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Doctrine Overseer Col. Peter J. Benson Command Surgeon United States Army Special Operations Command

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December 2011 Volume 15, Issue 8

The Golden Hour O Medical Training O Minimizing Preventable Deaths Combat Medics O Best Medic Competition O Water Purification

MADE IN AmerICA

Military Medical/CBRN Technology Features

Minimizing Preventable Deaths

December 2011 Volume 15 • Issue 8

Cover / Q&A

Hypothermia is the fourth leading cause of preventable battlefield deaths—the most frequent cause is hemorrhage. And there is a connection between those two phenomena. By Peter A. Buxbaum

6 Tactical Gear for Special Operations Medics Special Operations Command medics must fight and survive as well as save lives. They must have much of the same tactical gear that all soldiers need, and often need the best due to the extreme challenges all SOCOM personnel face. By Henry Canaday

9 Advancements in Medical Training Training exercises customized towards potential real-world threats are a familiar way in which the men and women of the armed forces obtain mastery in routine and hazardous tasks and missions. By Dr. Haru Okuda and Dr. Lygia Arcaro

17 Colonel Peter J. Benson Command Surgeon United States Army Special Operations Command

12 Maximizing and Extending the Golden Hour

22

In military settings, treating injuries during the golden hour presents unique challenges due to the severity of the injuries suffered, the conditions on the field at the time that medical care is being delivered, and the difficulties faced in evacuating our wounded warriors to safety. By Melanie Zahler and Bart Gray

Water Purification A fully-loaded Marine conducting a patrol in the 120 degree heat of Afghanistan may need to consume four gallons of water each day to stay minimally hydrated. His ability to survive and perform in an austere environment depends on his access to safe drinking water. By Joan Michel

23

Departments 2 Editor’s Perspective 3 MHS Health IM/IT Report 4 Program Notes/People 14 Vital Signs 27 Calendar, Directory

Industry Interview

Best Medic Competition Sixty-two soldiers from across the Army competed in a grueling 72-hour two-soldier team competition at Camp Bullis on November 4-6 to earn the title of best medic. By Lori Newman

26

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28 Brenda M. Butler, RN Vice President, Government Sales Zoll Medical Corporation

Military Medical/CBRN Technology Volume 15, Issue 8

December 2011

Dedicated to the Military Medical & VA Community Editorial Editor Brian O’Shea briano@kmimediagroup.com Managing Editor Harrison Donnelly harrisond@kmimediagroup.com Online Editorial Manager Laura Davis laurad@kmimediagroup.com Correspondents: Peter Buxbaum • Henry Canaday • Joan Michel

Art & Design Art Director Jennifer Owers jennifero@kmimediagroup.com Senior Graphic Designer Jittima Saiwongnuan jittimas@kmimediagroup.com Graphic Designers Amanda Kirsch amandak@kmimediagroup.com Scott Morris scottm@kmimediagroup.com Kailey Waring kaileyw@kmimediagroup.com

Advertising Associate Publisher Charles Weimer charlesw@kmimediagroup.com

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Publisher Kirk Brown kirkb@kmimediagroup.com Chief Executive Officer Jack Kerrigan jack@kmimediagroup.com Chief Financial Officer Constance Kerrigan connik@kmimediagroup.com Executive Vice President David Leaf davidl@kmimediagroup.com Editor-In-Chief Jeff McKaughan jeffm@kmimediagroup.com Controller Gigi Castro gcastro@kmimediagroup.com Trade Show Coordinator Holly Foster hollyf@kmimediagroup.com

Operations, Circulation & Production Manager - Circulation & Operations Toye McLean toyem@kmimediagroup.com Distribution Coordinator Duane Ebanks duanee@kmimediagroup.com Data Specialists Rebecca Hunter rebeccah@kmimediagroup.com Tuesday Johnson tuesdayj@kmimediagroup.com Casandra Jones casandraj@kmimediagroup.com Raymer Villanueva raymerv@kmimediagroup.com Summer Walker summerw@kmimediagroup.com Donisha Winston donishaw@kmimediagroup.com

The super committee has failed to reach an agreement to cut over $1 trillion in government spending over the next decade. Most Democrats, including President Barack Obama, are blaming Republicans for failing to compromise on tax increases for the wealthy while Republicans, such as Senator Mitch McConnell of Kentucky, are blaming Democrats for not accepting any proposal that would not expand the size and scope of government. Secretary of Defense Leon Panetta has been warning lawmakers for months that the automatic cuts that would go into effect if a deal has not been reached would create a hollow force that would invite Brian O’Shea Editor aggression. Panetta compared a “hollow force” to a ship without sailors, a brigade without bullets and an air wing without enough trained pilots, resulting in low morale, poor readiness and an inability to keep up with adversaries. “In effect it invites aggression,” he said. “A hollow military doesn’t happen by accident. It comes from poor stewardship and poor leadership.” The automatic cuts, known as “sequestration,” include $600 billion in cuts in addition to the $450 billion that the Pentagon has already agreed to. Senator Bob Corker, R-Tenn., said that the inability of the super committee to find a compromise by the November 23 deadline is a failure of leadership. In my opinion, I agree with Corker. The U.S. government is projected to spend $44 trillion over the next decade, and lawmakers could not agree on $1.2 trillion in cuts; I equate that to childish playground politics where one child is blaming the other for starting the fight. However, there are slivers of hope that I believe both political parties are counting on. The automatic cuts do not go into effect until January 2013. I think leaders in both parties are banking on the fact that they will have control of the White House and the damage from this failure to reach an agreement can be rolled back, on their terms. This is paltry politics. Our nation needs its defense budget maintained, and to play politics and hope your party is in control come November 2012 shows a dramatic ignorance in priorities. If you have any questions concerning Military Medical/CBRN Technology feel free to contact me at any time.

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KMI MEDIAGROUP A Proud Member of Subscription Information Military Medical/CBRN Technology ISSN 1097-1033 is published eight times a year by KMI Media Group. All Rights Reserved. Reproduction without permission is strictly forbidden. © Copyright 2011. Military Medical/CBRN Technology 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. Corporate Offices KMI Media Group 15800 Crabbs Branch Way, Suite 300 Rockville, MD 20855-2604 USA Telephone: (301) 670-5700 Fax: (301) 670-5701 Web: www.MMT-kmi.com

DoD/VA Medical Product Databank a Model of Collaborative Cost Avoidance

By U.S. Army Col. Chris Harrington Deputy Program Manager/ Medical Logistics Defense Health Services Systems As the federal government continues its vital efforts to identify ways to operate more efficiently, the departments of Defense and Veterans Affairs are using a model of collaborative cost avoidance in the federal health care supply chain. The DoD/VA Medical Product Databank Data Synchronization Program (MEDPDB) has produced over $73 million in documented cost avoidance to DoD and VA by standardizing and aligning product data from the supply chain information systems of military and veterans’ health care sites worldwide over the life of the program. In fiscal year 2010, MEDPDB reduced spending for DoD and VA by a combined $19 million and a future program goal is to include the pharmaceutical product line in MEDPDB to achieve further savings. MEDPDB gives DoD and VA health care facilities accurate, consistent, synchronized product and pricing data, resulting in better supply chain processes and avoided costs. For example, by using MEDPDB, DoD and VA have identified and moved more than $80 million in manual purchases to more efficient electronic ordering methods. By pulling product, purchasing and contracting data in MEDPDB, federal health care supply chain staff can quickly identify and research opportunities to reduce costs and leverage existing supply contracts to secure better pricing. www.MMT-kmi.com

MEDPDB aggregates millions of rows of critical product and packaging, pricing, enterprisewide purchasing, product classifications and contract data into a cohesive, standardized view of DoD and VA purchase, contract and product data. This standard electronic view offers quick glimpses at what’s available from any branch in the federal health care supply chain. This is an important shift. Before MEDPDB, military medical installations in theater could wait days or weeks to restock some medical supplies. With MEDPDB, users type in a National Stock Number, a manufacturer part number, a DoD/VA catalog number or a supply keyword, and can find the closest location of vital medical supplies. The U.S. health care industry has also been interested in having a single, unique and synchronized materials management system for years, to verify the correct product is used for patient care every step of the way—from manufacture to delivery, to use. Thanks to MEDPDB, national efforts are moving toward implementing a single data standards system, using the same electronic language to describe health care supply chain products. This move will help increase the U.S. health care industry’s ability to track and trace health care products from manufacture to patient, and will improve efforts to rapidly recall defective products. With MEDPDB, avoided costs to DoD or VA can range from a few hundred dollars to hundreds of thousands of dollars a year on a single item. Federal hospitals, in the United States and around the world, are quickly identifying alternate sources for supplies and zeroing in on best pricing from existing supply contracts. With MEDPDB, DoD and VA are finding the right products, at the right location and at the right price, for the benefit of all those who we are honored to provide care. O

America’s

Military

Health

System is a unique partnership of medical educators, medical researchers, health care providers and

their

support

personnel

worldwide. This DoD enterprise consists of the Office of the Assistant Secretary of Defense for Health Affairs; the medical departments of the Army, Navy, Marine Corps, Air Force, Coast Guard

and

Joint

Chiefs

of

Staff; the combatant command surgeons; and TRICARE providers (including private sector health care providers, hospitals and pharmacies). Visit www.health.mil to learn more about the Military Health System.

U.S. Army Col. Chris Harrington is the deputy program manager for medical logistics for Defense Health Services Systems. MMT  15.8 | 3

Compiled by KMI Media Group staff

P ROG R AM NO TES

Continuing Ft. Detrick Health Care IT Work CACI International Inc. has won four prime task order contracts, totaling $69 million, to continue supporting the defense medical logistics standard support system based at Fort Detrick, Md. The awards include: • • • •

$21 million for software development and sustainment, including IT and information assessment $24 million to migrate the theater-level medical supply chain management $18 million for system and software engineering life cycle and technical services $6 million in new work, providing system and software development and sustainment services for an e-commerce electronic catalog

“Transformative health care IT solutions and services that enable the efficient delivery of vital medical services to our armed forces are key components of our future growth strategy,” said CACI President and CEO Paul Cofoni. “This wide-ranging work with DMLSS clearly demonstrates that the significant corporate investment in health care IT and the dedication of our senior management are resulting in a growing momentum for success.”

Make the Connection: Shared Experiences and Support for Veterans Make the Connection, a new campaign launched by the Department of Veterans Affairs, is creating ways for veterans and their family members to connect with the experiences of other veterans—and ultimately to connect with information and resources to help them confront the challenges of transitioning from service, face health issues, or navigate the complexities of daily life as a civilian. “I have seen over and over again how important it can be for a veteran to hear a message from another veteran. This type of communication will be especially useful in helping to break down the stigma associated with mental health issues and treatment,” said Secretary of Veterans Affairs Eric K. Shinseki. “VA is leveraging this powerful connection using an approachable online resource that links veterans to personal stories from their peers, to VA resources and support, and to reliable information about mental health and resilience.” The campaign’s central focus is a website, www.maketheconnection.net, featuring numerous veterans who have shared their experiences, challenges and triumphs. It offers a place where veterans and their families can view the candid, personal testimonials of other veterans who have dealt with and are working through a variety of common life experiences, day-to-day symptoms,

and mental health conditions. The website also connects veterans and their family members with services and resources that may help them live more fulfilling lives. “VA is heartened by the tremendous commitment of veterans of all service eras, genders and backgrounds who are stepping up to share their stories,” said Shinseki. “Just as they would never leave a fellow servicemember behind on the field of battle, they are once again reaching out to support their fellow veterans with their compelling examples of successful treatment and recovery.” At maketheconnection.net, veterans and their family members can explore information on mental health issues and treatment— and easily access support—in comfort and privacy, anywhere, anytime. Visitors to the website can customize and filter their online experience, directly connecting with content that is the most relevant to their own lives and situations. VA’s Make the Connection campaign is raising awareness through public service announcements, advertising and partnerships with Veteran Service Organizations and mental health service providers nationwide. For more information, visit maketheconnection.net or VA’s mental health services website at www. mentalhealth.va.gov.

People Air Force Colonel Sean L. Murphy has been nominated to the rank of brigadier general. Murphy is currently serving as deputy assistant surgeon general, Directorate of Medical Force Development, Office of the Surgeon General, Headquarters U.S.

4 | MMT 15.8

Air Force, Pentagon, Washington, D.C. Air Force Colonel Charles E. Potter has been nominated to the rank of brigadier general. Potter is currently serving as senior executive officer and director of staff, Office of the

Surgeon General, Headquarters U.S. Air Force, Pentagon, Washington, D.C. Army Colonel John L. Poppe has been nominated for appointment to the rank of brigadier general and for assignment as chief of the Veterinary

Corps of the Army. Poppe is currently serving as chief, Department of Veterinary Science, Academy of Health Sciences, Army Medical Department Center and School, San Antonio, Texas. U.S. Army Special Operations

Command has announced the names of this year’s Medics of the Year awards: Sergeant 1st Class David Costa, A Co, 1st Battalion, 3rd Special Forces Group (Airborne), Special Forces Medic; Sergeant 1st Class Robert Foley, A Co, 98th

Civil Affairs Battalion, 95th Civil Affairs Brigade (Airborne), Civil Affairs Medic; and Staff Sergeant Roberto Sevilla, B Co, 3rd Battalion, 75th Ranger Regiment (Airborne), Special Operations Combat Medic.

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Propaq MD – Mission Ready for Extreme Situations As frontline Special Operations medics delivering tactical combat casualty care, you have unique requirements. The New Propaq® MD is designed for CASEVAC missions in extreme environments. It is the smallest and lightest technologically advanced monitor with an optional defibrillator/ pacemaker feature on the market. The rugged Propaq MD allows you to monitor ECG, SpO2, NIBP, EtCO2, three invasive pressures and two temperature channels, all with a single battery lasting longer than six hours. It also includes an NVG-friendly mode, and is backwards compatible with existing Propaq and ZOLL accessories. For more information visit www.zoll.com/propaqmd-mmt or call 1-800-804-4356

Propaq® MD

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©2011 ZOLL Medical Corporation. All rights reserved. AED Pro and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the United States and/or other countries. Propaq is a trademark of Welch Allyn.

Battling hypothermia and hemorrhage on the battlefield. By Peter A. Buxbaum MMT Correspondent The prevention of hypothermia among battlefield casualties is a major challenge for combat medics, and not only in extreme cold conditions. Hypothermia is the fourth leading cause of preventable battlefield deaths. The most frequent cause is hemorrhage. And there is a connection between those two phenomena. Hypothermia induces coagulopathy, a condition making blood clotting more difficult. “Even a small decrease in body temperature can interfere with blood clotting and increase the risk of exsanguination,” noted a 2010 memorandum from the Defense Health Board Tactical Combat Casualty Care (TC3) working group. “Combat casualties in shock are at even greater risk of hypothermic coagulopathy. Shock victims are thus predisposed to hypothermia.” A TC3 protocol encourages combat medics encountering a casualty suffering from a penetration wound to be mindful of the implications for hypothermia. “Hypothermia is far easier to prevent than it is to treat,” said the TC3 memo, “so prevention of heat loss should begin as soon after wounding as the tactical situation permits.” The U.S. military has acquired a number of products that help medics deal with this difficult battlefield situation. The armed services have also developed and acquired a range of cold weather garments, allowing warfighters to operate, and medics to treat casualties, in adverse conditions. “Our primary goal is to help the patient create clotting factors at the point of injury,” said Captain Martin Stewart of the 10th Mountain Division Medical Simulation Training Center in Fort Drum, N.Y. “In hypothermic patients it becomes difficult for them to create their own clotting.” “By using the right kind of gear and applying the right procedures it is possible to reduce the number of preventable combat deaths to zero,” said Ricardo Flores-Artola, director of military products at North American Rescue. “This has been documented 6 | MMT 15.8

among an Army Rangers unit that has been at the forefront of a lot of combat missions.” Cold weather clothing helps warfighters and medics to work in cold weather conditions. “We fielded the third generation of our Extended Cold Weather Clothing System in 2006,” said Major Barry Castro, assistant product manager for cold weather clothing at the Army’s Program Executive Office Solider. “We heard from commanders in Afghanistan that our soldiers had the ability to fight in cold weather while the Taliban had to hole up and were unable to exercise tactical operations.” “We understand the austere environments that warfighters face in theater,” said Sean McDearmon, Army branch specialist for W.L. Gore & Associates, the makers of Gore-Tex fabric, and a supplier to the Army’s Extended Cold Weather Clothing System (ECWCS). “Our innovation efforts are focused on the comfort and survivability of soldiers in these extreme weather situations.” North American Rescue produces the Hypothermia Prevention & Management Kit (HPMK), which has been endorsed by TC3. “HPMK is specifically designed to prevent hypothermia during tactical casualty evacuation,” said Flores. The HPMK includes the Heat Reflective Shell (HRS), constructed of a four-ply, composite fabric that provides thermal insulation and is impervious to wind and rain. The HRS has a built-in hood and fluid absorption pad. A system of hook and loop closures allows access by medics to the casualty. The kit also contains a self-heating, four-cell shell liner designed to sustain six hours of continuous dry heat at a temperature of 106 F. The company’s ARC-TC Thermal Wrap is a single-use disposal product designed for early prevention and management of hypothermia as close as possible to the point of injury. “Within 90 seconds of activation, the unit delivers 104 F of continuous radiant heat to the casualty’s back and chest, lasting a minimum www.MMT-kmi.com

The Thermal Angel blood warmer is a disposable, lightweight, and portable blood and IV fluid infusion warming device, providing warm fluids within 45 seconds. [Photo courtesy of Estill Medical Technologies Inc.]

of five hours from a fully charged BA-5590 battery,” said Flores. “This heating solution overcomes the limitations of chemical, self-heating devices by providing the capability to quickly produce constant heat for a long duration, even in high altitudes and in moist environments. The chest heaters can be adjusted to evaluate the casualty’s chest by moving the chest flaps to the side during the examination.” North American rescue is experimenting with a new Dupont material that could make its hypothermia wraps lighter, more rugged and more heat conductive. The company is awaiting approval from the Food and Drug Administration before introducing the product to the market. Estill Medical Technologies Inc. produces Thermal Angel, which heats fluids such as blood, Hextend, and other intravenous fluids, providing a casualty with warm fluids in an effort to prevent hypothermia. “Thermal Angel regulates the infusate at 5,000 times per second, producing a normothermic output temperature of 38 C [100 F],” said Brandon Lopez, the company’s vice president for sales and marketing. “The Thermal Angel does not require calibration, cleaning or maintenance. It is very easy to use and set up. It was designed to follow the patient throughout the entire continuum of care, streamlining the training requirements and decreasing the logistical footprint associated with managing the trauma patient.” Estill Medical also produces a portable power source for the Thermal Angel, known as the Thermal Angel Ultra Battery. A recently introduced product innovation reduces the weight of the power source from six pounds to 1.25 pounds. The Ultra Battery is chargeable from a variety of sources. “The caregiver can get out there on a mission,” said Lopez, “knowing that whatever power source is available will be able to charge the battery.” The U.S. Army Center for Predeployment Medicine trains doctors and physician assistants in the use of Thermal Angel as part of a course provided to them 90 days before they are deployed to theater. “It is a one-hour block of instruction,” said Brian Hill, a physician assistant and instructor in the tactical combat medical care course, “and we continue to use the product throughout the week-long course. Thermal Angel introduces the fluids to the patient at slightly warmer than normal body temperature in order to help prevent hypothermia.” “We have found that the hypothermic kit and the warm fluids are a really good combination,” said Stewart. “The new Thermal www.MMT-kmi.com

MMT  15.8 | 7

Angel battery system is more portable and more advantageous for medics to use on the battlefield.” The U.S. Army’s Extended Cold Weather Clothing System is a collection of seven layers designed to be mixed and matched by individual warfighters to meet their mission needs and the conditions of the environments in which they are operating. The various components of the system are supplied by several different manufacturers and then kitted and supplied to the military by ADS of Virginia Beach, Va. The Soldier Protective and Individual Equipment office of PEO Soldier designed and initially fielded the system, but the Defense Logistics Agency is now in charge of awarding long-term contracts for the garments. Material produced by TenCate Protective Fabrics has been incorporated in a number of military garments including the Marine Corps’ inclement The first generation of ECWCS weather combat shirt. [Photo courtesy of TenCate Protective Fabrics] was introduced in the late 1980s W.L. Gore does not manufacture garments itself, but supplies its and consisted of an outer layer parka and trousers, which incorpoGore-Tex fabrics to others who product the components for ECWCS rated the Gore-Tex fabric; a fleece middle layer; and long thermal and other cold weather gear for the U.S. military. These pieces include underwear. The second generation replaced the middle and under outerwear, footwear and gloves. “We describe Gore-Tex fabrics as layers with less bulky material that provided the same level of durably waterproof, windproof and breathable,” said McDearmon. warmth. To produce a finished fabric, a Gore membrane is laminated to “The third generation represents a significant improvement over various textiles including nylon, polyester, or Nomex. Gore-Tex fabthe second generation,” said Castro. “We never before approached rics have been incorporated into every generation of Army ECWCS, the problem holistically. This time we attacked the problem of layeras well as into outerwear for all other branches of the U.S. military. ing by giving soldiers the option of removing and replacing layers.” TenCate Protective Fabrics likewise produces materials that are The seven ECWCS layers consist of silk-weight top and bottom incorporated into garments manufactured by others. The company’s undergarments made of a thin, moisture-wicking fabric followed by Defender M fabric was designed primarily to be flame resistant, but a light fleece layer. The fleece top is equipped with a half zipper so has been incorporated in gear designed to protect warfighters from that the wearer can adjust the garment has he warms up. the elements. The third layer is a fleece jacket that provides protection against “The fabric was adopted by the cold but not wind. The next layer up is a wind shirt that provides United States Marine Corps for its wind protection. These two layers can be worn individually or inclement weather combat shirt,” together depending upon conditions. said Mike Stanhope, the company’s The fifth layer is a soft shell top and bottom, including a jacket global R&D manager. “The shirt is not with hood, designed to provide cold weather protection but only designed for extreme conditions but limited protection from inclement weather. Next up is a is a seamfor intermediate conditions requiring sealed wet/cold weather jacket and trousers constructed with twowater repellent properties and proteclayer Gore-Tex fabric that is completely waterproof, windproof and tion from cold and wind. If you are breathable. wet and it is 55 degrees out, you may Technically it is not a “rain suit.” Its design and construction Mike Stanhope suffer from hypothermia which could properties far exceed that of a simple rain suit. Finally, the seventh lead to death.” layer is a large puffy parka and trousers for use in extreme cold when The shirt is worn as part of a layered system, usually against the performing stationary tasks such as guard duty. skin and under the body armor, according to Stanhope. The Norwe“The system is tailorable to any mission,” said Castro. “As solgian, Italian and Australian militaries have also adopted the TenCate diers move and produce sweat they can take some layers off and put Defender M protective materials for some of their forces’ gear. O others on.” The Army doesn’t produce policies as to when each layer should be worn. “We have a mandate to operate from 120 degrees to minus For more information, contact MMT Editor 60,” said Castro. “It is up to the soldiers and their leadership. The Brian O’Shea at briano@kmimediagroup.com design of the system is user dependent. The feedback we have or search our online archives for related stories at www.MMT-kmi.com. received from soldiers has been great.” 8 | MMT 15.8

www.MMT-kmi.com

By Henry Canaday MMT Correspondent

Special Operations Command medics must fight and survive as well as save lives. They must have much of the same tactical gear that all soldiers need, and often need the best due to the extreme challenges all SOCOM personnel face. Protection of the head and eyes is especially important. Any gear that makes it easier for SOCOM medics to perform their medical missions also helps. Weight is crucial. Lighter, more easily handled bags and litters mean SOCOM medics can also carry more of what they need to survive in the battlefield. Dave Jones, a 20-year SEAL veteran and now director of the Special Operations Division at Blackhawk!, said SOCOM is always seeking to lighten the load on medics and make the equipment more organized. “They want to be able to do casualty care in triage where they have lots of stuff in big bags. They want to lighten it and they need efficiency and durability,” Jones said. “They want it to be easy to use so they can identify key items quickly, and they want to be able to jump with it, swim with it, carry it or put it in vehicles.” Senior Chief Petty Officer Clarence Conner was with the 1st Marine Special Operations Battalion for two years, went to Afghanistan with a regular Marine unit and is now acting commanding master chief at the 1st Marine Division rear in Camp Pendleton. After his tour in Afghanistan, Conner recalls several areas where medics and corpsmen might like to see improvements. First, Conner noted, the traditional prescription inserts in goggles and spectacles have been flat, not curved, so these can block eyelids when blinking. “If they were curved, they would keep the insert away from the eyes,” Conner noted. Medical packs were fine in their capacity and ability to organize necessary medical supplies. “But about midway through the zippers would break,” Conner noted. He estimates that of 65 packs brought home, only about 10 had correctly functioning zippers. In the cold months, thinner TAP cammies proved not to be as durable as regular issue. “When you bent down a lot, they tended to rip out,” Conner said. Litters were satisfactory but the Marines are looking into a poleless litter that folds up into a small pouch, can be easily carried and taken out quickly, and then used with straps around the neck to pull a www.MMT-kmi.com

casualty. “That leaves your hands free to return fire,” Conner explained. Vendors are continually improving both the protection offered by tactical gear and reducing the weight of all necessary equipment. One example of both improved performance and increased ease of use is Team Wendy’s new EPIC (Enhanced Protection Individual Comfort) Air Combat Helmet Liner System. Product Development Manager Ron Szalkowski said EPIC Air is useful for anyone wearing an anti-ballistic helmet and can protect against blunt impacts. This must be achieved without making medics uncomfortable and thus less effective in the field. “We have improved comfort and made it adjustable, without lowering protection,” Szalkowski explained. “The standard adjustment is to take pads out, which reduces protection. This can be adjusted without losing protection.” Launched in September 2011, the new EPIC Air has four air channels, so refreshing air can pass through. It fits like a baseball cap, with support around the entire perimeter of a soldier’s head, “so you do not have to have the chin strap as tight, but it still is stable,” Szalkowski noted. Revision Military has three products for use by SOCOM medics that are especially notable, according to Dan Packard, senior vice president sales. The Bullet Ant Tactical Goggle is a fully enclosed system with sealed eyecups that help prevent possible contamination from blood-borne pathogens or body fluids. It has interchangeable ballistic lenses for daytime and night or indoor operations. Optically correct lenses have anti-fog coating while clear and smoke lens tints make colors appear as they should. Revision’s Desert Locust Goggle also has a full seal around the eye and a single-lens maximum field-of-view. “It allows increased situational awareness, and that equals survivability,” Packard emphasized. “It provides superior ballistic protection and flawless optics for enhanced performance.” The Sawfly Spectacle is an all-purpose eyewear system ideal for medics when full seals of the eye are not required. Constant airflow minimizes fogging and lenses are hard-coated for anti-scratch protection. MMT  15.8 | 9

KEEPING COMBAT MEDICS EQUIPPED In a post-9/11 world, the requirements for the dedicated professionals standing in harm’s way to save the life of another are ever-changing. Constant feedback from infantrymen, combat lifesavers, SOF medics, law enforcement operators, paramedics and physicians provide a clear call for innovative solutions that help save lives on the battlefield. North American Rescue’s (NAR) goal is to empower first responders on the frontline with the highest quality lifesaving products and supplies for managing traumatic injury in the field. To achieve that goal, they believe that understanding precise customer requirements and an in-depth commitment to quality is what sets them apart from other companies. Since 1996, NAR has been the trusted resource for quality medical products. “NAR is driven by the evolving guidelines of tactical

combat casualty care (TCCC),” stated Samuel D. Wyman III, president of NAR. “Based on lessons learned and TCCC principles, NAR’s products are specially designed to have a direct correlation to decreasing preventable combat death.” A seasoned staff of former special operations medics and experienced law enforcement/ SWAT/EMS health care providers, combined with a commitment to quality—as demonstrated by their registration with the FDA and adherence to ISO 13485 and ISO 9001 standards—shows a unique insight into the unconventional challenges of tactical medicine and rescue and a willingness to provide the very best quality solutions. Through Rescue Human Factors engineering, NAR develops and validates products in real world circumstances for real end-users. Their tactical nylon C-A-T tourniquets, gauze

All three products provide ballistic eye protection and block harmful ultraviolet rays. “Importantly, each system can be outfitted with laser protective lenses to protect against a broad range of battlefield threats,” Packard added. Revision also has a new Exoshield Extreme Low-profile Eyewear System. It is a closed, single-lens system that seals close to the face for excellent interoperability with night vision goggles, optics and thermal-imaging equipment. “This eyewear is ideal for high-speed mobility and dynamic environments,” Packard said. It suits a variety of operational needs and can protect medics from the hazards of rotor wash during evacuations. Columbia River Knife and Tool makes equipment that is useful for general tactical purposes. These include CRKT’s M16, M21 and 1050K Fire Spark knives. Several of CRKT’s knives have also been used for tracheotomies by combat medics. Sales and Marketing Coordinator Lindsey Phelps said these include the M16-13T, M16-03Z, M16-01T and the M16-01Z, all with spear-point blades. Marty Wozniak of Blackhawk! argued that some breaching equipment should be part of every SOCOM medic’s standard kit. Wozniak recommends the smaller and more portable tools, such as the minibreacher, a hallagan-style device designed for close-quarter breaching with a stainless steel wedge and friction ridges on contact surfaces. Also useful would be Blackhawk!’s Small Pry, a breaching tool that combines prying capability with a cutting edge. The Small Pry is ideal for prying interior doors and drawers, breaking windows and tactical cutting such as removing screens and chopping through drywall. “It can cut, chop and pry,” Wozniak noted. “It is small and light, yet cuts screens and glass and can chop through sheetrock.” Blackhawk! generally does not make medical devices but does offer products that can carry this equipment. Here the aim is to make it as easy as possible for medics to carry necessary supplies and devices while preserving mobility. Shannon Taylor, once a Navy corpsman and now fire and EMS coordinator for Blackhawk!, suggested several bags for carrying medical equipment, including the STOMP II tactical operational medical pack. “It is designed for gear medics carry, with compartments to 10 | MMT 15.8

and bandages stand apart from competitors as American-made and Berry Amendment Compliant. According to Senior Vice President Joanne Walter, “This is quality that you can trust in the heat of battle. Our products have applications spanning the full spectrum of tactical casualty care, from the point of wounding to the doors of the trauma center.” “Our mission at NAR is to provide the lifesaving equipment needed to increase the number of soldiers that come home to their families and communities,” stated Walter. “We value our servicemembers’ dedication to our country and consider it an honor to support them with products that may very well serve them in their greatest time of need. This is something that we take very seriously.”

carry any devices, such as advanced airway devices,” Taylor explained. The STOMP II was designed to SEAL team medic specifications, and is made of heavy-duty 1000-denier nylon and breathable closed-cell foam padding. Shoulder straps, a sternum strap and a web belt provide a comfortable fit while allowing ample adjustment. It has drop pouches for jumps and webbing for accessory packs. Blackhawk! also makes smaller and lighter bags for various accessories, including a basic first-aid kit for simple items such as tourniquets. The STOMP Medical Pack Accessory Pouch can be carried on the leg or on a belt. Blackhawk!’s Special Operations medical backpack has webbing for attaching pouches and can stand upright when removed. A compact medical pack is good for triaging when several medics are available. Taylor emphasized that all Blackhawk! bags are modular and can be customized for specific needs. Finally, the company’s litters roll up and slip on to the bottoms of packs, so they are easy to carry. They can be used for four-point carrying or for dragging with wounded soldiers strapped in. Darley Defense distributes a range of combat or tactical gear. These products include the Micro T-1 Sight, ideal for machine guns, rifles, carbines and shotguns, laser grips for Glock and Beretta M9 weapons, Mojave hybrid hiker boots, hard-knuckle tactical gloves, a PVS-7 night vision goggle kit and a one-person combat tent. Darley also distributes the Rite Rescue Litter, which is light, very quick to deploy in dangerous situations and yet extremely capable. The ground Rite Rescue weighs less than eight pounds, while the mounted version weighs less than 12 pounds. An aviation model weighs less than 18 pounds. The litter enables deployment and having a soldier ready for extrication in two minutes. Speed and convenience are not purchased at the expense of capability. The Rite Rescue’s five-point integrated harness secures the patient and the harness provides an alternative attachment for safely hoisting, with double straps to secure groin and shoulders. Rite Rescue is being tested with some defense units. Darley said it was specifically sought out and requested by several high-speed units. Streamlight makes a variety of high-performance, extremely durable light-emitting diodes (LED) illumination devices suitable for www.MMT-kmi.com

SOCOM medics. Its Sidewinder military model has white, red, infrared and blue LEDs and is impervious to shock with 50,000 to 100,000 hours of life, depending on color. The Sidewinder Compact Team Soldier offers 20 flashlights in one and was engineered to be hands-free for a range of illumination requirements. ADS distributes operational, tactical and medical products that are designed to increase survivability and decrease added weight while providing the latest technology available, explained Ken Mullins, the company’s USMC/Mideast medical applications specialist. “We also help the supply guys by simplifying the ordering process,” Mullins noted. “We can combine all the best products into one kit and provide them one part number, saving time and effort.” ADS values its partners that include Combat Medical Systems (CMS), Tactical Medical Solutions (TMS), Cardiac Science, London Bridge Trading Company, and Skedco to name a few. Some of ADS’s newest products are the Cardiac Science CCMD, Celox Rapid and the Foxseal. One of their latest projects is the Cardiac Science’s Care Center MD paired with a Hewlett Packard Slate 500 PC Tablet, making it the first truly expeditionary 12 lead ECG monitor kit. The Cardiac Science CCMD kit provides cardiac diagnostic information to deployed field units. Until now, this level of care was limited to robust medical treatment facilities and large deck Navy vessels due to the lack of portability of the ECG machine. The CCMD software program can deliver a preliminary diagnosis with multiple reach back options for immediate medical officer concurrence. The CCMD kit provides in the field diagnostic information to rule out cardiac related chest pain versus non-cardiac related chest pain, saving lives and potentially saving thousands of dollars by avoiding unnecessary medevacs. Another example is Celox Rapid, which can be used to control severe bleeding faster than other hemostat dressings. With faster packing and faster compression, up to three minutes can be saved caring for a casualty. Celox Rapid Gauze offers a Z-fold presentation hemostat bandage, using the same instinctive steps as Celox Gauze: just pack the wound and apply pressure. The difference is that Celox Rapid is designed to speed up both of these steps, saving critical time for the medic and for the casualty.

Team Wendy EPIC Air Combat Helmet Liner System. [Photo courtesy of Team Wendy]

Celox Rapid uses Chito-R with activated chitosan to control bleeding. Chito-R sticks to wet tissue, providing pressure locally at the bleeding site, which augments the pressure applied by the responder. It is this wet stick that gives Celox Rapid reduced compression time, allowing Celox Rapid to reduce blood loss and save lives. The Chito-R in Celox Rapid is presented on a high volume, rapid packing gauze strip to maximize packing speed. Laboratory testing has shown that Celox Rapid Gauze could be rapidly packed on the wound on average within half the time of the predicate devices and demonstrated rapid wound adhesion the wound within 1 minute. It also filled a higher volume when wet and under compression than the predicate devices. The FoxSeal is newly designed occlusive dressing for open chest wounds that has been tested in extreme conditions, comes with two dressings in a compact package designed for IFAK carry, and is used for treating potentially lethal open chest wounds. O

For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.

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MMT  15.8 | 11

Simulation can offer clinicians a safer training environment . By Dr. Haru Okuda and Dr. Lygia Arcaro The military is no stranger to skill acquisition when preparing their warfighters and other personnel. Training exercises customized towards potential real-world threats are a familiar way in which the men and women of the armed forces obtain mastery in routine and hazardous tasks and missions. Thanks to the efforts of leading VA clinicians and technicians, health care is no longer different. A 1999 report by the Institute of Medicine entitled “To Err is Human,” found that between 44,000 and 98,000 people die each year in the U.S. as a result of preventable medical errors. Simulation is a credible teaching tool for both military and civilian populations to practice their skills in a safe, immersive environment in order to be mission ready and save lives. Just as the military uses simulations to train troops the way they would fight in hostile territory, VA uses simulation techniques to train clinicians the way they would practice in the clinical arena. Where did health care simulation get its start? In the 1980s, a young man named David Gaba completed medical school and, through his interest in the space program, became aware of how pilots and soldiers trained. Dr. David Gaba is now director, Patient Simulation Center of Innovation at the VA Palo Alto Healthcare System and associate dean for Immersive and Simulation-based Learning at Stanford University. He is considered one of the founders of health care simulation and defines simulation as a “technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.”

Extent of Training: How in-depth does it go? Typically, simulation is divided into four categories based on different modalities: standardized patients, screen-based simulation, partial-task simulation and high-fidelity mannequin simulation. 12 | MMT 15.8

Standardized patients have been traditionally used in the medical and nursing school environment to teach history-taking, assessment and physical exam skills using trained actors. Some standardized patients are also trained as “gynecological teaching associates” and are skilled in the art of providing feedback to the student examiner while undergoing a physical examination. Screen-based simulation ranges from online virtual patients that allow for the learner to read case histories and select from a variety of possible clinical responses, to avatar-based virtual worlds that enable providers to work as teams in a real-time web-based environment. Partial task simulation is often divided into two subcategories depending on the technology of the equipment. Task trainers are used in many instances, which are anatomical body part mannequins used for student practice. Simple task trainers enable learners to practice skills such as the placement of an intravenous line or chest tube. More complex task trainers simulate highrisk procedures, such as colonoscopy or laparoscopic surgery, using haptic technology that gives the learner a sense of physical resistance and touch feedback similar to what they will experience when performing the procedure in a real patient. High-fidelity mannequin simulation, sometimes called “simulation theater,” reproduces a real clinical environment such as an operating room using lifelike mannequins that are capable of breathing, sweating, seizing, blinking, speaking, and reproducing heart and lung sounds. Recently, the field of simulation has begun focusing research on where these modalities can best be applied in the health care setting. One area is in the application of simulation for education. Schools are using simulation labs to provide opportunities for health-professions students to become familiar with procedures, evoke critical thinking skills, and work with colleagues as a team when interacting with patients.

Surgical programs are requiring the use of simulation to teach laparoscopic skills prior to having the resident perform on a patient. Other programs, such as anesthesiology, are using simulation to train residents to use anesthesia machines and troubleshoot equipment. Emergency medicine and internal medicine programs are teaching skills like lumbar puncture on task trainers, and code team management on mannequins. The days of “see one, do one, teach one” are increasingly falling out of favor. The field of patient safety and quality improvement is researching ways of using simulation to improve patient care. In obstetrics, simulation is used to allow teams of clinical providers to practice managing high-risk, low-frequency events such as post-partum hemorrhage and shoulder dystocia. Studies have demonstrated a significant reduction in neonatal injury after simulation team training. Other hospital systems are training their physicians and nurses in the placement and management of central lines and demonstrating a reduction in central line associated bloodstream infections. This past year, at their annual meeting, the National Patient Safety Foundation dedicated a plenary session on simulation to showcase how it can be used to disclose errors. Apart from provider training, simulation is being used to test units and workflow within medical facilities. Testing entire systems in a health care organization can lead to the identification of latent safety threats. Prior to the opening of a new hospital or clinic, simulation experts can provide common scenarios to the staff of a certain ward or floor. For example, simulating a transfer from a patient room to other clinical environments, such as radiology, may reinforce a smooth process or expose hazards that need mitigation. A simulation test performed by the armed forces global emerging infections surveillance and response system (GEIS) in a new satellite hospital found 37 latent safety threats involving equipment, www.MMT-kmi.com

personnel and resources. Because GEIS used simulation to test the new facility prior to opening, they were able to address most of these potential threats prior to the arrival of patients. A popular attraction and well-known simulation event called “SimWars” has been featured at meetings like the International Meeting on Simulation in Healthcare, and American College for Emergency Physicians. These team competitions use both low- and high-fidelity mannequins in patient scenarios where competitors must work through the clinical problem in a fixed amount of time. Each team is evaluated against predetermined criteria that encompass the entire simulation process. There are “SimWars” played by accomplished health care professionals and students alike (www.vimeo.com/11084119), and scenarios may have components of team training and communication principles. The applications described above are only a few ways simulation is being used in health care. Studies are increasingly demonstrating the effectiveness of simulation.

What Is The Future Of Simulation In Health Care? As technology continues to advance, simulation will continue to provide an opportunity for the health care provider to practice procedures and become familiar with the equipment. Answers to questions about the functioning of the equipment, techniques or approaches to common and not-so-common surgical procedures, and the ability to fill in knowledge gaps if an error is made can be accomplished through the use of simulation well in advance of encountering a live patient. Boards controlling re-licensure of health care professionals are talking about using simulation in their decisions to define what procedures will need to be demonstrated prior to renewal. Percentages of time students can use simulated patient care activities in lieu of actual demonstrated live practice is being mandated by some licensing bodies. Standards and guidelines will continue to emerge from simulation associations. A compendium of broad categories of simulation modalities can be found on the

Department of Veterans Affairs SimLEARN Internet website, www.simlearn.va.gov/lib. asp. SimLEARN, an acronym for the Simulation Learning Education and Research Network, is a national program under the Veterans Health Administration for advancing clinical simulation training, education and research across VHA. The program is a collaborative effort of the Employee Education System, Office of Patient Care Services and Office of Nursing Services program offices. For more information, go to www.simlearn.va.gov. O Dr. Haru Okuda is SimLEARN National Medical Director, Department of Veterans Affairs, and Dr. Lygia Arcaro is SimLEARN National Director, Nursing Programs, Department of Veterans Affairs.

For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.

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FreeStyle Lite® blood glucose test strips are intended to be used with FreeStyle Lite® and FreeStyle Freedom Lite® meters only. FreeStyle® blood glucose test strips are intended to be used with FreeStyle® (also known as FreeStyle® 3 and FreeStyle® 5), FreeStyle Flash® and FreeStyle Freedom® meters only. 1. Versus original FreeStyle Lite® test strips. Study conducted in August 2009. Data on file, Abbott Diabetes Care Inc. 2. Only applies to FreeStyle Lite and FreeStyle Freedom Lite Blood Glucose Monitoring Systems. Precision Xceed Pro and Precision Xtra are trademarks of the Abbott Group of Companies. Other trademarks are the property of their respective owners. © Copyright 2011 Abbott ART21813 Rev A 03/11

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MMT  15.8 | 13

Compiled by KMI Media Group staff

Transformational Medical Technologies Website The new Joint Project Manager Transformational Medical Technologies ( JPM-TMT) website delivers a userfriendly experience with a fresh new look and streamlined navigation. The site features: • The latest program news from the areas of advanced development and acquisitions, response systems, and animal models • A social media hub that makes viewing up-to-the-minute posts from the program’s Twitter, Facebook, and YouTube pages fast and convenient • An updated calendar with events highlighting where and when you can meet and greet members of the JPM-TMT staff • A comprehensive resource guide housing the latest program information and materials for media and other users, and more! The JPM-TMT Program supports the overall mission of the Department of Defense by protecting the warfighter and the nation from emerging, genetically engineered or unknown biothreats. Chartered within the Joint Program Executive Office for Chemical and Biological Defense, JPM-TMT partners with DoD, other government agencies, academia, and industry for the advanced development of adaptable platform technologies that can be rapidly tailored and deployed to mitigate the effects of an unknown threat, whether it be naturally occurring or man-made. Program investments target the most difficult challenges of medical capability development and fill gaps not currently addressed by the biodefense community. For more information: www.jpmtmt.mil 14 | MMT 15.8

Rugged Tablet Introduced Guardian Mobile Clinical Assistant Model 1040 the 10.4 Intel Atom N450 Mobile Clinical Assistant from Industrial Computing is a rugged tablet that’s light enough to carry in the hospital, clinic or healthcare practice. It’s the perfect EMR solution to access practice manager so users can view patient records wherever Internet service is available and will even take pictures for users’ files. The Guardian Mobile Clinical Assistant Model 1040 features: • • • •

eHealthcare and clinical assistant application Soldered onboard Intel Atom N450 processor Electromagnetic digitizer with resistive touch Touch pen battery-free pen

EN60601-1, EN60601-1-2, UL60601-1 compliant. • Redundant battery (internal + hot-swappable external battery) w/ long battery life (3.5hrs) • Slim appearance - ultra-light weight (1.3kg) and ultra-slim (26mm) • Slip-free grip for easy handling • Multi-connectivity (Bluetooth, WLAN, Gigabit Ethernet) • Integrated 2-D barcode scanner, 2.0 megapixels camera, RFID reader • Multi-expansion (1 x RS-232, 1 x USB,1 x LAN,1 x VGA , and 1 x SmartCard) • Also available: RAM-ball Mount Cradle for Guardian Mobile Clinical Assistant Donald Berman; dberman@industcomputing.com

CREW: Helping Defeat IEDs “If it’s on, it’s going to work. So it’s 100 percent effective,” explained Eddi Bowers, the Regional Support Center-Kandahar site lead, about the Counter Radio Electronic Warfare system. CREW systems are helping soldiers to defeat deadly improvised explosive devices, or IEDs, by blocking radio signals that can be used by insurgents to detonate the devices remotely. The jammers were developed in 2006, when insurgents in Iraq were using cell phones to remotely detonate roadside bombs. The equipment developed by military scientists is basically equivalent to a transmitter on steroids, said Bowers. “It takes a little more than an off-the-shelf item to do that,” he said. CREW has been highly effective in preventing the remote detonation of IEDs by cell phones, said Bowers. “There are still radiocontrolled ones out there, but nowhere near as many as there used to be because they know we have it figured out,” he explained. “[Soldiers] love it,” Bowers said. “It gives them the boost of confidence to know that anything that’s radio operated out there, they’re going to jam it.”

An average installation takes between two to four hours. The RSC at Kandahar averages about 10 installations per day and every field service representative there usually does about four or five maintenance calls a day as well. The team also has nine FSRs out at various locations in Southern Afghanistan. “The biggest challenge for us is probably the kits for different vehicles,” Bowers said. “There is such a menagerie of vehicles at Kandahar [airfield]. It’s unbelievable. There are loads of different types of vehicles compared to Bagram [airfield] and you have to have a special kit for each one of these vehicles.” “And it’s a monster logistically. You have to have a special kit. And four or five [vehicles] will come in and then you’re out of kits and you have to wait to get more kits,” he said. Despite the challenges, RSC-Kandahar has the best production rate in Afghanistan. About 50 percent of all the theater-provided jammers are installed here. The team started out with 52 guys working out of single office container with two computers. “We have come a long, long way,” said Bowers. www.MMT-kmi.com

Automated External Defibrillator for Treating Victims of Sudden Cardiac Arrest Royal Philips Electronics introduced the Philips HeartStart FR3 automated external defibrillator (AED) in the U.S. for professional responders who treat victims of sudden cardiac arrest (SCA). As the smallest and lightest professional-grade AED among leading global manufacturers, the HeartStart FR3 is Philips’ most advanced professional-grade AED. The rugged and reliable HeartStart FR3 is designed to help make lifesaving faster and easier for professional responders. The FR3 requires a prescription for use in the United States, and must be used under medical direction. SCA is one of the leading causes of death in the United States, claiming nearly 300,000 lives each year. Defibrillation is recognized as the only definitive treatment for ventricular fibrillation, the abnormal heart rhythm most often associated with SCA. While cardiopulmonary resuscitation (CPR) may help prolong the window of survival, CPR alone cannot restore a normal cardiac rhythm. After 10 minutes without defibrillation, few attempts to resuscitate an SCA victim are successful. Recognizing that time to therapy matters, the HeartStart FR3 significantly reduces deployment time by eliminating steps to help responders start delivery of the right therapy— CPR or defibrillation—on the patient faster. The FR3 automatically powers on when the Philips HeartStart FR3 carry case is opened. The device also features easy-to-access,

www.MMT-kmi.com

pre-connected peel and place pads that do not require opening a foil pouch. These unique features help speed therapy delivery. The HeartStart FR3 includes several innovations designed to make it easier for professional responders to treat SCA, including a bright, high-resolution, color LCD that provides visible prompts for easier use in noisy environments; a CPR metronome that keeps the beat for consistent chest compressions; and bilingual configurability so that voice and text prompts can be clearly understood by a variety of responders. Philips makes it easy for programs to standardize on one pad set, as Philips Smart Pads III are compatible for use with Philips HeartStart FR2-series and work

with Philips monitor/defibrillators, including HeartStart MRx, for easy hand-off. The HeartStart FR3 also enables responders to treat infants and children faster. There is no need to change defibrillation pads, as the Smart Pads III can be used on adults and children. When inserted into the HeartStart FR3, the infant/child key automatically decreases the defibrillation therapy and implements the configured infant/child CPR protocols. “Philips helped chart the course for widespread use of AEDs among lay people and professional responders, and the HeartStart FR3 demonstrates Philips’ continued commitment to innovation,” said Bob Peterhans, general manager, AED, for Philips Healthcare. “The HeartStart FR3 is raising the bar for AEDs and is designed to address the evolving needs of professional responders, so they can respond to patients swiftly and with confidence.” For professional responders who are committed to doing an even better job of saving lives, the HeartStart FR3 is designed to help improve their emergency response. The HeartStart FR3 and Philips data management solutions are designed to help support a culture of continuous improvement and excellence among emergency response organizations, including optimizing training and fine-tuning SCA protocol. Brian Healey; brian.healey@philips.com

MMT  15.8 | 15

Doctrine Overseer

Q& A

Overseeing The Organization Of All USASOC Medical Elements

Colonel Peter J. Benson Command Surgeon United States Army Special Operations Command

Colonel Peter Benson was born and raised in Winchester, Mass. He graduated from the College of Engineering, Northeastern University in Boston in 1985. He received his commission upon graduation as a second lieutenant in the infantry in the Army Reserve. After completion of the Infantry Officer’s Basic Course, Fort Benning, Ga., and the Special Forces Qualification Course, Fort Bragg, N.C., Benson was assigned to A Company, 1st Battalion, 11th Special Forces Group (Airborne) at Fort Devens, Mass. During four years of Reserve Service, Benson worked as a quality control engineer and engineering manager for Raytheon Corporation, Waltham, Mass. In 1989 he matriculated into the Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine. Benson graduated and received a Regular Army Commission in the Army Medical Corps in 1993. He completed a transitional (rotational) internship at Madigan Army Medical Center in Fort Lewis in 1994. After completion of the Walter Reed Army Institute of Research, Tropical Medicine Course and the U.S. Navy Diving Medical Officer Course, he was assigned as battalion surgeon, 2nd Battalion, 1st Special Forces Group (Airborne) at Fort Lewis, Wash., in 1994. After three years in the 1st Special Forces Group, Benson was accepted into the Emergency Medicine Residency program at Madigan Army Medical Center, graduating in 2000. He was assigned as staff emergency physician and later chief of the Emergency Medicine Service at William Beaumont Army Medical Center, at Fort Bliss, Texas. While at Fort Bliss, Benson was also an augmentee to the Joint Special Operation Command Surgeon’s Office from 2000 to 2004. Benson served in multiple deployments to Operation Enduring Freedom and Operation Iraqi Freedom, serving as the task force surgeon for Task Force 121 in Operation Winter Strike in 2004. In 2004, Benson was assigned to Special Operations Command Europe in Stuttgart, Germany, as the first permanently assigned theater special operations (TSOC) command surgeon. He returned to Fort Bragg in 2007 as the first U.S. Army Special Forces Command (Airborne) command and regimental surgeon. He was assumed his current assignment as deputy chief of staff, surgeon of the U.S. Army Special Operations Command in 2009. www.MMT-kmi.com

Benson’s awards and decorations include the Bronze Star Medal, the Defense Meritorious Service Medal, the Meritorious Service Medal with oak leaf cluster, the Air Medal, the Joint Service Commendation Medal, the Joint Service Achievement Medal, the Joint Meritorious Unit Award, the Army Superior Unit Award, and other individual and service awards. He has earned the Special Forces Tab, the Combat Medical Badge, the Senior Flight Surgeon Badge, the Master Parachutist Badge, and the U.S. Navy Diving Medical Officer Badge, the French Military Parachutist Badge and the French Army Commando Course Badge. He completed the U.S. Army Command & General Staff College (Correspondence) in 2005. Benson is also a Diplomat of the American Board of Emergency Medicine and a Fellow of the American College of Emergency Physicians and the American Academy of Emergency Medicine, Q: What is your current mission and the responsibilities as the USASOC surgeon? A: The mission and the enduring focus of the USASOC surgeon’s office is to provide the very best personnel, training and equipment possible in order to field the most capable and ready special operations medical providers in the world. The surgeon’s MMT  15.8 | 17

office oversees the doctrine, structure, organization, training and equipping of all USASOC medical elements. It also provides subject matter expertise to the commanding general and the directorate staff. The central element in medically supporting Army special operations forces [ARSOF] is the enlisted, nonlicensed providers—the special forces medical sergeant [SFMS] of the special forces groups; the special operations combat medics [SOCM] of the 75th Ranger Regiment, 160th Special operations Aviation Regiment and 528th Special Operations Support Brigade; and the civil affairs medical sergeant of the 95th Civil Affairs brigade. The ability of USASOC’s John F. Kennedy Special Warfare Center and School [JFKSWCS] to train the most skilled non-licensed provider in the world has enabled ARSOF to deploy with an organic tactical medical capacity unrivaled elsewhere. This translates into not only a tactical or operational ability to mitigate medical risk on the battlefield, but to a strategic advantage of being able to deploy ARSOF anywhere in the world with the very best organic SOF medical capability possible. Q: What effects do you anticipate from the potential changes in deployments around the world? A: The potential changes in U.S. general purpose force [GPF] and coalition force [CF] deployment in Operation Enduring Freedom and Operation New Dawn will have a significant impact on the medical support to ARSOF. As the GPF and CF units scale down or redeploy from Afghanistan and Iraq, the danger to SOF elements is the removal of medical treatment and air evacuation capacity. The unprecedented improvement in killed-in-action and died-of-wounds rates in recent combat has been driven by two things: the universal fielding of the tactical combat casualty care [TCCC] protocols and the proximate availability of, or rapid evacuation to, damage control surgical care. ARSOF relies on GPF or CF surgical assets and often on their air evacuation assets for support. The redeployment of these assets will increase the risk to residual deployed SOF elements. Despite changes in OEF and OND, ARSOF will continue to be deployed and working in its core competencies around the world. USASOC forces are engaged in ongoing operations with partner nations in training, nation building and stability operations every day. The ability for USASOC to deploy small elements to far-forward, austere locations is made possible in great part by its internal self-supporting medical capacity. Striving to continually improve and maintain the medical edge is critical to keeping USASOC’s soldiers fit and supported in the field. Q: What are some of the key initiatives or programs that USASOC is working on or would like to see? A: USASOC is involved in several programs to improve its medical capabilities. One of the new number initiatives has been to lengthen the special operations combat medic course by including three additional weeks of medical treatment subjects. Reports from the SOCMs in the combat theater made it clear that more training was needed in order to support their unit’s primary care, host nation personnel support and village stability operations independent of a unit physician or physician assistant. The course at JFKSWCS now includes the necessary 18 | MMT 15.8

training to meet these medics’ expanding mission. USASOC is also working in partnership with the AMEDD Center and School in Fort Sam Houston, Texas, to reshape the current Cold War structured forward surgical team [FST]. The evidence that rapidly available damage control surgical capability can greatly decrease combat deaths is clear. The need to make the FST lighter, modular, and more medically and tactically agile while gaining efficiencies on the use of the Army’s medical professional human capital necessary to field the FST is paramount. USASOC greatly needs an agile surgical capability that is able to go beyond the OEF and OND model to SOF operations with a much smaller footprint. This is an achievable goal, and will hopefully be reached in the shortest possible time. Lastly, USASOC is working with U.S. Special Operations Command and the U.S. Army Medical Research and Materiel Command [MRMC] in to field lyophilized plasma, a freeze-dried, shelf-stable product of purified human plasma. This product provides a resuscitation fluid for coagulopathic, hypovolemic combat casualties. Research shows that combat trauma casualties who experience shock— especially when combined with hypothermia—are acidotic and coagulopathic, often rapidly and irreversibly so. The rapid fielding of a shelf-stable FDP that can reverse the traumatic coagulopathy and restore circulating volume will surely save lives, especially in SOF personnel who are often remote from definitive surgical care. Q: Can you give an overview of how you see Army special operations medicine and its effect on our overseas partner nations? A: USASOC has the largest number and best-trained special operations medical providers in the world. The proven training program at the JFKSWCS is a resource unable to be replicated in both scale and scope by most other countries. It is imperative that USASOC take a leading role in helping not only our established allies and partner nations, but also friendly developing and non-aligned nations to improve their SOF medical provider capacity. The strategy of the future will increasingly rely on the collaborative efforts of multinational coalitions. Achieving a common level of SOF medical capability will improve not only organic support, but interoperability. USASOC helps train other nations’ SOF medics in training exercises, as well as hosting international students at the SOCM and SFMS courses at the JFKSWCS. USASOC also stays actively engaged with the NATO SOF headquarters [NSHQ] participating in medical conferences, working groups and training courses. The NSHQ is a very important venue for the SOF medical personnel of the 27 member nations to exchange ideas and collaborate on development. Q: What are some of the SOF unique medical capabilities that USASOC is able to employ? A: The outstanding medical capability of USASOC’s SOCM and SFMS trained soldiers is the most important and unique capability that the command is able to employ. The highly developed medical knowledge and treatment skills of these soldiers are the sine qua non of special operations medicine. Our independent enlisted providers are critical enablers allowing the employment of the force in the confidence that ill and www.MMT-kmi.com

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injured soldiers will be provided the very best of care. USASOC’s medics are supported by a range of medical professionals, including preventive medicine specialists, environmental health specialists, veterinarians and technicians, medical logistics specialists, physical therapists, clinical psychologists, physicians and physician assistants. Together, this force is capable of deploying a very robust, tailored and agile medical support element to each operation. Additionally, the 160th Special Operations Aviation Regiment [SOAR] medics are not only SOCM trained but complete a rigorous flight paramedic certification program. This allows USASOC to utilize the SOAR in a secondary casevac role providing a high level of en route critical care support, which is currently not standard in GPF medevac assets. Q: What is the current status and the future of behavioral health within Army special operations? A: USASOC was a leader in recognizing the value of having organic behavioral health support in its units. Most units have a clinical psychologist at the special forces group or the regimental level in addition to the other professional medical staff and the chaplaincy. Force modernization plans include the addition of behavioral health technicians at the battalion level. Although initial Army plans for the addition of organic behavioral health assets to all brigade combat team-sized units omitted USASOC in the initial computation, the Army is working to redress the error and expects to gain the additional personnel in the future. The inclusion of behavioral health assets in the units is vital to the removal of the stigma in seeking behavioral health support. Additionally, there is a need to make behavioral health a “selfmaintenance” task, much like physical fitness. It is no secret that soldiers are showing the expected effects of a decade of continuous combat operations. To remove the stigma and let them know that there are expected consequences of repeated combat exposure will encourage soldiers to self- and buddy-refer those who need additional help. SOF soldiers have always served “for those on their left and right,” which makes it imperative to not let one’s self or a buddy suffer in silence or become impaired, endangering themselves or their teammates. Q: Can you give an overview of the USASOC Human Performance Program [HPP] called THOR3? A: In 2009, the U.S. Army Special Operations Command established a human performance program initiative for its component commands.  U.S. Army Special Operations Command’s HP Program is known as Tactical Human Optimization, Rapid Rehabilitation and Reconditioning [THOR3]. Specifically, THOR3 is a proactive SOF-specific training program for Army SOF warriors. The goals of the program are to increase combat performance/ effectiveness, prevent injuries, improve health and longevity and facilitate rapid return to duty if injured. These goals are accomplished through services and education provided by human performance enhancement professionals. Each unit has its own team of HP professionals made up of human performance coordinators, strength and conditioning specialists, physical therapists and performance dietitians, with cognitive enhancement specialists scheduled to be phased in. Although a performance and training program, rehabilitation is also an important component 20 | MMT 15.8

of THOR3.  Mission-specific human performance optimization is achieved through a periodized strength and conditioning, pre-habilitation and nutrition program that is fully integrated into unit tactical training.  The advanced credentials, skill sets and experience of unit HP professionals ensure a continuum of achieving and maintaining optimal performance and rapid bridging from injury rehab to pre-injury performance. Q: What are some of the medical research areas that USASOC has been working in? A: With such a talented and self-motivated pool of medical providers, USASOC has a number of ongoing research projects and studies either planned or underway. One of the greatest projects that has come out of the command is the 75th Ranger Regiment’s computer database Ranger Pre-Hospital Trauma Registry. This regiment developed trauma registry captures a holistic clinical record of the wounds, treatment and outcome for Ranger casualties. This pre-hospital database is the most complete and accurate reporting of wound patterns, TCCC treatment and outcomes ever produced. USASOC is also working with the Walter Reed Army Institute of Research on an explosive blast effects study, looking to quantify the effects of munitions load and distance on the “felt” blast-overpressure imparted on soldiers. This study will begin with a basic measurement phase by using multiple sensors on soldiers undertaking breached range training. This study will also measure pre- and post-blast exposure neurocognitive data for potential changes. USASOC has also taken part in a PTS/PTSD biomarker study. This study measured the P-11 neuropeptide as a potential marker for PTS/PTSD and correlated the measurements with positive screening measures. The P-11 test has great potential as an objective biologic screen for posttraumatic stress/post-traumatic stress disorder. Lastly, as part of the THOR3, Human Performance Program, USASOC has undertaken to a collaborative study with MRMC and the University of Pittsburgh to assess the USASOC operator for functional performance, flexibility and fitness. This study will provide a baseline measurement to help guide metrics and goals for THOR3. Q: With the availability of distance education, how can it benefit the special operations medic both during and after active duty? A: With the wider availability of online and especially wireless communications, the modern SOF medic has more access to courses, classes and lectures than ever before. There is almost nothing worthy of reference that can’t be accessed by searching the Internet, most often done on a smartphone. The USASOC Surgeon’s Office web portal site has a great many documents, policies and references that are useful for providers at all levels. The JFKSWC is also working to put all its course content online, which will be available for all JSOMTC graduates who maintain a “.mil” account. Also, the NATO SOF HQ is continually adding to their course content and briefings to their website. The ability for SOF medics and others to take medical courses or review medical references will continue to increase as time goes on. This is a tremendous value added that will key into newer learning styles and the tempo of near continuous deployments. Q: How can industry further support the mission of USASOC? www.MMT-kmi.com

A: Civilian industry has been tremendously responsive to USASOC’s medical requirements. Many of the key innovations have come from the collaboration of industry, academia and military medicine. The ultimate goal is to develop technologies, devices and pharmaceuticals that are practical, simple to employ, compact and lightweight. Despite all the emphasis in the media on highly advanced, technological weapons programs, special operations combat medicine often still comes down to a highly trained individual medic on their knees, trying to stop a bleeding artery on some frozen hillside in the dark and under fire. Being “high speed” in special operations medicine is being able to accomplish the basics to perfection. How industry can help that far-forward SOF medic is to support him with products that enhance and enable his function, without being too complicated or heavy: pro-coagulants dressings that are shelf-stable and effective, micro-patient monitors that operate remotely, IV fluid warmers that are small, lightweight and powerful. The center point for success or failure on the battlefield is the SOF medic and his patient. Those are the real customers that industry needs to consider in supporting SOF medicine, especially given that most combat casualty deaths occur in the pre-hospital environment. Q: What do you think are the major challenges USASOC will face over the five years? A: With respect to medical challenges, USASOC is an excellent position to continue training and fielding a fit and ready force, and the most capable independent, enlisted SOF medical providers in the world. The challenge is to be able to continue to deliver the high level of integrated health service support [HSS] to the forward SOF soldier as deployed forces pare down. The inevitable decrease in the deployment footprint means that HSS resources in theater will decrease as well, while SOF employment operations may actually increase. The continuation of the current level of HSS support for SOF is not a certainty. The removal of medical treatment and evacuation assets from the operational theaters is an issue that requires more discussion. Another major challenge is the preservation of a healthy and dynamic force after a decade of www.MMT-kmi.com

near-continuous operations. SOF cannot be mass produced and the key element to success in SOF operations is the individual soldier. Achieving a balance in training, deployment and substantive down time will be critical to the longevity and health of a functional force. Q: Can you go into some detail about a USASOC medic’s combat training? A: USASOC’s entire medic training is conducted at the Joint Special Operations Medical Training Center at the JFKSWCS. The basis of the course is the SFMS. This is a comprehensive 46-week course that covers a range of subjects in anatomy, physiology, pharmacology, medicine, surgery and nursing—as well as dentistry, preventive and veterinary care. The first 27 weeks of the SFMS course is a common program of instruction and is also the stand-alone special operations combat medic course, concentrating on combat trauma and primary care skills. This course makes use of the very best in didactic coursework, training aids and simulations, and hands-on practical skill training. This course has students from across USASOC as well as Navy Special Warfare Command, Marine Special Operations Command and international military students. Those going on for the full course have additional training in preventive, dental, veterinary and unconventional warfare medical skills, finishing with a four-week comprehensive proctored clinical experience in a military or federal service hospital. This course has produced the famous “18Delta” SFMS since the 1960s—by far the most highly skilled non-licensed military soldier-medic in the world. Q: Is there anything else you would like to say that I have not asked? A: Thank you again for the opportunity to discuss ARSOF medicine. The enduring focus of the deputy chief of staff, surgeon’s office is on supporting the ARSOF soldier-medic. Now and in the future, that soldier on the front line is the absolute edge of the national defense strategy. For all the men and women of USASOC who are out on the edge every day, we owe our best effort to ensure that they have the absolute best medical training, equipment and support possible. O MMT  15.8 | 21

New technologies help save lives on the front lines. By Melanie Zahler and Bart Gray The “golden hour” is a well-known window in trauma response. Rescue workers are keenly aware that the medical care provided during the first 60 minutes following an injury can have a dramatic impact on the outcome of the case. In military settings, treating injuries during the golden hour presents unique challenges due to the severity of the injuries suffered, the conditions on the field at the time that medical care is being delivered, and the difficulties faced in evacuating our wounded warriors to safety. Data shows that more than 90 percent of severe wound casualties die within the first hour after injury if advanced trauma life support is not administered. Approximately half of these casualties bleed to death. Given these challenges, technologies that can help combat medics treat patients quickly and effectively are vital. While the word technology conjures images of electronics for many people, in medical applications technology can be quite simple. Even small details like a bandage adhesive can have an important impact on a treatment’s effectiveness and the ultimate result for the patient. At the same time, advances in high-tech medical tools are also enabling impressive new breakthroughs in military medicine. In this environment, the military needs solutions for all aspects of medical care—both simple and complex.

Advances in Auscultation One of the most fundamental technologies in trauma response is the stethoscope. Even this relatively simple technology has undergone enhancements that help make it more useful in military applications. For example, a recently introduced stethoscope with a black-plated chestpiece and eartubes helps medics deliver treatment in the field more discreetly. With no exposed silver metal parts that could glint in the sun and attract unwanted attention, medics can focus more of their attention on the patient. In addition, recent improvements in tele-auscultation technology hold significant promise for military applications. The promise of this technology for military applications is apparent. With reliable tele-auscultation 22 | MMT 15.8

capabilities, combat medics can better communicate with experts far removed from their location, allowing them to identify problems they may not have detected on their own.

Wound Care Innovations While stethoscopes exemplify the hightech improvements that can benefit combat medicine, promising advances have been made in simpler technologies as well. Wound care solutions are of particular interest to the military, and a number of innovative products in this category are changing what is possible in the field. In combat, an adhesive primary wound closure designed for fast application can be applied very quickly to close a wound, and then easily removed once the patient has been transported. Adhesive primary wound closures are available in widths from 10 mm to 100 mm, and can be combined to achieve the length needed or to close a curved wound. This versatility makes them a valuable part of the combat medic’s toolkit. Clinical results also demonstrate the efficacy of the closures; a formal trial of lacerations treated with these skin closures versus sutures found the adhesive closures to be comparable to sutures in strength and performance. An additional study found these closures to have a faster closure time than sutures, with patients reporting less pain. Dressings are also an important tool in wound care, and new technologies have been applied to these as well. One of the most important features of a wound dressing is breathability—allowing oxygen in and moisture vapor out. By allowing the skin to function normally, a dressing can promote healing while preventing infection. Today’s dressings offer just these capabilities, with additional features that offer added convenience for health care providers. Clear dressings are available that can be left in place on a wound to promote faster healing, while still allowing care providers to monitor the color of drainage, the condition of periwound skin and the condition of the wound bed. This ability to monitor the wound without removing the dressing saves money and helps

promote faster healing. These dressings are also designed with a border area that can be written on with marker, which lets health care providers mark the date the dressing was applied and other relevant notes. Medical tape is another important tool in the combat medic’s kit, and new developments have been made in this technology as well. Traditional medical tape increases its adhesion over time, which can result in a painful removal procedure, ripping off skin and hair. However, a new silicone tape has been introduced with a softer and more comfortable adhesive that can be removed with minimal stripping of skin cells or pulling of hair. Because of this property, the tape can also be repositioned, as its surface does not pull off skin cells at a rate that compromises later adhesion. This tape maintains a constant adhesive strength for as long as it is left in place. With a product like this, health care providers can easily lift a gauze dressing and then replace it, with no need for new tape.

Tools for Saving Lives With more effective tools for assessing casualties and treating them quickly, combat medics can make even better use of the golden hour. In addition to providing more effective treatment, the right technologies can also enable faster and more comfortable healing for our wounded warriors. Whether a servicemember requires an assessment from a physician hundreds or thousands of miles away, or simply a more comfortable tape to hold on a gauze pad, the science exists to meet that need. These advances in medical technology are helping equip today’s military medical personnel with an impressive array of tools that can help save lives on the front lines. O

Melanie Zahler is director of strategic accounts, 3M, and Bart Gray is business development manager, 3M Defense. For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.

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Water Purification Staying hydrated in extreme heat.

A fully-loaded Marine conducting a patrol in the 120 degree heat of Afghanistan may need to consume four gallons of water each day to stay minimally hydrated. The ability to survive and perform in an austere environment depends on access to safe drinking water. In fact, safe drinking water is one of the most critical factors in successful military and emergency response operations. But contamination of water supplies in both urban and rural settings hinders access to safe water supplies, especially in countries with ill-maintained sanitation systems, and few regulations controlling the discharge of pollutants into water sources. And these are often the locations of conflict where a U.S. soldier must operate. Water transport is an enormous logistic and financial burden for the military. Each gallon of water weighs 8.3 pounds and each military member consumes an average of two gallons each day. Water transport costs account for one-third of ground wartime costs, according to U.S. Army Research Institute of Environmental Medicine (USARIEM). But probably worst of all is that military supply convoys suffer frequent casualties. A study conducted by the Army Environmental Policy Institute states that just in 2007, 68 servicemembers were killed or wounded while transporting water. Water purification technologies address the financial and logistical challenges of providing water for thousands of troops deployed in remote locations. The services have had effective water purification systems in place since World War I, but new technology and methods are providing cleaner, beter-tasting drinking water, on the move. www.MMT-kmi.com

Fielded in the 1980s and still in use by the Army, Marine Corps and Air Force, the 600- and 3,000-gallon reverse osmosis water purification units effectively purified fresh water, seawater and brackish water. These systems can produce up approximately 12,000 gallons per day. The Army and Marine Corps are replacing these systems with the Tactical Water Purification System, which will increase the processing rate, producing 1,500 gallons of potable water per hour. The Lightweight Water Purifier (LWP) provides water purification and storage for small military units and detachments, special operations forces, and support operations. It produces potable water from freshwater, brackish water and saltwater sources, as well as water contaminated by nuclear, biological or chemical (NBC) contaminants when configured with an NBC treatment component. The LWP provides 75 to 200 gallons of potable water per hour, with the ability to store up to 3,000 gallons. It is mounted in the rear compartment of the high mobility multi-purpose wheeled vehicle (HMMWV), or inside the C-130 aircraft or UH-60 helicopter. The requirements of operating in Iraq’s urban terrain and Afghanistan’s austere environment brought about advancements in water purification technology over the past few years. Also, advances in materials science permitted the engineering of more sophisticated filters and equipment. “In 2002-2003, we were carrying 35 pounds of water a day to do a full patrol. Now guys can carry the equivalent of 1.5 liters on

By Joan Michel MMT Correspondent their backs, and with the two [treatment] pouches, gives them the potential for 9 liters of clean electrolyte-enhanced drink,” said Randy Kerlee, a retired special forces medic, who now works for Hydration Technology Innovations (HTI), a company that specializes in water purification using forward osmosis technology. “In an urban environment, the problem is that while a country can have running water, it is not always potable,” said Kerlee. “And this can be mostly fine, but the issue comes in when the military is operating in an urban environment with no resupply capability.” HTI’s forward osmosis water purification system uses a membrane filter similar to those used in reverse osmosis systems, but does not require hydraulic pressure to move water through the filter. Dissolved solids are placed on one side of the FO membrane, and the dirty water on the other. The dissolved solids naturally generate osmotic pressure, which draws the water through the membrane. A sports drink syrup or powder is normally used as the osmotic draw agent in HTI hydration products. HTI’s industrial water purification systems, used in oil and gas exploration operations, rely on the same process, but employ different materials to draw the water through the membrane. “The technology can filter solids to the size of five angstroms, a unit of measure equal to one-billionth of a meter, whereas other filters on the market can only trap molecules MMT  15.8 | 23

more than 500 times larger,” said Kerlee. As a result the purified drink is cleaner, he added. “We’ve used chemistry to trick nature.” HTI products include the Expedition, a backpack hydration unit that can filter up to 500 gallons with extremely high purity levels, meeting EPA standards. The unit also protects against diarrhea and other water-borne symptoms, and provides calories and salts. Another HTI product, the XPack, is currently in use by Army, Marine Corps, Air Force and special operations personnel. This product can purify water from any source and provide 8.5 gallons of clean drink, while adding less than five pounds to a rucksack. “Our products do not produce water, but in my experience the calories and electrolytes in the drink our product provides are a huge benefit to soldiers in austere environments,” said Kerlee. L-3 Command and Control Systems and Software offers a reverse osmosis system that speeds up the water purification process, making potable water in about four minutes. The flexible, cost-effective system is available in multiple sizes, depending on a project’s requirements. The largest of four systems, the Series 5.0 Water Purification System produces more than 1,000 gallons per day, with a system weight of 70 pounds and a suitcase-sized footprint. Other systems range from 25 to 50 pounds and produce 180 to 700 gallons per day. Rhonda Wagner, sales and business development manager for L-3 Command and Control Systems and Software, said the system employs both reverse osmosis and ultraviolet light to kill the microorganisms and remove heavy metals. “Where some units might use RO membranes, ultra-filtration, or sediment, carbon and UV lights on their own,” said Wagner, “our system uses a combination of these technologies in series to ensure contaminants are given three different treatments, better ensuring water safety.” System components related to water safety (UV lights) and system operation (water detectors) are continually monitored to ensure operational performance while protecting the system parts from potential damage and contaminants. By providing safe, potable water at a low per-unit cost, the system avoids the use of chemical additives to add to the aesthetic features of the water and reduces the need for expensive and cumbersome stock consumables. “Our systems offer advanced technology and bottom-line value. From a cost and logistics standpoint, there are huge savings both 24 | MMT 15.8

in terms of the dollars spent and the cost of human lives,” Wagner said. Combat Medical Systems fielded water purification technology that features carbon nano-tubes woven into a filter material. Using an adsorptive technique that binds, similar to a magnetic or chemical attraction, microorganisms move toward the nano-tubes and bind to the filters. “Our technologies do such a great job of removing contaminants, you can drink it right away, from any water source,” said Shain Bobbitt, director of Army and Air Force programs for Combat Medical Systems, and former special operations officer. “In a country like Afghanistan, the soldiers don’t have time to sit Hydration is critical to warfighter performance and water is usually welcomed and wait for the chemicals to wherever it is found so long as it can be made useable. [Photo courtesy of HTI] work. This is definitely water “The lives that are lost just to transport on the move.” water to troops is devastating,” Bobbitt said. The Seldon WaterBox water purification “The military is just now coming to the unit, which comes in a box the size of a small realization of the huge cost and impact of suitcase and weighs 54 pounds, processes up transporting water. I would not be surprised if to 700 gallons of water per day. This provides in the near future the military became really enough water for a special operations team serious about water purification systems. and replaces 30-40 cases of water, according Water and purification systems capable of to Bobbit. All services are currently using the operating in austere and emergency environtechnology. ments are critical technologies.” The Seldon WaterBox was developed by “Rice-based oral hydration products Seldon Technologies, which holds the patent (ORS) CeraSport and CeraLyte are used to on the nonwoven carbon nanotube material help military personnel maintain proper that effectively removes bacteria, virus, cysts, hydration during training and combat operaspores and other contaminants without the tions. What and how much you eat and need for heat, ultraviolet light, chemicals, drink can mean the difference between top electricity, or waiting time. performance and completing the mission,” Combat Medical Systems and Seldon also said George Gurrola, Sergeant Major (Ret.) offer the WaterStick, a small device that acts U.S. Army and the director of operations of as a straw. A user places one end of the unit in Cera Products. a water source, and the water travels through “Non-combat” illnesses filters that remove bacteria, causing dehydration have a virus, Cryptosporidium and significant impact on military Giardia to EPA drinking water operations, resulting in loststandards. It also reduces sediperson days, hospitalizations, ment, chlorine, total organic a decrease in operational efficarbon, bad taste and odor. ciency and an overall decrease The WaterStick X100 filters in job performance. Ceraup to 100 gallons of water and Lyte (ORS) has measurably the X300 filters up to 300 galreduced the severity and duralons of water. The WaterStick tion of dehydration symptoms is designed to snap into existGeorge Gurrola, SGM (Ret.) while it rehydrates. ing military hydration packs. www.MMT-kmi.com

Humanitarian events can create devastating survivability issues, including the basics of clean, drinkable water. [Photo courtesy of HTI]

CeraSport and CeraLyte are used by all U.S. military branches, including the U.S. Army Special Operations Command (USASOC), TRADOC and several other commands. Cera Products are on the Joint Deployment Formulary (JDF), CEC Program and are approved for field hospital usage. In the Air Force, CeraLyte 70 was made directive in the IFAK and Buddy Self Aid medical kits in 2005 by the former Surgeon General, General George Peach Taylor’s testimony to Congress. Both CeraSport and CeraLyte are also used by the United States Marine Corps Special Operations (MARSOC) and Naval Special Warfare (NSW) schools as well. The U.S. Army Ranger School (Fort Benning, Ga.) has been using CeraSport since 2005 to prevent dehydration and to ensure that all soldiers are properly hydrated throughout the duration of one of the toughest courses in the armed forces. It is also a popular choice in many of the training schools of the Army at different installations including pre-Ranger Courses, Air Assault School, Infantry Basic Officer’s Leadership Course, and basic training courses. “I commanded the U.S. Army Airborne School Battalion for two years, which included portions of three Georgia summers, and saw nearly 40,000 students pass through,” said Lieutenant Colonel Jon Ring, former battalion commander for Airborne School. “The training environment at Fort Benning provides for long, hot and humid training. The fact of the matter is that soldiers, sailors, airmen, Marines, and Coast Guardsmen attending the course are subjected to the cumulative effects of heat from the moment they arrive. The environment is rife for heat injuries and, over time, there have been numerous severe injuries and even deaths. You absolutely must hydrate to the highest level possible—along with keeping www.MMT-kmi.com

electrolytes at the right levels. We instituted procedures where students were monitored using CeraSport to ensure that it was being used throughout the day—and it worked. In two years of command, we did not have a single heat injury that was categorized as such.” “CeraSport and CeraLyte should be considered for any type of training or combat operations that may cause the soldier to dehydrate due to high intensity training. The products significantly mitigate risk of dehydration, and as a U.S. Army veteran, I wish CeraSport had been available during my 23-year tenure, especially while training and conducting combat operations in remote areas like Africa, Turkey, Balkans, Europe and Iraq,” said Gurrola. Backed by Department of Defense, scientists at Sam Houston State University recently developed a waste water treatment system that uses bacteria, or bio-reactors, to purify water. These bacteria are naturally occurring, and in the right combination can clean polluted water. Sam Houston State University licensed its patents to Active Water Systems to manufacture and distribute technology. Active Water Systems developed a unit called the Water Phoenix, which is a portable treatment system can treat up to 15 gallons per minute, or up to 50,000 gallons per day. It is configurable for various settings. Dr. Jay Dusenbury, deputy for science and technology at U.S. Army Tank Automotive Research, Development & Engineering Center, recently published a paper on military water purification technologies that called for further development of water purification capability. Dusenbury writes, “While the current systems have provided the Army with the capability to purify any source water with sufficient quality and quantities to support deployed troops, both near- and mid-term

improvements are needed to support the water sustainment concept and transformation to a lighter, more mobile and deployable force. Near-term improvements are needed in membrane technology and systems to reduce the size and weight of the systems, reduce power, improve resistance to fouling, and improve rejection of potential chemical threat agents.” He went on to state that the goal of mid-term research is to reduce the logistics footprint associated with water production and distribution by developing advanced water purification technologies that are more energy-efficient, lightweight, and compact than current state-of-the-art water treatment technologies, and to recover water on demand from alternative sources such as vehicle exhaust and ambient air, to produce water when no traditional source (river, lake, or ocean) is available. O

For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.

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MMT  15.8 | 25 11/30/11 10:03 AM

Soldiers compete for Army’s best medic title. Sixty-two soldiers from across the Army competed in a grueling 72-hour two-soldier team competition at Camp Bullis on November 4-6 to earn the title of best medic. The inaugural Command Sergeant Major Jack L. Clark Jr. Best Medic Competition was dedicated to the 13th command sergeant major of the U.S. Army Medical Command. Clark’s family came from Florida to participate in the dedication ceremony and meet the competitors. “It is appropriate that such a prestigious competition be named after Command Sergeant Major Clark. He was one of the most respected leaders and noncommissioned officers in the history of our command,” said retired Command Sergeant Major Sandra Townsend, keynote speaker for the dedication ceremony. “[Clark] was a mover and a shaker, known for making every place he went better. He understood the important role of medics in the Army and the trust soldiers and leaders must have in the Army Medical Department.” In the end, Sergeant 1st Class John Maitha and Staff Sergeant Christopher Whitaker, representing the 3rd Battalion, 75th Ranger Regiment, Fort Benning, Ga., secured the title of the Army’s Best Combat Medic Team. “We had no idea where we were placewise, so we just kept going as hard and as fast as we could on everything,” Maitha said. The first day of the competition began with a physical fitness challenge, which included a three-mile run and pulling a tire that weighed several hundred pounds. The obstacle course tested the team’s agility and physical strength. Each team needed to complete 15 of 19 obstacles as quickly and safely as possible. The M-9 stress shoot mimicked a combat situation where every shot counts. Teams showcased their marksmanship skills, completing three separate firing engagements while evacuating a simulated casualty on a litter. 26 | MMT 15.8

“The M-9 stress shoot was the most fun,” Maitha and Whitaker said. Once the M-9 stress shoot was complete, the two-soldier teams marched six kilometers to the next part of the competition, the M-4 stress shoot. “We liked the night land navigation because it was challenging and it was different,” Maitha said. “They filled us in on a Blackhawk helicopter heading to an unknown [helicopter landing zone] and we had to figure out where we were before we could even start the course.” The advanced land navigation course began at 11 p.m. Teams were flown by helicopter and inserted into the rugged terrain of Camp Bullis. Once on the ground, each team had six hours to locate 12 grid coordinate locations using terrain association and topographical maps. “The night land nav was definitely the toughest,” Whitaker said. Early the next morning, the candidates tackled the urban assault lane. Using simulated munitions similar to paintball rounds, the soldiers had to engage the enemy while treating casualties and defending themselves. The day combat medic lane tested the candidate’s ability to perform casualty care in close quarters as well as their ability to evacuate wounded to a medevac aircraft. The night combat medic lane tested the competitor’s ability to perform medical tasks under the cover of darkness using the Tactical Simulator for Military Medicine. The teams were required to gain fire superiority, stabilize their casualty and move them from the simulator into a ground evacuation vehicle. Mounted land navigation tested the candidate’s ability to provide medical treatment while en route to the medical treatment facility. At 5:00 the next morning each twosoldier team worked together to complete a 75-question written exam designed to test their tactical and technical proficiency.

By Lori Newman After the written exam, the soldiers moved to the virtual convoy combat simulator. The simulator provided a 360-degree simulated battlefield, allowing the candidates the opportunity to perform basic soldier skills while mounted in a simulated environment. This event joined teams together to compete the scenario, engaging hostile targets and calling in situational reports. The leadership reaction course tested each team’s ability to think, lead and work together to negotiate eight obstacles. The final event was a timed 2.7 mile buddy run, testing the fortitude and endurance of the competitors. Each team had to complete the run carrying a 180-pound casualty on a litter. Shortly after Sunday’s last event, an awards ceremony was held at Camp Bullis. Lieutenant General Eric Schoomaker, Army surgeon general and commanding general, U.S. Army Medical Command, and the Clark family presented trophies to the winning team and recognized all the teams for their accomplishments during the 72-hour competition. Pricilla Clark, wife of Jack, who is deceased, congratulated all the competitors. “You have been tested beyond human capability and you have come through this standing and smiling,” she said. “You have given us the true definition of never giving up.” Staff Sergeants Gabriel Mendoza and Gabriel Valdez, representing 160th Special Operations Aviation Regiment (Airborne), Fort Bragg, N.C., accumulated the secondhighest points total and placed second in the competition. Third place was secured by Specialists Allen Klingsporn and Austin Kreutzfeld from the 82nd Airborne Division, Fort Bragg, N.C. O For more information, contact MMT Editor Brian O’Shea at briano@kmimediagroup.com or search our online archives for related stories at www.MMT-kmi.com.

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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.

MM T CALEND A R & DI REC TO RY Advertisers Index Abbott Diabetes Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 www.abbottdiabetescare.com Agilent Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C4 Rice-Based Electrolyte Hydration Drinks www.agilent.com/chem/5975t_informationkit • Fast yet Sustained Hydration Cera Products Inc.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 www.ceraproductsinc.com • Restores Fluids and Electrolytes • Improves Endurance and Performance Cera Products Inc.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 www.ceraproductsinc.com www.ceraproducts.com Combat Medical Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 843.842.2600 www.combatmedicalsystems.com Idaho Technology Inc.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 www.bio-surveillance.com Calendar cera_products_2x2_ad.indd 1 11/30/11 10:03 AM North American Rescue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C2 January 30-February 1, 2012 www.narescue.com 7th Annual CBRNe Defense Philips Healthcare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Conference www.philips.com/government Washington, D.C. www.cbrnevent.com Raydon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C3 www.raydon.com January 30-February 2, 2012 RDT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2012 Military Health Systems www.rdtltd.com Conference National Harbor, Md. Skedco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 www.tricare.mil/conferences.cfm www.skedco.com Zoll Medical Corporation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 www.zoll.com/propaqmd-mmt

NEXTISSUE

February 2012 Vol. 16, Issue 1

Dedicated to the Military Medical & VA Community

Cover and In-Depth Interview with:

Brig. Gen. W. Bryan Gamble Deputy Director TRICARE Management Activity

Special Section U.S. Army Dental Command A look ahead into 2012 and how the U.S. Army Dental Command is mitigating challenges and implementing new programs to combat these challenges.

Features 2012 Outlook Military leaders discuss upcoming initiatives and challenges to be faced in the 2012 medical and defense arena. DoD/VA Health Record Exchange Information dissemination between two agencies’ electronic health records and the challenges involved.

at Force Health Protection and Readiness Q&A with Dr. George Peach Taylor Jr., deputy assistant secretary of defense for FHP&R; a pictorial spread of the executive leadership; and an article outlining the nine divisions within FHPR and their future initiatives. Safe Patient Lifting The Department of Defense and Department of Veterans Affairs discuss how the area of safe patient lifting is evolving and what’s next on the horizon in 2012.

Insertion Order Deadline: January 9, 2012 • Ad Materials Deadline: January 16, 2012

www.MMT-kmi.com

MMT  15.8 | 27

Industry Interview

Military Medical/CBRN Technology

Brenda M. Butler, RN Vice President, Government Sales Zoll Medical Corporation Brenda Butler, vice president of government sales at Zoll Medical Corporation, has been providing guidance and critical care technology solutions to the military health care market for 20 years since joining Zoll. A former critical care nurse, her passion is understanding the significant medical requirements of our troops and responding with advanced solutions that improve clinical outcomes. Her combined clinical and business expertise results in a keen insight for developing strategies to assist U.S. military and veterans health care facilities. Q: Can you tell me a little about Zoll and your efforts in the military market? A: Zoll has partnered with the U.S. military for over 30 years, with an emphasis on advancing resuscitation and critical care technology. This relationship began shortly after our company founder, Paul Zoll, M.D., pioneered the first pacing device in 1952, which subsequently led to the military’s initial deployment of a noninvasive pacing device. Since then, the company’s mission has been to provide superior products that encompass every facet of critical care, meet the rigorous standards for airworthiness, and work as a total clinical solution to save lives and improve outcomes. In 2004, the Defense Logistics Agency awarded Zoll the first defibrillator corporate exigency contract, and then again in 2009, establishing Zoll as a long-term partner to provide critical resources for peacetime and wartime operations, as well as emergency preparedness and humanitarian missions. Zoll offers products for defibrillation and monitoring, circulation and CPR feedback, data management, and fluid resuscitation. A recent addition to the portfolio is our intravascular temperature management (IVTM) system, which provides the power and control needed to rapidly, safely and effectively manage the core body temperature of critically ill or surgical patients. Q: What new products are available for the military? 28 | MMT 15.8

A: Zoll is pleased to have introduced the Propaq MD (Monitor/Defibrillator) and the Propaq M (Monitor)—next-generation versions of the Propaq Encore 206 monitor, with more advanced monitoring parameters. With over 12,000 Propaq monitors in use throughout the U.S. and NATO militaries, Propaq is the trusted and proven standard of care vital signs monitor. The Propaq MD incorporates Zoll’s proprietary defibrillation and pacing technology. The Propaq MD was developed specifically to meet the unique needs of military customers and air medical operations worldwide. Development of this product was a joint undertaking between the Department of Defense and a cooperative arrangement between Welch Allyn and Zoll. Development was facilitated with grants from the U.S. Army Medical Research and Development Command. Designed for the austere environment, both the Propaq MD and M have an IP55 rating, which is industry’s highest ingress protection against water and dust. The Propaq MD is 60 percent smaller and 40 percent lighter than other similar monitor/defibrillators. Additionally, it has the most robust data management capability integrated into a fully featured monitor/defibrillator on the market today. Q: How do the New Propaq MD/M meet evolving mission requirements? A: The Propaq MD and the Propaq M are more advanced than vital signs monitors. Based on input from hundreds of military users, these devices were developed to offer the proven capabilities

of the Propaq 206, plus unparalleled advanced monitoring parameters and the robust data capability to meet varied mission requirements. Capturing patient data is currently a labor intensive process. The need for automation and trending of vital signs and key clinical events requires an open architecture to make the data available to clinicians and data integration partners. Zoll’s Propaq family provides this capability with a variety of transmission options. Zoll also recognizes that it is not enough to only transmit data in the battlefield environment. Making critical care decisions requires immediate, clinically accurate information. To this end, Zoll has partnered with industry leaders to offer superior capnography, pulse oximetry, and motion-tolerant NIBP [non-invasive blood pressure] technology. The Propaq MD/M maintains a common user interface and backwards compatibility with most Propaq 206 accessories. This facilitates ease of use, easier patient transfer, improved logistics and cost efficiency. Q: What do you consider Zoll’s biggest success in the military? A: Zoll’s strength is to deliver missionready technology that provides clinically accurate and reliable information for optimizing combat casualty care on the battlefield. With the need to transmit patient data, Zoll provides the military with a solution in the Propaq MD/M that allows easy access to all patient data collected. Zoll consistently delivers technologically advanced products driven by customer requirements without compromising our commitment and focus on improving clinical outcomes. As a U.S.-based global company and leading military supplier, Zoll is proud to provide innovative and reliable products that help improve health care from point of injury to definitive care for American servicemembers. O

bbutler@zoll.com www.MMT-kmi.com

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MMT 15-8 (Dec.)