt. Gen. Patricia D. Horoho Surgeon General U.S. Army Commanding General U.S. Army Medical Command

May 2012 Volume 16, Issue 3

Who’s Who National guard bureaU

Maj. Gen. David L. Harris Director, J-3/7

En Route Medical Evacuation O San Antonio Military Health System Veterans Affairs Police O AFMS Contracts

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Military Medical & Veterans Affairs Forum

May 2012 Volume 16 • Issue 3

Cover / Q&A

Features En Route Medical Evacuation Soldiers of the 160th SOAR (A) are highly trained and ready to accomplish the very toughest missions in all environments throughout the world. The regiment’s approximately 3,000 soldiers, including around 1,000 aircrew members spread across numerous CONUS and OCONUS locations, ensure the ability of this force to carry out its no-fail mission. By Mark Jacques and John Dobbins


San Antonio Military Health System San Antonio was a natural fit for consolidation and relocation of DoD medical missions as it is the home of Army Medicine and hosts the largest medical wing in the Air Force Medical Service. Now it is being recognized as the home of military medicine to include health care, research, and medical education and training. By Colonel Mary Garr


Leadership Insight: NMLC Q&A with Captain James B. Poindexter III, commander of Naval Medical Logistics Command. As Navy Medicine’s center of logistics excellence, NMLC supports big Navy objectives by designing, executing and administering individualized state-of-the-art solutions to meet customers’ medical materiel and health care service needs.


National Guard Bureau 21 23 24

Q&A with Major General David L. Harris CBRNE Enhanced Response Force Package National Guard Top 10 Contractors for FY 2011 and 2012 AFMS Facilities Contract


Q&A with Joe Mirrow, deputy director, Air Force Medical Service Commodity Council. In 2010, the Department of Defense took $33 billion out of the Air Force’s five-year operations budget. Therefore, the Air Force must reduce costs through efficiencies in order to maintain performance. The Air Force expects to generate these efficiencies in a variety of ways.

Veterans Affairs Police


Fred Jackson, director, Security and Law Enforcement at the Department of Veterans Affairs (VA), elaborates on maintaining vigilant security at medical facilities within the VA. The VA maintains a well-trained police force responsible for enforcing the law and providing protection to patients, visitors, employees and property at VA facilities.

16 Lieutenant General Patricia D. Horoho Surgeon General U.S. Army Commanding General U.S. Army Medical Command

Departments 2 Editor’s Perspective 3 MC4 4 Program Notes 14 Vital Signs 27 Calendar, Directory

Industry Interview

28 Dr. Kenneth L. Farmer Executive Vice President and Chief Operating Officer TriWest Healthcare Alliance

Military Medical & Veterans Affairs Forum Volume 16, Issue 3 • May 2012

Dedicated to the Military Medical & VA Community Editorial Editor Brian O’Shea Managing Editor Harrison Donnelly Online Editorial Manager Laura Davis Copy Editor Laural Hobbes

Art & Design Art Director Jennifer Owers Senior Graphic Designer Jittima Saiwongnuan Graphic Designers Amanda Kirsch Scott Morris Kailey Waring

Advertising Associate Publisher Charles Weimer

KMI Media Group Publisher Kirk Brown Chief Executive Officer Jack Kerrigan Chief Financial Officer Constance Kerrigan Executive Vice President David Leaf Editor-In-Chief Jeff McKaughan Controller Gigi Castro Administrative Assistant Casandra Jones Trade Show Coordinator Holly Foster

EDITOR’S PERSPECTIVE I am excited to announce that Military Medical/CBRN Technology (MMT) is changing its name to Military Medical & Veterans Affairs Forum (M2VA). Coverage will be shifted to have more of an emphasis on the Department of Veterans Affairs (VA) and IT within the VA, which is continually changing as legislation creates stricter security standards to adapt to technological advancements. Along with the name change comes a new publication from KMI Media Group, Border & CBRNE Defense (BCD). BCD takes an in-depth focus on homeland security and counterterrorism efforts including mitigating chemical, biological, radiological, nuclear and explosive threats along our Brian O’Shea northern and southwest borders and ports throughout the U.S. BCD coverage Editor includes all military support operations, disaster response, first responders and other federal agencies including Customs and Border Protection (CBP), Federal Emergency Management Agency (FEMA) and the Transportation Security Administration (TSA) that collaborate to ensure our country’s safety from hostile intrusion. A CBP project of note that will be covered in the first issue of BCD is the Integrated Fixed Tower (IFT) project. The IFT systems will assist agents in detecting, tracking, identifying and classifying items of interest along our nation’s borders through a series of fixed sensor towers and command and control center equipment that displays information on a common operating picture (COP). The procurement will consist of surveillance equipment (e.g., ground surveillance radars and surveillance cameras) mounted on fixed towers; all necessary power generation and communications equipment to support these tower sites; and command and control center equipment (including one or more operator workstations) capable of displaying information received from surveillance towers on a COP. KMI Media Group will continue to cover military and government operations as well as civil support agencies efforts’ to mitigate CBRNE threats to our borders and nation as a whole in BCD. I am excited for this shift in coverage and creation of a new publication. I look forward to working with a plethora of agencies and organizations as this new publication launches. As always, if you have any questions for me regarding M2VA or BCD, feel free to contact me at any time.

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Subscription Information Military Medical & Veterans Affairs Forum ISSN 1097-1033 is published eight times a year by KMI Media Group. All Rights Reserved. Reproduction without permission is strictly forbidden. © Copyright 2012. Military Medical & Veterans Affairs Forum is free to qualified members of the U.S. military, employees of the U.S. government and non-U.S. foreign service based in the U.S. All others: $65 per year. Foreign: $149 per year.

Border Protector

Michael J. Fisher Chief U.S. Border Patrol U.S. Customs and Border Protection

June 2012 Volume 1, Issue 1

Leadership Insight: Robert S. Bray Assistant Administrator for Law Enforcement/Director of the Federal Air Marshal Service

Wide Area Aerial Surveillance O Hazmat Disaster Response Tactical Communications O P-3 Program

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Health Care Collaborator Lt. Gen. Patricia D. Horoho Surgeon General U.S. Army Commanding General U.S. Army Medical Command

May 2012 Volume 16, Issue 3


MAJ. GEN. DAVID L. HARRIS Director, J-3/7 National Guard Bureau

En Route Medical Evacuation O San Antonio Military Health System Veterans Affairs Police O AFMS Contracts

Medical Communications For Combat Casualty Care Data Developer

Colonel Brian Eastridge Director Joint Theater Trauma System

Colonel Brian Eastridge, a trauma surgeon, is the director of the Joint Theater Trauma System (JTTS) at Fort Sam Houston, Texas. His work focuses on developing and implementing the Joint Theater Trauma Registry (JTTR), a repository for all DoD trauma-related data that is helping the Army to identify trends and problems within certain health care processes and begin to facilitate change. During more than 20 years of service, Eastridge has deployed five times and has witnessed the evolution of the JTTS, gaining firsthand experience in gathering data on the battlefield as a physician. Data stored in electronic medical information systems is transforming the methods and procedures medical staff use on and off the battlefield. His work focuses on improving resuscitation strategies for casualties and developing pre-deployment training strategies for medical units. Q: What are your thoughts on the current electronic medical recording systems used in the field? A: There’s been tremendous evolution in the JTTR system. Registry data has really evolved because of computer-based technology. In 2004, it was exclusively paper records, but Medical Communications for Combat Casualty Care [MC4] programs have allowed us to have more access and communication in theater. Electronic

medical systems have really advanced the timeliness in which we know the information and there’s no question that it has improved our data capture and data integrity. They’ve allowed deployed medical staff to get a lot more work done in less time.

bled too much by the time they reached the hospital. Now that we have this data, we can begin to implement some changes so medics have the appropriate hemostatic devices to potentially change an injured soldier’s outcome.

Q: How are the current methods of gathering health information impacting patient care?

Q: Where do you see data collection going in the future?

A: Perhaps the most notable example is how we’ve completely altered the massive transfusion paradigm that we’ve named the Damage Control Resuscitation. The registry system was able to show the impact of the resuscitation strategy the Army was using for years, since about the 1970s. Before a change was implemented in 2006 and 2007, the mortality rate for massive transfusion causalities was 40 percent. After we instituted a change, it dropped to less than 20 percent consistently. We achieved this change by simply changing the order in which a patient receives bloodclotting fluids. The data in the registry gave us the information we needed to effectively make this change, which has also been adopted by our civilian counterparts and internationally. Q: What is the most recent example of change being instituted? A: The most recent analysis we conducted was to find out why combat causalities die at medical treatment facilities. We used the data from the Office of Armed Forces and the direct leader of JTTR. We code casualties as potentially survivable or not based on the severity of the injuries. After looking at all the deaths over the course of the wars, both Operation Iraqi Freedom and Operation Enduring Freedom, we found that 50 percent were potentially survivable, meaning in the optimal circumstance they had immediate care, a short evacuation and survived appropriate surgical care. One of the biggest issues for battlefield causality is non-compressible hemorrhaging. We looked at the data in the registry and found that injured soldiers we could potentially save were dying from hemorrhaging because they perhaps had

A: We’ve transitioned to the degree we can to gather data electronically so our trauma nurse coordinators downrange can enter data that goes into the registry. If there are any gaps, they can look to the electronic health record on the registry or speak to other nurses and physicians. Right now, the registry is not web-based; everything we do on the registry is currently stored and forwarded to the composite registry in San Antonio. Having a web-based system is on the very near horizon. Q: What other types of technology takeaways did you have when you left OCONUS? A: I’m on the Technical Combat Casualty Care Committee and I can tell you from my experience that our pre-hospital data is woefully inadequate. We only get about 10 to 20 percent of our data from medics. I’m not sure a real-time handheld is the solution. They are working under very difficult conditions and getting data is not first and foremost on their mind, and rightfully so. In order to make a big impact on combat casualty care, we need to work aggressively in providing medics with a handheld tablet that is practical and offers a high degree of reliability. Voice recognition seems very practical. Alternatively, we’ve successfully piloted a new process: upon returning from a mission, medics shower and eat before they document data. This downtime gives them the opportunity to decompress after the mission so when they do sit down to document the data, they are calm and collected. O

This interview is also available on The Gateway at M2VA  16.3 | 3

Program Notes Army Reservists Graduate from Professional Development Program Externship GE Healthcare recently announced the graduation of the first class from its joint externship program with the U.S. Army Reserve’s 807th Medical Command (Deployment Support) (807th MDSC). The program provides training and fosters career development for biomedical equipment specialists with the goal of producing highly skilled soldiers for Army Reserve war and peacetime missions and facilitating their employment in the civilian health care technology industry so soldiers stay mission-ready. Last year, GE established a partnership with the 807th MDSC, which manages deployment of all Army Reserve field expeditionary medical units from Ohio to California, to help address the critical need for biomedical equipment specialists both within the command and in the private sector. The pilot program graduated seven Army Reservists. A second wave made up of seven externs is midway through the program, and a third wave will commence shortly. The externship program aligns with GE’s commitment to strengthening America’s global competitiveness by building a more highly skilled workforce and supporting the integration of the nation’s veterans into industry. In February 2012, GE announced plans to hire 5,000 veterans over the next five years and to partner with the U.S. Chamber of Commerce to support its “Hiring our Heroes” initiative through career opportunities and training for veterans in 50 U.S. cities. GE Healthcare has already hired three employees through the program. “GE is proud to count among our employees thousands of military veterans whose leadership skills and training supports our culture of dedication and commitment,” said Richard Neff, vice president and general manager of service for the United States and Canada, GE Healthcare. “We are pleased with the results of this pilot program and look forward to expanding our efforts to provide career opportunities to our servicemen and women, addressing needs in the health care industry, and helping drive ‘what works’ in the American economy.” Biomedical equipment specialists participating in the program obtain professional qualifications for both military and civilian standards. Externs complete hands-on “mission” assignments as well as duty military occupational skill qualification requirements and acquire experience in regional medical equipment concentration sites, advanced, multi-modality biomedical training and process management training with regular progress review. “We are pleased to collaborate with GE Healthcare to not only help meet the need for specialized biomedical training in the health care industry, but to also provide important opportunities for military veterans to integrate into the civilian workforce,” said Major General L.P. Chang, commander, 807th Medical Command.

4 | M2VA 16.3

Orthopedic Surgeon: National Hero of Military Medicine Air Force Major Erik Nott, M.D., a SLU Care orthopedic surgeon at Saint Louis University Hospital, was honored for his bravery, leadership and skills as a surgeon and educator by the Henry M. Jackson Foundation for the Advancement of Military Medicine. Nott has been a practicing orthopedic surgeon for five years. Howard Place, M.D., professor of orthopedic surgery at SLU who served in the Army for a dozen years, said the Jackson Foundation typically honors high profile public officials such as congressmen or high ranking members of the military, who have had years of military service. Nott is assistant mission commander for an elite, eightperson Air Force medical operations unit known as the special operations surgical team/special operations critical care evacuation team, which provides close support for military troops on special missions. They stabilize injured members of the military so they can be transported to hospitals for further medical care. When not in the field, that military unit is embedded at SLU and Saint Louis University Hospital, teaching residents and medical school students and keeping their

skills sharp as they care for patients at a Level 1 trauma center. Able to mobilize quickly and go where needed to save the lives of troops and civilians, the team is on call for deployment at least once a year. The unit, based at Hurlburt Field, Fla., is one of two pilot programs that could transform future medical military care. Nott’s squadron and flight commanders nominated him for the national award, noting he led the seamless reassignment of his special operations medical Air Force team to Saint Louis University Hospital, where the team improved clinical and trauma skills that are important in caring for wounded troops and civilians. In one instance while serving in Afghanistan, Nott changed the life of a local interpreter by surgically reconstructing his right thumb, which restored the man’s ability to write. In another, he performed a surgery that allowed a patient to keep his foot, which otherwise would have been amputated. Nott was vigilant outside the operating theater as well. Three to five times a week, he visited a local patient to care for his leg wound, helping the injury to heal and sparing the leg from amputation.

By Mark Jacques, MD, MPH, MAJ, MC, SFS, Regiment Surgeon, 160th SOAR (A) and SFC J ohn D obbins The mission of the 160th Special Operations Aviation Regiment (Airborne) [SOAR (A)] is to organize, train, resource and employ Army special operations aviation forces worldwide in support of contingency missions and war fighting commanders. Soldiers of the 160th SOAR (A) are highly trained and ready to accomplish the very toughest missions in all environments throughout the world. Elements of the 160th have been actively and continuously engaged in combat operations since October 2001. The regiment’s approximately 3,000 soldiers, including around 1,000 aircrew members, spread across numerous CONUS and OCONUS locations ensure the ability of this force to carry out its no-fail mission.

The 160th SOAR (A) Medical Section has become an integral part of the mission, ensuring the regiment’s combat readiness, and has been a part of the global war on terrorism for more than the last 10 years. The medical section consists of over 50 enlisted flight medics and 12 medical officers, both physicians and physician assistants. Over the course of the last 10 years, the section has grown in size, abilities and capabilities, and in technology brought to the battlefield. This growth has drastically improved the ability of the 160th SOAR (A) medics to perform casualty evacuation (CASEVAC) duties. We have become effective and efficient at receiving the wounded and providing in-flight care as we transport them to definitive

care facilities. The advancements we have made involve not only pieces of equipment and hardware, but also the education and capabilities of the medical personnel caring for their wounded comrades on the battlefield and in the back of our helicopters. The ultimate result has been the performance of more than 1,000 CASEVACs, involving patient triage, patient monitoring and basic and advanced life support measures and interventions, throughout the theaters of both Iraq and Afghanistan. The 160th medic has evolved from a traditional Army medic to an en route critical care provider. This has been accomplished through the expansion of the education and training requirements of our flight medics. All of our M2VA  16.3 | 5

medics initially complete basic training and the Army’s medic-specific Advanced Individual Training program. Before beginning the specific training required of 160th flight medics, many have completed tours of duty, including overseas deployments, with traditional Army units. As they enter the training pipeline to become a 160th flight medic, they must complete the rigorous nine-month Special Operations Combat Medic School, which teaches advanced anatomy, pathophysiology, pharmacology and trauma management. To provide exposure to the realm of special operations aviation, all members of the medical section complete the Special Operations Aviation Medical Indoctrination Course. This course provides instruction on a variety of aeromedical issues and helicopter CASEVAC operations. In order to be considered as “fully mission qualified” or FMQ, the medics must obtain their National Registry of Emergency Medical Technicians-Paramedic Certification. Our medics are also required to achieve the Board for Critical Care Paramedic Transport Certification qualifications and standards as a nationally certified flight paramedic (FPC). These certifications are achieved and maintained through extensive didactic and hands-on training which prepares the flight medics to succeed at both the practical and written portions of the national certifying exam. To solidify and reinforce the information learned, the medics receive education in both sick call and clinical aviation medicine (non-trauma module or NTM), and trauma and critical care based training in the Medical Proficiency Training rotations. The education of our medical officers has likewise evolved over the last several years. All of our physician assistants are aeromedically trained; all of our physicians are board-certified providers, with aeromedical training as well. All providers are required to complete additional training in special operations aviation medicine and achieve certification as a FP-C. Our medical providers, enlisted and officers, are trained to operate within a spectrum of rotary wing aircraft, not just the standard Army medevac Black Hawk. We are trained to utilize both the Chinook and the Little Bird as CASEVAC platforms in addition to the Black Hawk. Each platform provides unique advantages, allowing for patient transport, essentially under any circumstance. Perhaps the most easily visible advances in the technology we use have occurred in our medical gear and equipment. Over the last 10 years, we have continuously assessed and evaluated our role and performance 6 | M2VA 16.3

as CASEVAC providers. This self-assessment has driven changes and advances that have allowed us to adapt to our environment on the battlefield and in the back of an aircraft. The changes are evident in the gear that we wear, our choice of medical supplies and the equipment we utilize during CASEVAC operations. Our kit begins with what we wear, an extension of our body armor. We have developed the gear we wear to allow us to maintain tactical maneuverability, while at the same time affording us the ability to treat significant injury in multiple casualties. One of the worn items is the newly developed MARCH (massive hemorrhage, airway, respiration, circulation, hypothermia) belt. It provides easy accessibility to a supply of items used for hemorrhage control, airway management and respiratory support. Members of our section also carry a slimmed-down aid bag, which affords adequate space for supplies while decreasing the medic’s silhouette and allowing for increased maneuverability. In addition to the gear we wear and carry, we have the gear specifically arranged on the aircraft we operate on. Our gear has been developed and specifically tailored to the 160th flight medics skill set and mission, as well as the airframe. Our choices in equipment and supplies fall in line with the recommendations of the Committee on Tactical Combat Casualty Care (CoTCCC). At a minimum, this gear includes all of the following: Patient Monitoring Systems: Increasing in-flight patient monitoring capabilities has been one goal of the 160th SOAR (A) Medical Section over the last several years. We employ multiple devices that together will monitor blood pressure, pulse, temperature, SPO2, 3 lead electrocardiogram and capnography. As we continuously seek to improve our capabilities, we are currently investigating the possibility of including ultrasound on board our CASEVAC aircraft. Hypothermia Prevention: A major concern while transporting patients in the various environments we operate in is prevention of hypothermia. To combat this we use both intravenous fluid warmer systems and patient hypothermia prevention kits. Hemorrhage Control: Numerous recent advances have been made targeted at improving hemorrhage control. With guidance from the CoTCCC our sets have evolved to include approved hemostatic agents, tourniquets and clamps. Pro-Coagulants: In accordance with CoTCCC guidelines, use of tranexamic acid

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Evaluation and Treatment The evacuation and treatment of wounded troops operating in the global war on terror throughout the last 11 years has been and remains the highest priority for the U.S. military. Numerous advancements like improved hemostatic gauze and tactical monitoring devices have increased casualty survivability rates. However, the unique challenges of remote operations with minimal support found in this war have greatly challenged the conventional methods of evacuation. Traditional doctrine called for dedicated field ambulances and medical evacuation helicopters to remove casualties from the battlefield. Too often this has proven to be extremely challenging. Dispersed operations and small elements cannot always be supported by customary evacuation measures. Readily available, dedicated, unarmed medevac aircraft requiring armed escorts have been limited as well. Their efforts have been and remain remarkable and essential, but they cannot be everywhere all the time. The result is that a high percentage of casualties are being evacuated with utility aircraft. While it is substantially more effective to evacuate casualties on aircraft that are already operating in the battlespace rather than to call and wait for a dedicated medical aircraft, this answer poses its own problems. When using utility aircraft already in the area, the casualties and medics are

often required to “compete” for space in the helicopter. If just two litter casualties are loaded into the helicopter, it is nearly “cubed out” of usable space. Often, casualties are placed directly on the floor where vibrations are greater, which can cause rebleeding of wound clots and accelerate hypothermia. While difficult to statistically quantify, the care that medics are capable of providing under these conditions has been extremely compromised, and it remains the most difficult and non-standardized phase of the evacuation continuum. In the attempt to maximize a casualty’s survivability rate and the medic’s capability to treat the wounded, new measures must be taken to properly fit our existing fleet of U.S. helicopters to tackle to the demands of both taking in and retrieving the same number of soldiers from the battlefield. There has been much discussion recently about how to improve the evacuation of casualties. The obvious choices are to field more medevacs in theater, to use utility aircraft that are more readily available with a medic riding aboard, or to create a hybrid of combat medevacs—robust medical packages on a utility airframe like the highly successful special operations evacuation model. In addition to the limits of medevac density and availability are the weight issues with medevac in theater with both the

outgoing “carousel” and the replacement system IMMSS found on the new HH-60 medevacs. In most cases, these systems must be removed to gain performance, which results in the casualty being once again floor loaded. Currently only one system is designed to augment this capability shortfall—the AllEvac Tactical Rapidly Installable Medical Evacuation Rack (TRIMER). TRIMER is a folding litter rack system that allows every mission Black Hawk to be a dedicated tactical casualty evacuation platform. The TRIMER weighs only 180 pounds and fits in the space of the rear wall of a UH & MH-60 A/L/M Black Hawks. It allows for a full complement of operators or cargo but converts to carrying two critical casualties in a matter of seconds. The TRIMER holds every NATO litter that can be floor loaded in a Black Hawk, providing the in-flight medic a dramatically improved position from which to accomplish vital and time sensitive en route critical care. Every minute following a battlefield wound is crucial. The importance of removing a casualty from the battlefield, transporting him effectively and efficiently, and delivering him to the next level of care cannot be overemphasized. Every reasonable effort should be made at every level to ensure America’s best receive the best care when they need it most.

is being implemented as part of our treatment protocol for appropriate patients with severe blood loss. Communication: Due to noise (specifically from the aircraft) inherent to the battlefield environment in which we operate, provider-to-provider and provider-to-patient communication has always been challenging, if not impossible. In light of recent technological advances, we now carry a device that allows two providers, or a provider and a patient, to “plug in” and communicate effectively either in-flight or on the ramp of an aircraft. This now allows us to clearly communicate with a coherent patient during en-route care and effectively communicate with an additional provider as we “receive” or “hand off” our patients. Aircraft Mounted Trauma Panel: This has been developed and improved over 10 years. Our latest trauma panel incorporates a modular system to allow for treatment of patients in a confined space, with

specific modules incorporated for pediatric and canine patients. Light Sources: An integral part of patient care is the ability to visualize treatments, wounds and equipment. We have incorporated lights that are tailored to our mission that improve patient care while maintaining tactical light discipline. Oxygen Delivery: One of our technological hurdles has been a way to provide oxygen to our patients without putting the crew at risk from an explosive oxygen cylinder, running out of oxygen, or having to exchange cylinders. A device developed to mitigate this is a self-contained oxygen generating device, which we are currently fielding at this time. All of these advances have improved the ability of our medics, PAs and physicians to receive our wounded comrades off the battlefield, care for them in-flight in the back of our helicopters and deliver them to the next level of care. We will continue to

assess our performance and make improvements as advances in technology continue to evolve. O

8 | M2VA 16.3

Major Mark Jacques, MD, MPH, is a physician, board-certified in both pediatrics and aerospace medicine. He is a U.S. Army senior flight surgeon and nationally certified flight paramedic. He currently serves as the regiment surgeon for the 160th Special Operations Aviation Regiment (Airborne). Specialist First Class John Dobbins, FP-C, NREMT-P, is nationally certified as both an EMT-paramedic and flight paramedic. He currently serves as the Regiment Medical Section NCOIC for the 160th Special Operations Aviation Regiment (Airborne).

For more information, contact MMT Editor Brian O’Shea at or search our online archives for related stories at

Integrating, aligning San Antonio health care organizations.

By Colonel Mary Garr The 2005 Base Realignment and Closure (BRAC) was a watershed decision by Congress that would greatly change the military medical landscape in San Antonio. Along with the trend of civilian medical health care costs escalating over the last decade, military expenses for health services have experienced a similar incline. Congress’ decision was primarily driven by opportunities to consolidate resources and services, reduce infrastructure costs, and decrease product line redundancies in many military communities. Focus on efficiency and increased collaboration throughout multiple military health care organizations are expected to help reduce overall Department of Defense health care expenditures. In San Antonio, Lackland and Randolph Air Force Bases joined with Fort Sam Houston Army Post to become Joint Base San Antonio (JBSA). Over the years, BRAC has joined an additional 200 organizations to create an even larger JBSA within the seventh largest city in the United States. San Antonio has one of the largest military populations made up of active duty members, retirees and their families. It is commonly referred to as “Military City, USA.” San Antonio was a natural fit for consolidation and relocation of DoD medical missions as it is the home of Army Medicine and hosts the largest medical wing in the Air Force Medical Service. Now it is being recognized as the home of military medicine to include health care, research, and medical education and training. Some of the medical changes included consolidating all enlisted medical training as well as the establishment of the medical education and training campus, which conducts over 60 programs supporting more than 21,000 enlisted students every year from the Army, Navy, Air Force and Coast Guard. Separately, the Army Medical Department Center and School provides over 300 education and training programs to almost 35,000 students a year, including several nationally ranked programs. Bringing the sister services together in one location for medical training will ensure continuity of care and common skills that will extend from our home stations out to the combat zone.

Maj. Gen. Byron Hepburn

Maj. Gen. M. Ted Wong

In the field of health care research, the Battlefield Health and Trauma Center was created to collocate the Army Institute of Surgical Research, the U.S. Army Dental and Trauma Research Detachment, the Naval Medical Research Unit - San Antonio, and the U.S. Air Force Dental Evaluation and Consultation Service. The collocated medical research entities now have the unique ability to leverage each organization’s strengths, resources and, most importantly, their personnel’s research expertise. Military medical organizations from JBSA conduct joint and federal innovative research while collaborating with academia and industry. Beyond education, training and research, consolidation of services in San Antonio was intended to improve health care delivery. The two primary medical centers for the Air Force and the Army integrated. The military moved all inpatient care to Brooke Army Medical Center (BAMC), the facility was renamed San Antonio Military Medical Center (SAMMC) and a 102-bed inpatient tower was added. The Air Force’s former Wilford Hall Medical Center (WHMC) was converted to the DoD’s largest ambulatory surgical center and renamed Wilford Hall Ambulatory Surgical Center (WHASC), providing outpatient services and same day surgery. As the missions have changed, so has the staff mix. The Air Force moved nearly 2,000 staff inside SAMMC and now even more Army M2VA  16.3 | 9

and Air Force staff work in both SAMMC and WHASC. It’s truly a partnership able to capitalize on the best each service has to offer. “SAMMC is carrying on BAMC’s legacy of providing the best patient-focused and safe health care to all of our patients,” said Army Major General M. Ted Wong, BAMC commanding general and deputy director of the San Antonio Military Health System (SAMHS). “With the integration of Air Force and Army staff, our organization can share best practices resulting in even better health care for our active duty servicemembers, families and retirees. Even though we are in the initial stages of integration, the teamwork, collaboration and camaraderie between the staff has been phenomenal.” The 59th Medical Wing (MDW) maintains several medical centers of excellence in eye care, diabetes and hearing. It is also home to the critical care air transport team, a pilot unit for the Air Force which provides in-flight intensive care support for wounded warriors evacuated from combat operations. In summer 2011, the 59th MDW added to its mission by standing up a contingency aeromedical staging facility (CASF) to house, treat and redistribute patients from overseas operations. More than 1,700 patients have been cared for in the CASF’s first nine months of operation. BAMC, as the command overseeing the San Antonio Military Medical Center, is home to DoD’s only Level 1 trauma center in the United States, DoD’s only bone marrow transplant unit, the Center for the Intrepid (which provides state-of-the-art amputee care), and also supports DoD’s only burn center under the Army Institute for Surgical Research. BAMC is also an amputee care, breast imaging and cardiovascular Center of Excellence. Sister service collaboration has existed for years in San Antonio in the physician education realm. Many of those existing relationships and processes served as a foundation for the facility integration between BAMC and WHMC. This partnership, the San Antonio Uniformed Services Health Education Consortium, oversees 35 graduate medical education programs. On average, 575 military residents who graduate the program will average a first-time board pass rate of 92 percent, well above the national average. Several of the residency programs within the Consortium work closely with the University of Texas Health Science Center, San Antonio. All the military medical services, research capabilities, and training and education now exist under the recently formed SAMHS. The SAMHS was created to align Army and Air Force health care delivery as one system with the vision of becoming DoD’s premier health care system. Collectively, the SAMHS has 12,000 staff supporting over 230,000 beneficiaries across 10 military treatment facilities. The SAMHS provides oversight on readiness skills sustainment, providing improved high-quality health care and health services, supporting graduate medical/health education and training, and conducting biomedical research. The SAMHS intends to improve effectiveness while keeping patients first with a continued commitment to patient safety, high-quality care and organizational excellence. The SAMHS leadership team is comprised of senior leaders from both the 59th MDW and BAMC commands. The SAMHS director/ deputy director positions are filled by the commanders of the 59th MDW and BAMC on a rotational basis. The SAMHS chief operating officer and two deputies, one for clinical operations and one for business operations, also rotate between the Air Force and Army. The SAMHS office includes a mix of Army and Air Force staff facilitating subcommittees responsible for various functions that apply systemwide to effect positive change. From a strategic perspective, 10 | M2VA 16.3

the SAMHS office is responsible for long-term planning and communication, partnering with other federal health organizations, and developing the data analysis to support decision-making processes to improve the health system. From an operational perspective, the SAMHS is responsible for reviewing product lines, ensuring centralized systemwide appointing and referring, developing or ensuring consistent messages internally and externally, integrating business processes, logistics, contracting and more. “The SAMHS has the patient’s experience of care as one of its top priorities,” said Air Force Major General Byron Hepburn, SAMHS director. “As we continue to improve our clinical and business processes, we will also achieve financial savings. The end result will be enhanced quality of care for our large military population in San Antonio.” The ever changing health care landscape has afforded SAMHS the ability to identify, vet and leverage opportunities across the 59th MDW and BAMC. While we are still in the nascent phases of developing and maturing as one military health system, great advances have occurred in San Antonio. SAMHS is developing a number of ambitious initiatives with a focus on improving health, not just health care. On the horizon are plans to collaborate with our greater military and civilian communities to address today’s health issues, such as obesity, evaluate certain chronic disease processes, improve fitness, and examine lifestyle choices that influence health and ultimately raise the costs of health care long term. The SAMHS is uniquely postured to develop the DoD model for integration and alignment of multi-service health care delivery entities. San Antonio has been a wonderful host city with great community support for the military while boasting an extensive health care market. Many residents of San Antonio have a direct connection with the military, having served at some point. San Antonio provides the right environment for support and collaboration and, with a sincere and sustained commitment from all echelons of military leadership, we expect to see continued success over time. The charter is clear, the way ahead auspicious and the SAMHS aims to deliver on its mission of being the premier health care system providing high quality patient-centered medical care, readiness, education, training and research. O

Col. Mary Garr

Col. Mary Garr is the chief operating officer, San Antonio Military Health System.

For more information, contact M2VA Editor Brian O’Shea at or search our online archives for related stories at

Supporting big Navy objectives with state-of-the-art solutions. Q: What are the primary roles and objectives of the Naval Medical Logistics Command [NMLC]? A: Let me first thank you for recognizing NMLC and our contributions to Navy Medicine, the Navy and warfighters around the globe. As Navy Medicine’s center of logistics expertise, we support big Navy objectives by designing, executing and administering individualized state-of-theart solutions to meet customers’ medical materiel and health care service needs. Our staff of logisticians, analysts, clinical engineers, contracting officers and attorneys is dedicated to helping customers define their requirements, understanding the marketplace to support the requirements, and providing cost-effective, efficient contracts to satisfy those requirements. Last year, we executed purchases of more than $215 million in medical equipment and maintenance for the operating forces and fixed treatment facilities, and contracted more than 4,000 health care workers for service in Navy treatment facilities. Beyond our purchases of medical equipment and health care services, we support a number of high profile programs. We provide engineering support for medical and dental space configuration for new ships’ construction and maintain authorized medical and dental allowance lists for the operational forces. We are the field operating agency for non-clinical immunization issues related to logistical support of vaccine programs for the Navy. We execute the Navy’s radiographic picture archiving and communication system and serve as Navy Medicine’s representative for electronic business systems development and maintenance. These are just a sampling of the logistical functions we perform. Our subordinate commands include the Naval Ophthalmic Support & Training Activity, which provides optical fabrication services for all operational, contingency and worldwide humanitarian missions. The Navy Expeditionary Medical Support Command, which also reports to NMLC, designs, builds and ships expeditionary medical facilities and forward deployed preventative medicine units to anywhere on the globe. NMLC Detachment in Pirmasens, Germany, provides and projects medical logistics support and training across the full spectrum of military operations to the United States European Command, Central Command, Special Operations Command Europe, Africa Command and the Department of State. To put this in practical terms, last year we became the organization that answered the chairman of the Joint Chiefs of Staff’s call to provide a medical technology to warfighters in theater that had not been previously accomplished. In record time and with the assistance of joint services throughout the Department of Defense, we developed the requirements, surveyed the sites and managed all the obstacles involved with acquiring three mobile Magnetic Resonance Imaging [MRI] systems, and transported them to Afghanistan to aid in the diagnosis and treatment of mild traumatic brain injury. NMLC was uniquely positioned to lead the MRI effort. As the Center of Logistics Excellence for Navy Medicine, NMLC had the necessary clinical engineers, logistics experts, medical equipment

By Captain James B. Poindexter III

contracting authority and legal expertise. We developed an acquisition strategy that was able to reduce procurement time and overcome multiple logistics issues in seven months as opposed to the normal 12 to 18 months to procure a typical MRI system in the United States. That ambitious timeline required considerable planning and coordinaCapt. James B. tion to gain a full understanding of Poindexter III the project’s challenges and develop plans to mitigate them. A joint civilian and military clinical engineering site survey team traveled to Afghanistan to assess each of the proposed MRI deployment sites. Their assessments helped finalize the project plan and further refine the specifications of the MRIs to be purchased. Not only was this the first time mobile MRI units would be placed into theater, it was also the first time mobile MRI units would be transported via airlift. Because of the size, weight and special handling requirements, unique airlift assets had to be identified and obtained. Additionally, the roads in theater were inadequate to support the weight of the MRIs transiting from the airfield to the final installation locations. The existing power supply was insufficient to reliably operate the systems and avoid image distortions. There was a need for heavy-duty filtration systems to keep sand and dirt from damaging the MRIs and for shielding systems so the units’ powerful magnets would not interfere with operational communications and control systems. NMLC successfully addressed those issues by designing a contract strategy to procure trailer-mounted, self-contained MRIs having their own power sources, multiple filtration systems and enhanced shielding. Further, NMLC contracted for the personnel needed to stage and maintain the systems. Working with its contract partner, Philips Healthcare Global Sales and Services North America, NMLC secured contract field service representatives to assist with off-load and deployment of the systems in theater, to install the systems, and to provide on-site maintenance support to ensure the systems remained operable. This was an unprecedented feat and we were thrilled to successfully get this equipment there to have an immediate impact on warfighter care. Although this is only one example of the vast array of tasks my organization is responsible for, this is representative of the types of challenges we face and overcome routinely. Our primary objective is military medical health care solutions and everything involved with delivering those solutions. Q: What are some of the highlights of research and development for NMLC in 2012? A: In December 2011, the Investigational Research Omnibus Contract multiple award contract was awarded to support Navy Medicine’s clinical investigation program. It has a five-year performance period and a M2VA  16.3 | 11

$49.9 million ceiling value for the contracts. This is the first significant research support contract vehicle that we have awarded. We issued our first broad agency announcement [BAA] on the government website in January. The BAA solicits research proposals under three areas of interest: infectious disease research, non-communicable disease research and combat casualty care research. The BAA is an exciting tool that enables NMLC to provide additional support to Navy’s Bureau of Medicine and Surgery’s [BUMED] research mission. We plan to issue our first grant awards as the result of projects selected for funding under the BAA. We also plan to issue program announcements on for research efforts that do not fit within the scope of the BAA. We hope to make a significant number of grant awards in 2012 for projects that are important to Navy Medicine. The command is also working closely with BUMED and the Naval Medical Research Center on projects involving the development of a malaria vaccine, studies on military suicide and therapies for combat casualty care. These are examples of important research projects that NMLC is supporting in 2012. Q: How important is NMLC’s relationship with industry in meeting its goals? A: Our relationship with industry is very important from several perspectives. First, it’s important for our engineers to stay abreast of changing medical technology so we can evaluate and integrate that technology into the inventory as soon as it is practicable. Our engineers do a lot of web research, attend conferences and symposia, and contact vendors directly in order to stay up to speed. We also meet regularly with our services contractors to understand the problems they are having and to get their input on process changes that might benefit our customers. In addition to listening to what industry has to say, it is also important to communicate our needs to industry so that they can position themselves to satisfy those needs. Recently, we invited industry professionals to provide briefs on current technologies available to meet a project requirement known as the real time locating system [RTLS]. The initial focus of the RTLS initiative is to provide asset management tracking to ensure a myriad of medical equipment can be located in the most expeditious manner and properly maintained on a recurring basis. Future RTLS capabilities include infant security, staff/patient tracking and temperature monitoring. We also held an industry day for our medical services contractors last summer to let them know about upcoming changes to our medical services contracts. I have also designated my small business programs officer as our industry outreach coordinator. Part of her job is to be our face to vendors—particularly new vendors we might not have any experience with—so they can learn how to do business with us and we can learn about their capabilities. Q: What programs are in place to ensure small businesses have the maximum opportunity to participate in the Navy’s acquisition program? A: We have had a successful small business program in place for several years. Over the last five years, we have consistently exceeded our target goals for contract dollars awarded to small businesses, as well as exceeding statutory goals. As I mentioned earlier, our Office of Small Business Programs is staffed by a full-time director who serves as the gatekeeper 12 | M2VA 16.3

to small businesses and assists and counsels them on how they can support Navy medicine acquisitions. By facilitating meetings between small business firms and acquisition and the technical staff, everyone benefits from increased opportunities to maximize small business utilization and improve their understanding of the marketplace. While our organization provides worldwide acquisition support for Navy shore-based medical treatment facilities and fleet and operational forces with medical equipment and supplies, the bulk of our acquisitions are for direct patient care services. These medical and dental staffing services augment the military health care system and provide contract civilian practitioners and clinical support staff. The health care staffing service contracts, which have averaged around $400 million annually over the last five years, have been exclusively set aside for small businesses. In addition, we are looking at other initiatives, to include partial set-asides within set-asides. For example, where a multiple award contract for medical staffing services is setaside for small businesses, a portion of that contract will be awarded to a more specific socio-economic division of small businesses [e.g., a service-disabled veteran-owned small business firm]. This will further maximize opportunities for small businesses. Within the newly established and growing mission of supporting Navy medicine’s research and development requirements, we have numerous opportunities to promote small business sub-contracting. In order to keep current on Department of Defense small business initiatives, the Small Business director offers periodic training to staff personnel and takes advantage of professional development wherever possible. She is also a member of the DoD Mid-Atlantic Regional Council–Small Business Education Advocacy. Another very valuable training forum is the DoD Office of Small Business Programs conference held annually. This conference is often held jointly with the Small Business Administration [SBA] and reports on best practices and provides valuable networking resources across the DoD and SBA communities. These best practices are then brought back to the organization to advance and improve our existing small business program. So as you can see, we have robust engagements within the small business community. They have become a viable and important aspect of supporting Navy medicine requirements. Q: What are the top challenges NMLC will face in 2012? A: We will need to meet several important challenges in 2012. Navy Medicine has implemented limits on our numbers of civil service positions, which would ordinarily mean an increase in contracting support provided by us in order to make up any potential deficit of care. I say “ordinarily” because there are several factors in play that will have the effect of restraining that outcome. The DoD has implemented guidance prohibiting the conversion of services from civil service to contracting, which may make it more difficult for our medical treatment facility customers to use contracting as a way to acquire skills missing in the active duty or civil service inventory. The Navy’s Bureau of Medicine and Surgery’s new security policy may be another challenge in 2012. It has implemented a more stringent security requirement for contractors than in prior years. This will make it more difficult to acquire some medical specialties, and we may end up paying more for those specialties. That brings me to the last potential challenge—budget uncertainties. As we transition to a more austere budget environment, we will need to work very closely with our medical treatment facility and operational customers to wring out all the value we can from our contracts.

In an effort to reinforce supply chain efficiencies, the Office of the Secretary of Defense has decremented the budget of the services’ medical commands by more than $250 million spread across the next five years. The Navy’s portion of that decrement is $51 million. In order to successfully absorb this budget decrement, one of Navy Medicine’s primary logistics and acquisition objectives in fiscal year 2012 is to increase our E-Commerce purchases through the Defense Logistics Agency’s [DLA] MedSurg and Pharmaceutical Prime Vendor and Electronic Catalogue contracts, while decreasing overall purchase card, depot and open market procurements. We call this sourcing optimization. In addition, we recently coordinated with the Defense Medical Logistics Proponency Committee and DLA Troop Support to develop several key initiatives aimed at reducing medical material costs through the use of DLA Business Intelligence tools. During 2012, NMLC will be rolling out standard operating procedures and implementing new controls in order to ensure Navy Medicine can feel confident that we are making the most optimal sourcing decisions using the very best data and information available. Foreseeable budgetary constraints and personnel hiring controls pose a challenge for us to accomplish our mission of ensuring MTFs continue to possess state-of-the-art medical technologies to fulfill warrior and other Military Health System beneficiary health care needs. It is now, more than ever, incumbent on commands to be frugal and efficient in overseeing Navy Medicine’s medical equipment inventory, which consists of about 300,000 pieces of equipment valued in excess of $1 billion. Ongoing improvements in program management [e.g., central budgeting, life cycle management, total asset visibility] will be key. Pharmacy automation and RTLS, as I previously mentioned, are a couple of the latest initiatives NMLC has undertaken to be good stewards of its resources. Navy Medicine is deploying pharmacy automation systems in its MTFs to fill prescriptions in a more expeditious and accurate manner. RTLS will be deployed throughout the enterprise to enhance the patient care Navy Medicine delivers.

Earlier, I mentioned two exciting enterprisewide initiatives that are worth repeating. Our engineers and acquisition professionals are executing a requirement to update pharmacy automation in all Navy MTFs. We’ve had process engineering support from the analysts in the Navy’s Bureau of Medicine and Surgery to help refine the pharmacy delivery model in conjunction with the new automation. The resultant solution will increase efficiency, decrease wait time and decrease medication errors. And the RTLS will begin as an asset tracking system to provide property accountability from an audit perspective, but future technological spirals will deliver added capability such as patient monitoring and duress alerting. We also hope to gain some traction on at least two strategic sourcing projects in 2012—medical equipment maintenance and orthopedic implants. Commodity working groups are in place and working on acquisition models for both of these initiatives.

Q: What new initiatives will we see from your Acquisition Management Directorate in 2012 to support the medical and dental activities within the Navy’s Bureau of Medicine and Surgery?

Q: Is there anything else you would like to say that I have not asked?

A: We have a lot of significant new contracting initiatives in play this year. I’ll talk about the services side first, then equipment. I already mentioned the exciting things we’re doing in R&D in answer to a previous question. We just awarded our first locum tenens [short-term medical staffing] contract for physician services. This will give us a faster temporary backfill capability when active duty providers are deployed in support of operational or humanitarian missions or when any provider is out on extended leave. We are restructuring our multiple award task order [MATO] services contracts to align them more closely with the medical staffing industry. We used to have multilabor band MATOs under which contractors were required to provide everything from specialized physicians to medical assistants. Well, the industry is naturally aligned in market segments—physicians, nursing and allied health—so we’re aligning our MATO contracts the same way. We will see significant initiatives to support patient centered medical home and pain management on the services side in 2012. In fact, Navy Medicine is trying a very innovative approach to integrating pain management into medical home for those patients who experience chronic pain.

Q: How will drawdowns in both Iraq and Afghanistan affect the NMLC role? A: The drawdowns will happen, but the medical consequences of these conflicts will be with us for awhile. For example, I expect us to continue to support psychological health/traumatic brain injury and pain management initiatives for quite some time. I think we will also be called upon to support the Individual Disability Assessment System as all the services, including Navy, work in earnest to process the backlog of returning warriors awaiting transition to the next phase of their lives. I hope the drawdowns give us the opportunity to look at medical staffing from more of a total force perspective. What I’m saying here is that the success of medical services contracting depends on making market-savvy decisions about what kinds of services can be bought, where and at what price. There are some markets where certain providers just aren’t available at prices we can afford. I’m hopeful that we’ll have some flexibility to station returning deployed providers in MTFs where there is no market to support a contracting solution.

A: I would just like to reiterate that NMLC has routinely worked behind the scenes in providing world-class Navy medicine health care equipment, personnel and medical logistics solutions in support of warfighters, active duty and reserve personnel, military retirees and dependents, and to those through the DoD who rely on military medical health care. The current economic environment has made health care a daily topic of discussion, including the cost of military medical health care, adjustments to TRICARE and military retiree deductibles, and the governance of the Military Health System. With so much attention being placed on military health care, I think it is important to remember that despite what is occurring in today’s economical environment, there is an organization keeping an eye on the proverbial ball. As Navy Medicine’s Center of Logistics Expertise, NMLC remains committed to providing individualized state-of-the-art solutions to meet customers’ medical materiel and health care service needs. O

For more information, contact M2VA Editor Brian O’Shea at or search our online archives for related stories at

M2VA  16.3 | 13

VITAL SIGNS Frozen Packaging Solutions AcuTemp Thermal Systems recently announced an expansion to their family of packaging solutions. The newest addition to the line of AcuTemp frozen shipping solutions focuses on substantially reducing the amount of dry ice required for shipping. AcuTemp’s expanded frozen solution offering comprises 27 payload sizes, with durations that range from 24 to 192 hours. The design allows for a significant reduction in the amount of dry ice needed. Thermal testing has shown that for the same payload and duration, there is an average reduction of up to 88 percent over EPS and a 67 percent reduction over PUR. This results in substantial supply chain savings. These significant dry ice reductions are possible because AcuTemp packaging utilizes ThermoCor vacuum insulation in a patented molded design that results in less dry ice, smaller packaging size, longer hold times, larger payloads and superior temperature control, resulting in lower overall costs. In addition to thermal efficiency, the lightweight and less bulky features of ThermoCor allow for a high degree of design flexibility. There are many challenges associated with dry ice, including handling, cost and availability. Many airlines and forwarders are increasing the overall freight capacity but decreasing dry ice capacity, increasing the possibility of dry ice shipments being bumped. However, shippers of frozen products want the consistency they receive with dry ice. AcuTemp’s frozen shipping solutions provide the performance of dry ice required by shippers while also reducing total systemic costs.

14 | M2VA 16.3

Airworthiness Certification and MRMC Approval Remote Diagnostic Technologies’ (RDT) Tempus IC Professional patient monitor has been granted a fleetwide airworthiness release (AWR, Aircraft Clearance) from the U.S. Army and has concurrently received the Aeromedical Certification Memorandum by the commanding general at the Medical Research and Materiel Command. The AWR has been signed-off on for the required aircraft and medevac platforms, approving its use on all U.S. Army UH/ HH-60A/L/M, MH-60K and MH-47G helicopters. The stringent evaluation process includes electromagnetic interference and compatibility, environmental and human factors testing at the U.S. Army Aeromedical Research Laboratory, with in-flight assessments by both engineers and medical personnel under a range of flight conditions. This means the Army can be confident using the IP66 rated medical monitor in the extreme environments which it is deployed. Tempus offers three distinct capabilities: all the patient monitoring capabilities modern warfighters expect, patient record data collecting and sharing, and integrated secure real-time telemedicine reach back over military and civilian communications. “RDT is committed to bringing a 21st-century approach to vital signs monitoring with solutions that meet the needs as described by the modern warfighter,” said Chris Hannan, RDT’s operations director. “We

are proud to offer special and conventional forces a comprehensive medical monitoring solution that is designed specifically for their requirements. This AWR approval recognizes the efforts RDT took to design a commercial product that meets extremely demanding military applications. Having been the first to provide a number of other military-focused features like the electronic TCCC card on the Tempus monitor, we look forward to continuing to respond to the needs of the medic with a range of innovative monitoring and diagnostic technologies.” Tempus IC Professional has been selected as the primary monitor in the USSOCOM TCCC casevac set provided by Tribalco and is playing a key part in multiple development projects with different conventional and special forces groups. Rachael Hill;

Chemical and Toxin Detection for Vehicles, Robots and OEMs The new ChemProDM (Detector Module) is a compact module for the detection and classification of toxic industrial chemicals (TICs) and chemical warfare agents’ (CWAs) vapors. Its multi-sensor detection array has 10 sensing channels, with a unique open loop ion mobility spectroscopy (IMS) sensor at its heart, to provide CWA sensitivity below military action levels, quick response and industry-leading false alarm rejection even to low vapor pressure threats like VX. The ChemProDM’s compact package includes mounting flanges for vehicle, robot mounting or incorporation into OEM systems. The ChemProDM does not have its

own display. If the vehicle or robot has a digital backbone, the digital output of the ChemProDM can be directly integrated into the vehicle’s displays. If a digital backbone is not available, the optional remote alarm unit (RAU) can be mounted away from the ChemProDM module. The RAU fully emulates display of the ChemPro100i. An optional vehicle radiation detector allows the ChemProDM and RAU to simultaneously provide both vapor and gamma radiation detection for CRN protection with a very compact footprint. Both the ChemProDM and the ChemPro100i have the ability to detect more than 40 TICs and CWAs.

Compiled by KMI Media Group staff

EMS Solutions with Latest Evolution of the Defibrillator

Philips has introduced the tactically enhanced HeartStart MRx monitor/ defibrillator for emergency medical services (EMS). Designed in collaboration with EMS professionals, the latest enhancements will further help professional responders improve and save lives. EMS professionals require easy to use, technically advanced monitors to focus on what matters most: patient care. With a commitment to meaningful innovation, Philips is introducing numerous improvements in the HeartStart MRx monitor/ defibrillators. The newest innovations are based on extensive feedback from EMS professionals. Each enhancement is designed to help professional responders optimize workflow and include: • • • • • •

Tactical gray color option designed to show less dirt and wear over time Automatic lead switching, which allows users to focus on the patient, not the monitor Improved ECG performance, including new ‘ruggedized’ EMS lead sets Flexible event summary print options for enhanced workflow Enhanced event markers, with the ability to enter drug dose and unit of measure Auto switching from demand-mode to fixed-mode pacing if the primary ECG lead is lost

The HeartStart MRx combines industry-leading monitoring technology with diagnostic measurements and Philips’ patented defibrillation therapies in a rugged, lightweight device. The HeartStart MRx provides several advanced features important to EMS professionals, including Philips’ advanced DXL 12-Lead ECG algorithm, a large color display, fast time to shock and the longest battery operating time for ECG monitoring among eight leading monitor/defibrillators, according to published manufacturer’s specifications. Additionally, Q-CPR, the most clinically proven CPR measurement and feedback tool, is available as a fully integrated option. Brian Healey;

Blood Glucose Monitoring System Receives FDA Clearance Abbott recently announced that it has received U.S. Food and Drug Administration (FDA) clearance for the FreeStyle InsuLinx Blood Glucose Monitoring System, the first from Abbott to include a touch-screen interface, automated logbook and several personalization features designed to improve the diabetes management experience for patients. This unique device is also equipped with built-in FreeStyle Auto-Assist software that enables patients to track progress, analyze trends and easily display data for their health care providers. The FreeStyle InsuLinx System will be available to U.S. consumers within the coming months. According to the American Diabetes Association (ADA), approximately 25.8 million people in the United States have diabetes, and of those, many require insulin to manage their condition. The FreeStyle InsuLinx System is the newest addition to Abbott’s portfolio of glucose monitoring systems and is designed to use FreeStyle technology to help insulin-using patients monitor their blood glucose levels to allow them to more effectively manage their condition. Specifically, the FreeStyle InsuLinx System offers: • • •

Touch screen designed for ease of use Automated logbook that assists with tracking logged insulin doses and blood glucose levels Personalization features, including the ability to upload weekly messages, pre-and post-meal markers and a personal photograph to the home screen FreeStyle Auto-Assist software that can be uploaded to a computer via USB connectivity and is designed to help people with diabetes, health care teams and caregivers manage diabetes with reports, reminders and messages

The FreeStyle InsuLinx System is compatible with the FreeStyle InsuLinx blood glucose test strips. “The new FreeStyle InsuLinx System represents Abbott’s latest advancement in delivering innovative products for people with diabetes who use insulin,” said Heather L. Mason, senior vice president, Abbott Diabetes Care. “The improved functionality, data sharing tools and personalization features are designed to improve the diabetes management experience for patients. We are excited to make this product available to diabetes patients in the United States.” Daniel Moberly;

M2VA  16.3 | 15

Health Care Collaborator

Q& A

Providing Care and Support to the Warfighter Lieutenant General Patricia D. Horoho Surgeon General U.S. Army Commanding General U.S. Army Medical Command Lieutenant General Patricia D. Horoho assumed command of the U.S. Army Medical Command on December 5, 2011, and was sworn in as the 43rd Army surgeon general on December 7, 2011. Her previous positions include deputy surgeon general, Office of the Surgeon General, Falls Church, Va., from 2010 to 2011; 23rd chief of the U.S. Army Nurse Corps, from 2008-2011; commander, Western Regional Medical Command, Fort Lewis, Wash., from 2008 to 2010; commander, Madigan Army Medical Center, Tacoma, Wash., from 2008 to 2009; commander, Walter Reed Health Care System, Washington, D.C., from 2007 to 2008; and commander, DeWitt Health Care Network, Fort Belvoir, Va., from 2004 to 2006. As a registered nurse, Horoho earned her Bachelor of Science degree from the University of North Carolina at Chapel Hill in 1982. She received her Master of Science degree as a clinical trauma nurse specialist from the University of Pittsburgh. She is a resident graduate of the Army’s Command and General Staff College and the Industrial College of the Armed Forces, where she earned a second Master of Science degree in national resource strategy. Other military assignments include staff nurse on a multi-service specialty ward, staff and head nurse of a Level III emergency department, Evans Army Community Hospital, Fort Carson, Colo.; nurse counselor, 1st Recruiting Brigade (Northeast) with duty at Harrisburg and Pittsburgh Recruiting Battalions; head nurse of a 22-bed emergency department, Womack Army Medical Center, Fort Bragg, N.C.; chief nurse and hospital commander of a 500-bed field hospital, 249th General Hospital, Fort Gordon, Ga.; assistant branch chief, Army Nurse Corps Branch, United States Total Army Personnel Command, Alexandria, Va.; assistant deputy for Healthcare Management Policy in the Office of the Assistant Secretary of the Army (Manpower and Reserve Affairs), Pentagon, Washington, D.C.; deputy commander for nursing and commander of the DeWitt Health Care Network, Fort Belvoir, Va.; and deputy commander for nursing, Walter Reed Army Medical Center and North Atlantic Regional Medical Command, Washington, D.C. In 2011, Horoho deployed with I Corps as the special assistant to the commander, International Security Assistance Force Joint Command, Kabul, Afghanistan. Recognitions include being selected in 1993 by “The Great 100” as one of the top 100 nurses in the state of North Carolina. In the same year, she was also selected as Fort Bragg’s Supervisor of the Year. She deployed to Haiti with the Army’s first health facility assessment team. In 1998, she co-authored a chapter on training field hospitals that was published by the U.S. Army Reserve Command Surgeon. Horoho was honored on December 3, 2001, by Time Life Publications for her actions at the Pentagon on September 11, 16 | M2VA 16.3

2001. On September 14, 2002, she was among 15 nurses selected by the American Red Cross and Nursing Spectrum to receive national recognition as a “Nurse Hero.” In 2007, she was honored as a University of Pittsburgh Legacy Laureate. In April 2009, she was selected as the USO’s “Woman of the Year,” and in May 2009, she became an affiliate faculty with Pacific Lutheran University School of Nursing, Tacoma, Wash. In May 2010, the Uniformed Services University of Health Sciences appointed her as Distinguished Professor in the Graduate School of Nursing. In 2011, University of North Carolina School of Nursing selected her as the Alumna of the Year. Horoho’s awards and decorations include the Distinguished Service Medal, Legion of Merit (2 OLC), the Bronze Star Medal, Meritorious Service Medal (6 OLC), Army Commendation Medal (3 OLC), Army Achievement Medal (1 OLC), Armed Forces Expeditionary Medal, Afghanistan Campaign Medal and various service and unit awards. She served as the head nurse of Womack’s emergency department when the hospital was awarded the Superior Unit Citation during the Pope AFB Crash in 1994. She is also authorized to wear the DA Staff Badge and is the recipient of the Order of Military Medical Merit Medallion. Q: What changes and improvements do you plan on implementing within the first year of being the U.S. Army Surgeon General? What are the top priorities for the U.S. Army Medical Command? What are the top three biggest needs?

A: Over the past decade, Army Medicine has led the joint health care effort in the most austere environments. As part of the most decisive and capable land force in the world, we stand ready to adapt to the Army’s reframing effort. Ten years of contingency operations have provided numerous lessons learned. We will use these as the foundations from which we deliver the Army’s vision. The following focus areas are the pillars upon which we deliver on that effort. Support the Force—Army Medicine exists to serve the soldier in the operating and generating force. Delivering timely, effective care at home and abroad enhances the medical readiness of our soldiers. We will establish collaborative partnerships with supporting agencies to ensure the holistic readiness of the soldier and their families. It is our duty to stand alongside the soldier from point of injury through rehabilitation and recovery, fostering a spirit of resiliency. We are dedicated to identifying and caring for those soldiers who have sustained psychological and physical trauma associated with an Army engaged in a protracted war. A focus on wellness and prevention will ensure that our warriors are ready to heed the nation’s call. The Care Experience—The warfighter does not stand alone. Army Medicine has a responsibility to all those who serve, to include family members, and our retirees who have already answered the call to our nation. We will fully engage our patients in all aspects of their health care experience. At each touch point, starting with the initial contact, each team member plays an important role in enhancing patient care. We will make the right care available at the right time, while demonstrating compassion to those we serve and value to our stakeholders. The collective health care experience is driven by a team of professionals, partnering with the patient, focused on health promotion and disease prevention to enhance wellness. We will continue to partner with community resources, seek innovative treatments, and conduct militarily relevant research to protect, enhance and optimize soldier and military family well-being. Unity of Effort—The ability to form mixed organizations at home and on the battlefield with all service and coalition partners contributing to a single mission of preserving life is proof of the flexibility and adaptability of America’s medical warfighters. We will build on these successes on the battlefield as we perform our mission at home, further cementing our commitment to working as a combined team, anywhere, anytime. There are multiple stakeholders relying on the successes of Army Medicine. We will facilitate efficient and effective health care governance both throughout the MEDCOM and within the Military Health System. We are at our best when we operate as part of a joint team, and we need to proactively develop synergy with our partners as military medicine moves toward a joint operating environment. Innovate Army Medicine and Health Services Support—Army Medicine’s medical innovations borne from lessons learned in combat have become the world-class standard of care for soldiers on the battlefield and civilians around the world. As our presence in the current war begins to change, we must remain vigilant in developing and assessing strategies to protect, enhance and optimize soldier wellness, prevention and collective health. Through leverage of information technology and militarily relevant research strategies, we will continue to develop new doctrine and education programs to reflect best practice health care on and off the battlefield, while ensuring that Army Medicine remains responsive and ready. Optimize Resources—One of Army Medicine’s greatest challenges over the next three to five years is managing the escalating cost of providing world-class health care in a fiscally constrained

environment. People are our most valuable resource. We will employ everyone to their greatest capacity and make every dollar go a little bit further. We will leverage our information technology solutions to optimize efficiencies. To capitalize on the overall cost savings of procurement and training, we will standardize equipment, supplies and procedures. We will be methodical and thoughtful in our preparation for budget constraints to ensure that the high-quality care our warriors and military families deserve is sustained. Develop Leaders—The Army calls each of us to be a leader, and Army Medicine requires no less. We will capitalize on our leadership experiences in full spectrum operations while continuing to invest in relevant training and education to build confident and competent leaders. Within this focus area, we will examine our leader development strategy to ensure that we have clearly identified the knowledge, skills and talent required for leaders of Army Medicine. Organizations will be more engaged in synthesizing lessons-learned to posture themselves to respond to our nation’s call. Support the Army Profession—Army Medicine has a rich history of sustaining the fighting force, and we need to tell our story of unprecedented successes across the continuum of care—from the heroic efforts of our medics at the point of injury to the comprehensive rehabilitation of our wounded warriors in overcoming exceptional challenges. After more than 10 years of persistent conflict, it is time to renew our collective commitment to the Army, its ideals, traditions and ethos. We have earned the trust of our combat tested warfighters, and it is critical that we continue to demonstrate integrity and excellence in all that we do. Q: How important is MEDCOM’s partnership with industry? A: From the perspective of medical research and development, academia and industry play key roles in all aspects of the product development process. While the Army labs serve as a source of many good ideas, academic and industry partners also support the pipeline of new concepts and ideas for development. These partners often work directly with Army labs to develop these concepts and ideas working through basic and applied research into prototype development. Similarly, industry partners serve as the critical link translating these prototypes into fielded products by providing funds, expertise and infrastructure for advanced development and production, often baring the largest financial burden based on sound business decisions that allow industry to profit from their investments, all while assisting DoD in meeting their unique military medical requirements. Q: What policies and initiatives does MEDCOM have in place to handle the growing problem of traumatic brain injury [TBI] and post-traumatic stress disorder [PTSD]? A: MEDCOM has numerous policies and initiatives both in the garrison and deployed environments to address concussion and traumatic brain injury. In 2009, MEDCOM implemented an “educate, train, track, treat” strategy to promote early identification of concussive injuries, ensure prompt treatment and change the culture to one that encourages soldiers to seek care for these invisible injuries. In the deployed environment, the Department of Defense implemented a policy in June 2010 that mandates a medical evaluation and a period of downtime following an event associated with a concussion, or mild TBI [mTBI]. In the garrison environment, DoD published clinical practice guidelines [CPGs] in March 2009 that incorporate state-of-the-art science, technology and M2VA  16.3 | 17

evidence-based outcomes to standardize TBI evaluation and treatment. A July 2011 study in brain injury rated the VA/DoD clinical practice guideline the highest out of eight CPGs for mTBI. In June 2011, the Army published an order mandating that all soldiers receive TBI education, including pre-deployment education. Educational materials are readily available on the Army Training Network to ensure standardized education to soldiers from all components worldwide. Soldiers and family members affected by TBI can be confident they will receive the world’s finest treatment from Army Medicine. We will continue to critically evaluate new approaches with the highest degree of scientific rigor and quickly adopt evidence-based, effective interventions to facilitate recovery from the effects of TBI. In the area of post-traumatic stress, Army Medicine is committed to strengthening psychological resilience and improving the behavioral health of our soldiers and their families. Army leadership is taking deliberate steps to ensure an array of behavioral health services are available to soldiers and their families to help those dealing with posttraumatic stress disorder, post-traumatic stress symptoms and other psychological effects of war. In the past year, the Army implemented the Behavioral Health System of Care Campaign Plan. This initiative is nested under the Army Campaign Plan for Health Promotion, Risk Reduction and Suicide Prevention. The Behavioral Health System of Care is intended to further standardize and optimize the vast array of behavioral health policies and procedures across the medical command to ensure seamless continuity of care to better identify, prevent, treat and track behavioral health issues that affect soldiers and families during every phase of the Army Force Generation cycle. The Army medical department provides behavioral health services in all garrison and operational environments. The Army currently supports 23 enterprise behavioral health programs supporting soldiers and families who have experienced multiple deployments and other demands of military life during increased operational tempo. PTSD is only one diagnosis in a range of stress-related responses that an individual may develop as a result of exposure to potentially traumatic events. The Army provides support for all such behavioral health conditions. Q: How has the Embedding Behavioral Health [EBH] program benefitted warfighters so far? A: EBH provides multidisciplinary community behavioral health care to soldiers in close proximity to their unit area and in close coordination with unit leaders. The U.S. Army Public Health Command conducted a retrospective, mixed-methods evaluation of a pilot effort at Fort Carson to document the process and determine the impact and effectiveness of the program on soldiers’ behavioral health service utilization, risk level and deployability. Overall, soldiers and key unit leaders, especially company commanders and first sergeants, reported high levels of satisfaction regarding accessibility, quality of care and trust of their EBH providers. Increased provider capacity resulted in significantly fewer off-post referrals for BH care therapy increasing command visibility of soldiers seeking BH care. Units supported by EBH also had significantly fewer psychiatric inpatient admissions, documented risk behaviors and non-deployable soldiers for BH reasons than units not supported by EBH. A cursory cost analysis suggested that EBH may produce cost-savings, especially with regard to the prevention of emergent psychiatric care. EBH is fully operational at Fort Carson. At the beginning of fiscal year 2012, the Army has resourced the expansion of this program at 18 | M2VA 16.3

eight additional installations: Fort Stewart, Fort Hood, Fort Leonard Wood, Schofield Barracks, Fort Bragg, Fort Bliss, Fort Drum and Fort Knox. Currently, the Army is preparing to roll EBH to an additional 10 installations and, when fully operational, will establish EBH in support of 44 brigades in the Army inventory. Q: Could you describe how the U.S. Army medical community is utilizing medical simulations and what the benefits of those types of training are? A: Warfighters led the way in simulated mission rehearsal on the ground, at sea and in flight, and they provide rich examples to train for high-risk, high-consequence events. The U.S. Army Medical Department [AMEDD] uses simulation-based training at all levels of care, from first responders at the point of injury to surgical teams in the operating room. We train daily for injuries we hope never occur. Fortunately, in the continental U.S., war type injuries are rare. But the rarity of war injuries makes it essential we identify the most effective yet cost-effective simulators/systems of training to stay prepared. Medical simulation training devices enhance the skill level of medical personnel, as well as non-medical first responders (combat lifesavers and individual warfighters). Prior to 2007, there were no dedicated resources for sustainment or enhancement of combat medic skills after soldiers completed advanced initial training. Sustainment training for soldier medics was neither standardized nor consistent from installation to installation. The Theater Combat Casualty Care Initial Capabilities Document was approved in 2007 to address the gap in medical training and it noted that valuable lessons learned from current military operations can be incorporated into simulation training scenarios in order to refresh medical skill sets for current environments. Supporting battle-focused training for providing care in the first 10 minutes following injury is the objective of the new Medical Simulation Training Centers [MSTC]. The MSTC Program started in 2006 and is managed by Program Executive Office Simulation, Training, and Instrumentation. This system affords commanders the flexibility to validate their soldiers’ medical skills prior to deployment and allows the greatest flexibility in creating training relevant to contemporary operating environment and the unit’s mission essential task list. The initial operational capability for this system was the fourth quarter of FY08. Full operational capability is planned for the fourth quarter of FY15. This system will have the capacity to train 85,000 personnel annually. This robust training capability, at 24 locations, provides a standardized training platform for classroom and simulated battlefield conditions. Nearly 500,000 soldiers have been trained since it began. This powerful capability would not have been possible without simulation-based systems. In support of medical simulation training requirements, the U.S. Army Medical Research and Materiel Command [MRMC] invested in development efforts to produce high quality medical simulation systems for training of first responders, both medical and non-medical personnel. The U.S. Army Research Engineering Development Command and the MRMC joined forces to develop the iStan patient simulator. It is a high-performance and ultra-realistic patient simulator that is completely wireless, has fully articulated movement and tetherless control—with new and improved features that make it the most powerful and most advanced patient simulator in the world. It also has an advanced realistic skin that is ruggedized for use in field environments.

It has fully reactive eyes that provide both consensual and independent, automatic pupillary response to light and trauma. It also has an improved airway, quieter operation and gives high-quality patient sounds to include voice, lung and heart sounds. The system is capable of training most of the combat medic critical task list for initial entry, transition and sustainment training. This patient simulator is anatomically correct in weight, size and physical attributes, as well as exhibiting appropriate human physiological behavior. It also provides the capability to objectively evaluate student performance through the implementation of valid, accurate and repeatable medical simulations that eliminate subjective influences on simulation outcomes or assessment of student performance. The Trauma FX Multiple Amputation Trauma Trainer simulates severe battlefield injuries to improve medical task training and provides critical emotional and stress conditioning to medics before deployment. This trainer is a state-of-the-art medical training simulation tool that has been used to support scenario-based training for pre-deployment training for soldiers and Marines going to Iraq and Afghanistan. It is a unique product using ruggedized, tetherless trauma training mannequins with lifelike skin and numerous wounds that simulate an improvised explosive device blast injury. The simulator addresses the number one cause of death on the battlefield: hemorrhage control. It is the first trauma simulator to implement robotic movement of the injured limbs, which significantly increases the realism and difficulty of treatment. It is currently being evaluated by multiple Army and joint services training sites and agencies and has been granted a provisional patent by the U.S. Government Patent Office.  The VIRGIL system combines the use of a realistic manikin with a PC-based graphical interface that tracks the internal position of chest darts and chest tubes during training exercises. VIRGIL provides realistic force feedback during the skin incision, dissection through intercostal muscle and pleura, and subsequent placement of a 36Fr chest tube. As the educational scenarios become progressively more difficult, the system tracks the trainee’s progress and detects patterns of error. The system is used in a trainee/instructor configuration, with about 10 minutes required per trainee. A web-based educational tutorial is also available for refresher training. VIRGIL, the first practical demonstration of a long-term research program, directly addresses the expressed needs of the special forces medics to learn and practice safe treatment of combat chest trauma. The simulator combines sophisticated 3-D anatomic models generated from CT scans of actual human anatomy with a manikin built utilizing the same measurements as the computer models. Since the internal organs are proper in size, location and density, this simulator is remarkably realistic. This anatomic realism contributes to “transfer of learning” from the simulated world to real world trauma scenarios. Through collaboration between the Uniformed Services University of the Health Sciences [USUHS] in Bethesda, Md., and Boston Med-Flight, the Simulation Group participated in a series of controlled studies designed to validate the VIRGIL Chest Trauma Training System in a classroom environment. Participants responded enthusiastically to VIRGIL, citing better visualization and increased understanding of the procedure. The Army Trauma Training Center conducts pre-deployment team training at the Ryder Trauma Center, University of Miami, led by experienced trauma surgeons at Ryder, and the U.S. Army. Technologically advanced manikins developed by industry have sophisticated capabilities and are their primary training tool. Team communication skills are done on their first full day of training and repeated near the end of their rotation, again focusing on the team’s ability to

communicate effectively and to transfer information. Universally, the teams’ communications skills improve between iterations. The Department of Defense operates its own medical school, the Uniformed Services University of the Health Sciences. One agency of the USUHS is the National Capital Area Medical Simulation Center [NCAMSC], one of the nation’s most advanced “MedSim” centers and accredited as a Level 1 Accredited Educational Institution by the American College of Surgeons. Medical students from all DoD agencies are educated here, and simulation is embedded throughout the curricula. Skills labs have manikin and surgical part-task trainers to provide highly realistic scenarios for surgical and emergency medicine training. Students in clinical skills lab can communicate with human actors, called standardized patients to learn communication and interview skills. NCAMSC teachers are using—and developing— haptic technologies to simulate the “feel” of surgery. Simulation supports experiential learning, increasing performance, saving time and resources, and providing reliable feedback. The Army’s Graduate Medical Education [GME] program trains residents at 10 Army Military Treatment Facilities. The Charles A. Andersen [ASC] Simulation Center, Madigan Army Medical Center, Joint Base Lewis-McChord, Wash., provides an excellent illustration of the breadth of simulation use and innovative leadership. In 2002, GME leaders made a request to create a Central Simulation Committee, both to address new GME residency training requirements for 12 medical specialties and to address skills degradation of health care providers returning from deployment. A standardized, state-of-the-art, simulation-based curriculum and centralized electronic evaluation system resulted, so they could address problems in a safe environment rather than with live patients. For team training, they incorporated the TeamSTEPPS, developed jointly by the DoD and the Agency for Healthcare Research and Quality to improve patient safety by improving communication and teamwork skills. ASC trained 30,000 health care personnel in 2011. The Andersen Simulation Center is accredited by the American College of Surgeons as an Accredited Educational Institute and is accredited by the Society for Simulation in Healthcare. Simulation has been embedded in just about everything the ASC is doing, i.e., GME training of interns, residents and fellows; undergraduate medical students and physician assistant students; nursing education; combat medic refresher training; continuing medical education; and team training. While benefits differ, training officials from Madigan are reporting reduced complications, improved bedside imaging, reduced risk to live patients and increased confidence before stateside or deployed assignments. Skills can be practiced over and over, with no risk to live patients. Medical specialty boards are recognizing the importance of simulation in the Maintenance of Certification process for anesthesia and surgery. Simulation supports Life Support courses, e.g., Basic Life Support and Advanced Cardiac Life Support, required for credentialing and is being used in the evaluation of some new medical devices and for equipment standardization. Simulation systems can be used as platforms for research and may have a place in the evaluation of some new medical devices and for equipment standardization. A systematic approach to training, including appropriate levels of fidelity, can replicate clinical events in many hospital environments, e.g., clinics, nursing units, interventional and operating suites. Each member of the health care team can practice use of individual skills, even switch roles, while learning to work as a team. This is where TeamSTEPPS is critical. The Army’s chemical-biological training makes use of specialized manikins for training in response to nerve agent exposure. Medical M2VA  16.3 | 19

personnel at the U.S. Army’s Medical Research Institute of Chemical Defense [USAMRICD] collaborated with simulation industry in developing high-end manikins that simulate a human seizure and the cholinergic crisis caused by severe nerve agent exposure. These manikins have totally replaced non-human primates for the training of medical personnel. Also, medical personnel from USAMRICD collaborated in developing sulfur mustard blisters than can be placed on manikins or human actors to simulate mustard agent exposure. Moving beyond training, Madigan Army Medical Center and the National Center for Telehealth and Technology [T2] are exploring simulation to improve evidence-based behavioral health treatments for PTSD. With the University of Southern California’s Institute for Creative Technologies, they piloted simulation to improve ecological validity of cognitive assessments for active duty soldiers at Joint Base Lewis-McChord. T2 now uses simulation to deliver interactive PTSD psychoeducation. In summary, simulation has become one of the most effective modalities to train cognitive, psychomotor and communication skills among medical teams. Scenarios with authentic noises, visual cues and other sensory stimulators, even smells and “feel,” are replacing sterile labs, sometimes-boring lectures and “there-I-was” stories. Synthetic environments train rote skills and critical thinking and yield more predictable outcomes, improved patient safety and quality of care. Serious gaming offers iterative learning in learner-centric environments, to engage tech-savvy volunteer soldiers. Of course, academics are still important, but the ability to synthesize academic information approaches reality through simulation. As we learned from Captain Sullenberger’s water landing on the Hudson, his training in the aircraft simulator and years of experience saved many lives that day. Simulation can do that for the military medical community as we care for our patients, whether care is given on the battlefield, in the air during evacuation, or at a brick-and-mortar medical facility. If the outcome of a simulation is not good, we reset the simulator and try again. Our medics and providers need standard, effective, repeatable training, tailored to learner needs, for yet more capable and confident caregivers, so we can protect and care for our warfighters and their families. The Army has developed, validated or provided significant monetary support for many of the medical simulators available today, either as working prototypes or in use by civilian hospitals and emergency medical services. Improvements in simulation technology have been impressive, but we must keep our eyes on the ball, seek the resources necessary, and close the gap between what we have and what we need. Our medical personnel and our patients deserve no less.

implemented into training conducted at both forward locations and at the AMEDDC&S’ Academy of Health Sciences. The proposed Medical Skills Reset Program is designed to take advantage of the vast resources of the Army Medical Department for maintaining a skilled enlisted force. AMEDDC&S representatives will be working with the stakeholders such as the combatant commands, Forces Command, Army National Guard and the Army Reserve to determine the professional standards of trained and ready medical soldiers. Relevant, engaging and effective training will be implemented and executed through close coordination with medical education departments of installation medical, veterinary and dental activities. Distributed learning products will continue to be available to units to maintain competency in deployment related medical skills while in a garrison environment. Currently, there are more than 280 Army Training Requirements and Resources System courses available through distributed learning technology. Q: How has the U.S. Army medical community addressed the growing numbers of soldiers who are medically unfit for deployment? A: MEDCOM has addressed the issue of medically not ready soldiers through several initiatives: •

• • • •

Q: What will be the primary focus of training of the medical caregiver as troops begin to come home from deployment? A: As the Army transitions to a garrison-based, expeditionary force, the challenge will be to keep the skills of the battle-proven medical soldiers current and sharp. Various methods of instruction will be employed to ensure a well-trained, competent and ready medical force. The 315 programs of instruction currently offered at the U.S. Army Medical Department Center and School [AMEDDC&S] are continually updated using the latest science, technology, innovations and lessons learned from the field. Medical simulations for both collective and individual skills will continue to be improved and 20 | M2VA 16.3

Increasing the number of providers and support staff to ensure adequate resourcing to meet established timelines and ensure appropriate individual attention Flexing capacity through virtual capabilities like the implementation of telehealth assets and VTC capabilities Improving information systems to improve efficiencies and enhancements to eProfile and eMEB Improving and standardizing staff training to provide a more efficient and better informed workforce Creating a consolidated, centrally-managed program with detailed and prescriptive directions to subordinate organizations Automating the Army system for the creation of physical profiles for soldiers with medical limitations and mandated that all physical profiles be created in an electronic database [eProfile]. This allows visibility of both temporary and permanent profiles on all soldiers by eliminating the pocket profile, and provides transparency for providers and commanders in real time. Automating the system for identification of soldiers with evidence of a permanent medical condition and no medical or administrative board outcome in MEDPROS. These soldiers will automatically be moved into the ‘not ready’ population. Once a board finds a soldier fit for duty, they will automatically be moved into the ‘ready’ numbers. This process identifies soldiers as not ready if they have not been boarded and forces adjudication by a medical or administrative board. Developing an Individual Medical Readiness Leaders Course which: assists leaders to ensure soldiers are medically ready; gives leaders an understanding of medical profiles, individual readiness and unit medical readiness; and familiarizes leaders with the medical readiness classifications and available reports for monitoring unit medical readiness and profiles. O

National Guard Bureau

Coordination Provider

Q& A

Providing Domestic and Global Support for Army and Air Force Operations Major General David L. Harris Director, J-3/7 National Guard Bureau Major General David L. Harris is the conduit for the chief, National Guard Bureau, and director, Joint Staff for the National Guard Bureau Joint Coordination Center, where he assists with the planning, coordinating, information sharing and integration of all aspects of National Guard activity relating to domestic operations. Harris provides direct leadership for domestic operations programs including homeland defense, civil support, counterdrug and military support to civil authorities. As a direct consultant to the adjutant generals, their Joint Force Headquarters, and the Joint Chiefs of Staff of the States, he coordinates operational issues with key leaders and agencies within United States government agencies, which include the Department of Defense, Department of Homeland Security, [DHS] Federal Emergency Management Agency [FEMA], and the combatant commanders of United States Northern Command, United States Pacific Command and United States Southern Command. He is also responsible for the force development of training and exercise policies and programs to ensure the National Guard is trained and ready to respond to crisis operations, homeland defense and security missions. Harris began his career as a commissioned officer in the Indiana Army National Guard on May 11, 1979.

A: We coordinate and provide resources so the states can perform their mission. We also coordinate for our federal mission, which is our war fighting mission, to make sure we provide the resources to different services so they can conduct the broader worldwide mission. In our case, it’s the Army and the Air Force.

Iraq is pretty much complete now, but we still have a few members in Kuwait working to organize all the equipment and move it back to the U.S. Guard members remain in Afghanistan, where we support all aspects of the warfight to include in the air and on the ground. The National Guard also provides support in a couple of other overseas locations. A lot of people have forgotten we still do a mission in the Sinai that is completely supported by the National Guard. We also provide a majority of the forces deployed to Kosovo, where they may remain for some time.

Q: Can you give us an overview of domestic support operations?

Q: What programs are planned to be implemented in 2012?

A: Our role in domestic support operations is to coordinate with our interagencies to assist in the state, local and federal response efforts to both man-made and natural disasters. It’s our responsibility to coordinate with organizations like DHS FEMA to make sure that we’re providing the right resources at the right place at the right time, and in the most cost-effective manner.

A: In 2012, the National Guard is going to continue on with the current domestic and contingency missions we’re engaged in right now. We’ll also continue our partnership program—which has been an extremely successful program—with up to 63 partner countries now. We also are doing some theater engagement by supporting the combatant commanders, especially in AFRICOM and EUCOM. We are also engaged with SOUTHCOM and PACOM, and most of our work on the domestic side is with NORTHCOM. I don’t see a lot of changes in 2012 regarding our support; it will stay pretty much the same as we continue current efforts. But it will be interesting to see how the global posturing might change in the future.

Q: As the joint coordinator for homeland defense, what is the primary role of the National Guard Bureau?

Q: Can you give an overview on global support operations? A: The National Guard has morphed from a strategic reserve to an operational force over the last 10 years in support of Operation Iraqi Freedom and Operation Enduring Freedom. Our participation in

M2VA  16.3 | 21

National Guard Bureau Q: How do proposed budget cuts affect the NGB’s acquisition in 2012? A: Because of the result of the continuing resolutions and the way the budget in the program objectives memoranda is set up, there will probably not be a huge impact in 2012. However, in 2013 impacts to the Guard will be significant. In 2012, the National Guard is adjusting to prepare for those cuts in 2013. The real cuts will start in fiscal year 2013. For example, our National Guard Counterdrug program is going to take a significant cut on some of the missions that we do. We could see cuts to the program up to 40 percent. Our CBRNE mission seems to be pretty safe. We think we’ll be able to actually modernize a little bit in the end of 2012 and the beginning of 2013. The Army Guard is working through some of the potential restructuring as the active duty is going to reduce their forces quite a bit in 2013, and some of those changes will evolve into the National Guard. But the biggest impact is probably on our Air National Guard, which is taking significant cuts in all of its missions across the board. These cuts will not only affect the Air Guard’s ability to respond to the warfight, but it will affect the ability to respond to a domestic response also. Q: Can you describe the main objectives and operations of the Army National Guard and the Air National Guard? A: When we talk about the federal mission where we support the services, our missions and objectives are pretty straightforward. The Army Guard supports the Army and all of the missions they are responsible for. They do everything from ballistic missile defense to infantry, armor and aviation across the board. The Air Guard supports the overseas fight with airlift, refueling, tactical air to ground aircraft, and they’re developing into more unmanned aerial vehicle capabilities. I think the future for both the Army Guard and the Air Guard is a more significant capability in cyber. That seems to be the area we’re very concerned with and working our capabilities to be able to do an active defense to make sure that our systems are secure. Q: How is the UH-72A Lakota being used for medevac operations? A: The Lakota is not a significant medevac piece of equipment because of its size. It could in that capacity if it had to, but what it’s really suited for is to do lift, surveillance and search and rescue. This aircraft has a very capable communication package that not only allows us to talk within our services but allows us to talk to our civilian counterparts. So, when working with local law enforcement or search and rescue teams on the ground, the Guard can speak directly to them with this aircraft. The surveillance equipment on it is very versatile, so whether we are working on the southwest border with the border patrol trying to prevent illegal entrance into the United States, or flying through the mountains in Colorado trying to find a lost hunter or hiker, the surveillance equipment will find these people very easily, allowing precise coordination for the recovery. The Lakotas are a very capable new aircraft that we are really looking forward to fielding across all the 54 states and territories. Q: How is the NGB utilizing unmanned ground and aerial vehicles? 22 | M2VA16.3

A: In the warfight, we support our men and women on the ground with these aircraft all over the world. It’s quite a capability we’re starting to get all the way from the smaller Ravens up to the larger Predators, including some of the larger unmanned aircraft that we’re seeing come into the inventories. Additionally, we have the organizations and the systems to do the analysis of the data being collected off those aircraft and provide it back to the commanders so they can conduct successful operations. We are also finding uses for unmanned vehicles on the domestic side especially as we work with DHS and CBP to secure our borders. Right now we have a lot of issues we’re working through with the Federal Aviation Administration to make them comfortable with the Guard flying unmanned aircraft in U.S. airspace and we’re working through that process with DHS and some of the other federal organizations involved in the approval process. It would be my platform of choice in a CBRNE environment, if we had a nuclear or chemical disaster either man-made or natural, to go in and do observation and surveillance over that area. Unmanned vehicles give us the lowest risk to our servicemen and women and they provide extremely good data. So we think domestically the unmanned aerial vehicles of all different types have a big piece in domestic response, whether it be security operations or an evaluation of a disaster area. As far as I know, the only unmanned ground vehicles the Guard is currently using are the small robots that some of our explosive ordnance disposal teams have. Those types of vehicles are really not into the inventory yet and haven’t been fully developed. Q: Is there anything else you would like to say that I have not asked? A: We talked a little bit about some of the things that the National Guard is doing now, but I’d just like to highlight that in the future, as we develop our capabilities, we continue to look to the Northwest, up into the Alaska area and beyond. As you know, the ice is starting to melt and as a result there are new sea lanes opening up, and it’s one of the things that DHS and DoD both are extremely concerned about. When those corridors open up and we see more drilling of oil up there and more shipping lanes develop, we have to start thinking about how we are going to react to an environmental action or a search and rescue requirement—maybe even an ocean liner that’s up there with tourists. It’s a very difficult area to work in, not a lot of infrastructure up there, but if needed to conduct such missions our Alaska National Guard probably has some of the best in the nation at working in such a difficult environment. Because of these emerging requirements and concerns, we are partnering with the Coast Guard and the Air Force to develop future tactics and techniques on how we would jointly respond up into the Northwest corridor. Also, we have about 60 percent, maybe 70 percent of the CBRNE response force available here in the United States between the active duty and the National Guard providing a good response force as well as the potential for foreign consequence management. We think these organizations have not only the capability to work here in the U.S. but to work overseas supporting our partner countries. Whether it’s a CBRNE event or a consequence management mission as we saw in Haiti or Japan, these same organizations provide a great capability to support our overseas partners. O

National Guard Bureau

CBRNE Enhanced Response Force Package Army Col. Heinrich Reyes

Division Chief J39 Division, Combating Weapons of Mass Destruction National Guard Bureau

Q: Can you give me an overview of what the CERFP team’s role is? A: The CERFP is comprised of traditional National Guard members that are task-organized from existing NG units to provide specialized CBRN consequence management capabilities to local, state or federal authorities. These task forces receive additional special training and equipment to plan and conduct casualty search and extraction [emergency medical triage, treatment and patient stabilization], mass casualty decontamination, and fatality search and recovery operations in support of the incident commander. These tasks are in addition to their primary Army Military Occupational Series or Air Force Specialty Code and they should maintain proficiency in both. Units assigned to the CERFP will continue to perform their assigned primary mission. The training and tailoring of existing National Guard forces into specific CBRN response organizations ensures preparedness, response and flexibility for the mission. When requested, the CERFP will respond to an incident of state or national-level significance to provide the command, control and capabilities to support the incident. Security is also required to provide cordon and entry control point support and other law enforcement related duties, as well as other mission related duties as manpower allows for supporting additional mission requirements. Security is not a dedicated component of the CERFP, but should be provided from the Homeland Response Force [HRF] and/or the states response force or other Army National Guard or Air National Guard resource.

rope rescue, and limited confined space operations. Additionally, elements of the CERFP can conduct basic operations in a nonstructural collapse or nonstructural entrapment environment. FSRTs provide a lifesaving force multiplier in that those individuals who perish while in our care will need to be removed and turned over to authorities. Having an embedded team already trained ensures that this responsibility does not take away from the other elements’ primary mission sets. Conducting a dignified handling of the remains has a profound and long-lasting effect on the mental health of both responders and survivors. Fatalities at an incident site should be handled in accordance with local jurisdiction and the scope and tempo of the rescue operation. This element may be activated either by itself, or as an element of the CERFP or HRF in response to CBRN incident mass fatality operations that require support to domestic local, state or federal agencies. The primary mission of the FSRT is the handling and removal to the collection point of human remains where the death occurs while the individual is in the possession of a CERFP element. In its modular capability, multiple FSRT elements may be deployed to a single incident based on need. CERFP incident site fatalities management includes the location, documentation, recovery, collection, temporary staging and transport of fatalities to the incident commander-designated fatality collection points within the incident site. Q: How about the CERFP team’s role in CBRN response?

A: The CERFPs are extensive search and extraction [S&E] and fatality search and recovery teams [FSRT]. When activated, these teams act as force multipliers to assist, augment and provide support for the incident commander. The mission of the S&E element is to support local, state and federal agencies with casualty S&E operations with the ability to perform extraction operations in a CBRN contaminated environment. The element can conduct light operations, which includes rescue at incidents involving light frame and heavy wall construction, low- and high-angle

A: The evolving threats to the homeland, along with the requirements of the defense support of civil authorities mission, require the National Guard to continue developing response capabilities addressing CBRN threats and hazards. This also includes threats to critical infrastructure, both private and government, that are essential for governance, transportation, energy distribution, production of goods and services, food, commerce and communications. CERFPs are designed to respond to CBRN incidents when requested by civilian authorities. CERFPs fulfill their mission by augmenting civil support teams and federal, state and local responders when requested. The CERFPs provide trained and ready units to locate, extract and decontaminate casualties, as well as perform medical triage and emergency treatment. They can provide command and control, casualty S&E, ambulatory and nonambulatory mass casualty decontamination, medical triage and stabilization, and fatality search and recovery.

Malcholm Reese

Q: Can you describe the CERFP team’s acquisition process?

Q: Can you describe the CERFP team’s role in a search and extraction capacity?

Deputy Division Chief J39 Division, Combating Weapons of Mass Destruction National Guard Bureau

Q: What are the major challenges the CERFP teams will face in 2012? A: Rotation/Deployment/Retention: Due to the fact that the CERFP team members are not assigned to a CERFP unit type code or unit manning document, but are assigned to units, they are susceptible to rotation or deployments. These actions will take a trained CERFP member away from the team. Therefore, the teams will have to continue to train new members in order to stay capable of responding when called. Another challenge will be to keep trained members on the team. As the economy improves and the private sector need for trained HAZMAT/CBRN trained personnel increases, there will be a challenge to keep members from being lured away for increased pay in the private sector. Funding: As with all sectors of the government, the CERFP program will have to fight to keep adequate funding for the teams. The CERFP will have to justify its budget. If an adequate budget is not approved and funded, there could be severe shortfalls in the capability of these teams to respond.

A: CERFP specialized equipment was purchased with National Guard and Reserve Equipment Account and Global War on Terrorism funding. The CERFP equipment is sustained through programmed Army and Air Force Operations and Maintenance funding. Q: If you had a wish list, what does the CERFP program need from industry to better meet your goals and objectives? A: • Detection equipment easier to calibrate and perform basic repair in the field. • Detection equipment that will/can be easily incorporated into existing systems to complement, supplement and enhance existing equipment. • Personal protective equipment that is lighter, safer and provides increased comfort in a hot or cold environment encountered during an incident. • More efficient communication capability, i.e., intrinsically safe, encrypted radios and cell phones. O M2VA  16.3 | 23

National Guard Bureau

Gen. Craig R. McKinley Chief National Guard Bureau

Lt. Gen. Harry M. Wyatt III Director Air National Guard

Maj. Gen. Randy E. Manner Acting Vice Chief National Guard Bureau

Maj. Gen. William H. Etter Deputy Director Air National Guard

National Guard

Maj. Gen. Timothy J. Kadavy Deputy Director Army National Guard

Top Ten Contractors

For FY 2011 & 2012

Top Ten By Dollar Vendor Name

# of Obligated Amt Actions Change

Lt. Gen. William E. Ingram, Jr. Director Army National Guard

Top Ten By # of Actions

Prod or Svc Name

Business Type

Vendor Name

# of Obligated Amt Actions Change

Prod or Svc Name

Business Type

Other Administrative Support Services Other Administrative Support Services

Woman/ Minority Owned

Laughlin, Marinaccio & Owens Inc.



Advertising Services

Veteran Owned




Military Personnel Services Corporation



Other Management Support Services

Serv Disabled Vet Owned

TSI Corp.



Military Personnel Services Corporation



Other Professional Serv Disabled Services Vet Owned

Systems Research and Applications Corporation


Food Services

Non Profit


ADP Software

Woman/ Minority Owned



Family And Social Services Administration, Indiana

Woman/ Minority Owned





Other Administrative & Service Buildings

Other Professional Services

Woman/ Minority Owned

Military Personnel Services Corporation ACC Health Inc.




Other Other Than Administrative Small Business Support Services

Other Professional Services

Serv Disabled Vet Owned



Woman/ Minority Owned

Cellco Partnership DBA Verizon Wireless



Federal Prison Industries Inc.



Mac’s Vacs LLC



Dell Federal Systems LP



Fed-Con-1, A JV Document and Packaging Brokers Inc.






Other Administrative Support Services

Raydon Corporation



Operational Training Devices

Other Than Small Business Woman Owned Emerging Other Than Small Business

Mass Service & Supply LLC



Other Industrial Buildings

Document and Packaging Brokers Inc.



Advertising Services

24 | M2VA 16.3

Serv Disabled Vet Owned

Dentistry Services Woman Owned ADP Telecommunications Other Than & Transmission Small Business Services Office Furniture Trash/Garbage Collection Srvcs-Incl Port ADP Support Equipment

Federal Agency Woman Owned Other Than Small Business

By Joe Mirrow, Deputy Director, Air Force Medical Service Commodity Council Q: Can you explain how the Air Force expects to generate savings through consolidation of contracts? A: In 2010, the Department of Defense took $33 billion out of the Air Force’s five-year operations budget. Therefore the Air Force must reduce costs through efficiencies in order to maintain performance. The Air Force expects to generate these efficiencies in three ways. First of all, the Air Force currently uses other agencies [Office of Personnel Management, TRICARE Management Activity, GSA, Department of Veterans Affairs, Army and Navy contracting] to meet its needs for services. The Air Force must pay fees for using these services ranging from 1.9 percent to up to 6 percent for use of these contracts. Using an Air Force contract alleviates these fees. Secondly, since 2005, the Air Force has successfully implemented strategic sourcing of clinical services and medical administrative support services. By reducing the number of contracts and requiring competition on strategic vehicles, the Air Force has significantly driven down non-service related expenses [contractor profit and overhead] while meeting market-based demand for direct labor costs. To justify the consolidation, the Air Force used industry reports from IBISWorld to compare ratios of expected savings between the various types of services to reported, non-service related expenses by current vendors. The expected efficiency is 7.9 percent. Administrative savings through process standardization is the third method of generating efficiencies. Standardized ordering, requirement templates and improved management practices facilitate faster business processes. For example, a new contract may take the Air Force over 18 months to procure, however a task order off of the CATS contract is expected to take less than a month.

A: The contract is designed to be as flexible as possible because it is task order-based and its use is driven by budget availability. $985 million is the contract maximum amount and the contract minimum amount was established at the time of award. Ordering offices are able to acquire advisory and assistance services of any type using contractors that were carefully screened to have capability and knowledge about the Military Health System. The contractors are required to compete on most task orders, which lowers costs to the ordering offices. However, the contract standards are set very high for contractor performance and the program management team ensures that the contractors will meet these standards. Q: What are some of the primary services [in the form of information, advice, opinions, alternatives, analyses, evaluations, recommendations, training] that the Air Force anticipates acquiring to complement the government’s technical expertise? A: Some of the services that the Air Force expects to acquire are system analysis for testing and support of the electronic medical records, various subject matter experts for support and advice in areas such as advanced research, knowledge transfer and project management, financial studies on future budgetary impacts and training services to support implementation of new programs generated by the Department of Defense. Q: What is the estimated number of acquisitions that the Air Force expects to make over this five-year period? A: The number of acquisitions is entirely budget-dependent and no estimate can be made of the entire five-year impact.

Q: What types of task orders will be awarded in this program?

Q: Is there anything else you would like to add?

A: The Air Force Surgeon General uses different types of contract services for analysis and support of health care operations. Task orders are expected to be awarded for health care support services using engineering and technical, management and professional services, as well as studies/analyses and evaluations. These services will reach all levels of the Air Force including headquarters offices, major commands and military treatment facilities.

A: We are excited to finally have CATS awarded and look forward to using this strategic vehicle as a complement to the Clinical Support Services and Medical Support Services contracts providing the full spectrum of contract options for the Air Force Medical Service. Our next effort in 2012 will be to provide a similar set of options to our military treatment facilities located overseas. O

Q: How is the $985 million contract designed to give the Air Force Medical Service maximum flexibility to meet its mission depending on its budget?

For more information, contact M2VA Editor Brian O’Shea at or search our online archives for related stories at

M2VA  16.3 | 25

The Department of Veterans Affairs (VA) maintains a well-trained police force responsible for enforcing the law and providing protection to patients, visitors, employees and property at VA facilities. Shouldering these duties are approximately 3,200 trained VA police officers stationed at all major VA facilities and many VA outpatient clinics. VA’s mission to maintain safety and security and to enforce the law throughout its national health care system is based in Title 38 of the U.S. Code, the federal law creating and organizing VA. Chapter 9 of that law assigns to the Secretary of Veterans Affairs the responsibility for prescribing rules and regulations “for the maintenance of law and order and protection of persons and property on Department property.” The law also provides authority for department police officers who enforce federal law as well as the rules and regulations. The FBI has primary investigative jurisdiction on federal property and VA maintains a close relationship with the FBI at each location. Jurisdiction is concurrent at most locations, enabling prosecution of crimes in state and local courts, as well as federal. Within this system of law enforcement, VA police are dedicated to a philosophy that permeates VA training and policing: “Protecting Those Who Served.” Uniformed VA police officers are the primary deterrent to crime within VA’s jurisdiction. The focus of these professionals is always to deter, detect and respond to crime that takes place on VA property, ensuring safe and secure environments of care and service. This dedication to service is reflected in the fact that the majority of VA police officers are military veterans themselves. As of January 2012, approximately 85 percent of VA police officers are veterans, and many still are affiliated with military reserves and National Guard units. VA police officers must have specialized law enforcement experience to be hired as a police officer by VA. Standards are set by the U.S. Office of Personnel Management and require experience with basic laws and regulations, law enforcement operations, practices and techniques. Prior jobs must include responsibility for protecting life and property and the maintenance of law and order. This experience may have been gained as a police officer for a municipal, county, state or federal agency, a military policeman or a parks or forest service policeman, or in similar positions that require the necessary 26 | M2VA 16.3

knowledge and skills in law enforcement. A degree in criminal justice may be substituted for some of the experience requirement. Additionally, each police officer is subjected to a background investigation and is required to take an entry medical examination and annual medical and psychological assessments. New VA police officers are trained at the VA Law Enforcement Training Center (LETC), located on the campus of the Veterans Affairs Medical Center in North Little Rock, Ark. The officers go through an intense eight week training academy with emphasis on dealing with assaultive patient situations. Additionally, continuing education or sustainment training is provided in order to keep police personnel current on issues related to changes in the laws as well as new law enforcement practices and procedures. The LETC’s mission is to provide quality job specific training for law enforcement personnel, which is designed to ensure the proper exercise of federal statutory law enforcement authority. The training also enables the police officers to effectively deal with situations that arise in a health care and public service setting. The LETC provides an excellent opportunity for students to train in a similar environment to the one in which they will work. The unique setting in which VA law enforcement personnel work requires that they receive specialized behavioral science training that is not offered at any other federal or state law enforcement training institution. In addition, the LETC provides extensive training in traditional police disciplines, including firearms training, arrest procedures, interviewing skills, report writing and defensive tactics. These are among several topics in the LETC curriculum. VA police encourage everyone to be a sensor. Active patrols, physical security surveys, cameras and electronic surveillance also enhance the safety and security of the veterans, visitors, employees and patients who visit and work at VA. O Courtesy of the Office of Operations, Security, and Preparedness Fred Jackson, Director, Office of Security and Law Enforcement

For more information, contact M2VA Editor Brian O’Shea at or search our online archives for related stories at

The advertisers index is provided as a service to our readers. KMI cannot be held responsible for discrepancies due to last-minute changes or alterations.



Combat Medical Systems LLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C4

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August 13-16, 2012 ATACCC Fort Lauderdale, Fl.

June 25-27, 2012 CBRN 2012 Regimental Week & Conference (Formerly Joint CBRN) Fort Leonardwood, Mo.

September 9-12, 2012 NGAUS Reno, Nev.

RDT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ScriptPro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C3 Skedco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Zoll Medical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2


June 2012 Vol. 16, Issue 4

Dedicated to the Military Medical & VA Community

July 12-13, 2012 Warrior Expo East Virginia Beach, Va.

Don’t Miss

the Inaugural Issue!

Border & CBRNE Defense joins KMI Media Group’s other proven defense publications

Cover and In-Depth Interview with:


Dr. Jonathan Woodson

Chief U.S. Border Patrol U.S. Customs and Border Protection

Assistant Secretary of Defense for Health Affairs

Michael J. Fisher

Special Feature Yellow Ribbon School Directory

Features Integrated Networks Pharmacy Automation Combat Search and Rescue Insertion Order Deadline: June 15, 2012 Ad Materials Deadline: June 22, 2012

Centering around our exclusive Q&A interviews with senior leaders in the homeland security community, BCD delivers articles that are important to the military and federal user. The first issue of BCD will include articles featuring: • Leadership Insight from Robert S. Bray, Assistant Administrator for Law Enforcement/ Director of the Federal Air Marshal Service

• Integrated Fixed Towers • Wide Area Aerial Surveillance • Tactical Communications • Hazmat Disaster Response

M2VA  16.3 | 27


Military Medical & Veterans Affairs Forum

Dr. Kenneth L. Farmer Executive Vice President and Chief Operating Officer TriWest Healthcare Alliance Dr. Ken Farmer has the overall responsibility to ensure that 2.9 million West Region TRICARE beneficiaries have access to quality health care. Farmer retired as a Major General from the U.S. Army Medical Corps in 2006 after 31 years of service. During his military career, he served as the commanding general, North Atlantic Regional Medical Command and Walter Reed AMC. He also served as the Army’s deputy surgeon general, and as chief of staff, U.S. Army Medical Command. During Desert Shield/Storm he commanded the 85th Evacuation Hospital deployed to Saudi Arabia and oversaw residual theater medical support. Q: Tell us about TriWest and what your company offers the U.S. military. A: TriWest is privileged to provide West Region warfighters, retirees and their families access to the highest-quality health care at the lowest possible cost to taxpayers through our network of more than 175,000 civilian health care providers in the 21-state TRICARE West Region. For 16 years this has been our sole focus—our only mission. Q: As the managed care support contractor for the TRICARE West Region, how does TriWest differ from the other contractors? A: We know what it means to serve. In addition to myself, many of TriWest’s 1,700 employees are military retirees, veterans or family members. We are proud to stand shoulder-to-shoulder with the exceptional team in the Military Health System (MHS) to deliver care, service and support. We know that life in the military has its challenges. Accessing health care shouldn’t be one of them. Our mature and stable network of 175,000 health care providers and facilities includes tens of thousands of providers in remote and hard-to-reach communities to meet the needs of National Guard and Reserve members and retirees, who don’t live near military bases or have access to the military’s direct health care system. 28 | M2VA 16.3

Deployments and returning troops have put increased pressure on both the direct and purchased care systems to be flexible. Our network has been carefully structured to meet the ever-changing demands for health care services to support the direct care system. We believe we owe it to those who put their lives on the line to make sure their health care is the best it can be, and we deliver. Additionally, we believe being a steward of the TRICARE program means playing an active role in the communities we serve. We put the words of our motto “Whatever It Takes” into action, and allocate a portion of our bottom line to help build and strengthen programs and services that help military families. This includes military support organizations, dozens of National Guard Family Assistance Funds and many others. We are proud to stand beside them in their important work. Q: What are the major priorities and initiatives for TriWest in 2012? A: Quadruple Aim is a shared strategic framework for the MHS and its contractors. We recognize readiness is at the core, therefore our priorities and our contribution to that strategy is our priority. For example, in recent years we have been very focused on ensuring care and support for wounded warriors, providing treatment for traumatic brain injuries and addressing comprehensive behavioral health needs with a network of more than 22,000 behavioral health providers. Our focus in this area is unwavering. In fact, our 24/7 behavioral health contact center—which handles 2,500 calls a month—has been certified by the National Association of Suicidology as a crisis line.

We also are leveraging sophisticated technology to process authorizations, referrals and claims to be a more cost-effective partner for the military, while maintaining the highest levels of performance in terms of meeting—and exceeding—contract standards and customer satisfaction. TriWest is recognized as an industry leader in customer service delivery and operations, earning recurring JD Power & Associates accreditation for our contact center operations and URAC accreditations. Our support infrastructure has expanded to provide innovative self-service channels that give beneficiaries and providers secure online access to their information 24/7, including authorizations, referrals and claims status. Our mobile application and mobile site enables them to find a provider or urgent care center while on the go. We have completed the development of comprehensive population health and condition management programs. These programs are also data-driven, drawing from clinical measures. What’s at stake is operational readiness of our servicemembers and the health of our nation’s military families. We are relentless in our efforts to keep them healthy and improve their overall quality of life. Q: With the proposed increases in the TRICARE Prime enrollment fees, how will this affect West Region beneficiaries? A: At this time of unprecedented budget deficits, it is essential DoD find the most cost-effective ways to ensure access to quality health care to beneficiaries. TRICARE is an essential benefit for military families and we realize that to maintain this benefit, both the department and its contractors must find solutions to controlling health care costs. We are committed to doing just that—in fact, over the course of the current contract, we have afforded the taxpayer more than $1.2 billion in network discount savings alone. By improving our operational efficiency and maintaining a solid provider network, we can help preserve and protect this benefit for the long term. O

M2VA 16-3 (May 2012)