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6th Med Group First Aid Eye/Targeted Stethoscope Litter Innovations Educational Opportunities

tacticaldefensemedia.com | Q1 2014

RDML BrianS. PechaThe Medical O cer of the Marine CorpsHeadquarters USMC, Health Services

Arlington, VA

Commanders Corner

B URN TRAUMA

S AVING L IVES IN THE F IELDARMY IMPROVES PRE - HOSPITAL CARE

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Experience CountsZOLL, with over 25 years of experiencemanufacturing resuscitation technologiesfor the military, understands that to meettodays demands, you require more than justthe best monitoring technology available. TheZOLL Propaq M, in addition to providing thetrusted and proven vital signs you have cometo expect from Propaq, now has signicantlyenhanced data communications allowing you

to capture patient care data from the point ofinjury through denitive care.

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3/32tacticaldefensemedia.com Combat & Casualty Care | Q1 2014 | 1

Burn Care ForwardThe Armys Burn Center isproviding state-of-the-art pre-deployment training to ForwardSurgical Teams.By Steven Galvan

First Aid: More thanMeets the EyeThe Army is now issuing a morerobust, streamlined rst aid kitthat better tackles eye injury.By C. Todd Lopez

Documenting PreparednessLast years best photographs ofU.S. military medical training.

Industry Partner

SkedcoSupplier of casualtyimmobilization and transportequipment to DoD.

Online and In Combat Accessible educationprograms for deployed andreturning servicemembers.

Command Prole

6th Med GroupThe USAF 6th Medical Groupis a key provider of combatcasualty care in theater andpost transport.

Cover: Soldiers from the 528th Sustainment Brigade(Airborne) unload a simulated casualty from a UH-60Blackhawk during a MEDEVAC eld training exercise onFort Bragg, N.C.

RDML BrianS. PechaThe Medical Ofcer ofthe Marine CorpsHQ USMC,Health Services

Arlington, VA

Features Recurring Highlights

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C o m m a n d e r s

C o r n e r

Targeted AmplicationUpdate on the recently approvedNoise Immune Stethoscope.By Catherine Davis

DepartmentsMedTech

DARPA Dots Ad Listing/Calendar of Events

Bridging the

Survival GapSan Antonio Medical CentersEmergency Medical andDisaster Medicine Fellowshipprogram is addressing the needto reduce pre-hospital caretime post trauma.By David Vergun

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4/32tacticaldefensemedia.com2 | Combat & Casualty Care | Q1 2014

With all the talk of change in the military over the past few yearswhetherdue to drawdowns or budgetsthe word risks becoming a bromidewithout evidence to support it. In the 2014 issues of Combat & CasualtyCare (C&CC), we will try to provide that evidence: C&CC will highlight programsand people that have attempted to transform the technology, methods, andeducation of combat medicine professionals based on lessons learned from war. Inthis issue, these individuals include generals, officers, and private companies; eachhave a different perspective, and each will make major contributions to improvingbattlefield care.

From U.S. Army San Antonio Medical Center, TX, readers get a look throughthe eyes of a former Special Forces medic at why and how he organized a BattlefieldResponse and Disaster Medicine Fellowship program, addressing the need for theimplementation of rapid first response techniques so often used in civilian settingsto save lives in the balance, but which remain too absent at the side of our critically-wounded war heroes.

Amidst the harsh realities of combat casualty response, we also summarizesome of the technologies that are enabling more effective golden hour treatments,such as the new Army first aid kit. Moving beyond the initial stages of injury,articles will show the greater focus across the DoD medical community on casualty

care that goes beyond mere short-term, Band-Aid level solutions, looking at waysto better manage immediate care more holistically so that patients have the bestchance of survival and quality of life well after physical wounds heal.

In an exclusive interview, RDML Brian Pecha, The Medical Officer of theMarine Corps, speaks to C&CC about the challenges his department faces inaddressing the unique medical needs of a globally-deployed, multi-purposeforce. From force-ready care to ongoing R&D forming the basis for the criticaltechnologies of tomorrow so often needed today, our discussion sheds some lighton USMC health programs, partnership with civilian educational institutions, andhow the Corps medical operations might change after Afghanistan.

To round out this issue, we offer readers a profile of 6th Medical Group, MacDillAFB, Tampa, FL, supporting the combat capabilities of the 6th Air Mobility Wing,U.S. Central Command, U.S. Special Operations Command, and 36 other diversemission partners, by providing administrative, logistics, and ancillary medicalsupport to 220,000 beneficiaries in the DoDs largest single catchment area.Theyre likely to stay busy regardless of drawdowns.

As always, feel free to contact me with questions, comments!

Sincerely,Kevin Hunter Editor Combat & Casualty [email protected]

Christian SheehyManaging Editor

Tactical Defense [email protected]

Assistant Editor George S. [email protected]

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Sonia BagherianPublisher Tactical Defense [email protected]

Shean PhelpsContributing Editor

Combat & Casualty [email protected]

Insights

Combat & Casualty Care ISSN: 2159-7103Online ISSN: 2159-7197

is published by Tactical Defense Media, Inc.

All Rights Reserved. Reproduction withoutpermission is strictly forbidden. 2014

C&CC is free to members of the U.S.military, employees of the U.S. government,

emergency responders, institutions, and non-U.S.embassies based in the U.S.

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Innovation Equipment

The U.S. Army recently approved the NoiseImmune Stethoscope for production thatenhances targeted bodily resonations to helpovercome ambient interference.By Mrs. Catherine Davis, Public Affairs Specialist,U.S. Army Aeromedical Research Laboratory

In collaboration with Active Signal Technologies, a Small BusinessInnovation Research partner, the U.S. Army Aeromedical ResearchLaboratory, Fort Rucker, AL, and U.S. Army Medical Researchand Materiel Command, Fort Detrick, MD, developed a medical

device that can be used to listen to heart and lung sounds in high-noiseenvironments such as medical evacuation vehicles.Heart and lung sounds are a necessary component of casualty

triage and ongoing care. Hearing and assessing these sounds withtraditional acoustic stethoscopes is very difficult on the battlefield.It is vitally important that military medical care providers havethe necessary tools while managing patients. said Maj. Tim Cho,USAARL Aeromedical Factors Branch Chief.

Automated Listener The Noise Immune Stethoscope (NIS), like a standard acousticstethoscope, uses an acoustic listening mode, and also addsultrasound-based technology that is noise immune to amplify heart

and lung sounds. This technology has the capability for users to easilyswitch from Doppler to acoustic mode. Both modes immediately turnbody sounds into electrical signals for enhanced performance. TheCommunications Earplug, currently being used by aviators, attaches tothe NIS and allows auscultation while wearing the flight helmet.

The dual-mode stethoscope is specifically designed for high noiseconditions, said Cho. As a result, the fight surgeon or flight medicwill be able to make more accurate decisions while en route to higherechelons of care during flight.

The NIS enables medical personnel to assess abnormalities ofthe cardiopulmonary system in high-noise environments like the

transportation of wounded soldiers in medical evacuation aircraft,ground warfare, and intensive care units.

Moving ForwardBetween 2007 and 2013, the NIS received U.S. Food and DrugAdministration 510(k) clearance, and through a series of rigorouslaboratory and field tests conducted by USAARL, the NIS received anairworthiness release for use on-board the Black Hawk helicopter. Thedevice is now approved for full-rate production for use in real-worldoperational environments.

More info: www.usaarl.army.mil

Targeted Amplification

( U S A A R L )

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Innovation Training

The U.S. Army Instituteof Surgical ResearchBurn Center is providingstate-of-the-art pre-deployment training toForward Surgical Teams.By Steven Galvan, USAISR

Public Affairs Officer

A highly skil led group of critical careproviders tasked with providingcombat wounded medical attention

within a war zone during the first hourfollowing a traumatic event, ForwardSurgical Teams (FSTs) are key respondersduring the golden hour of injury.Deployed to support Overseas ContingencyOperations, FSTs are composed of 20critical care team members who trainfor months prior to deploying to ensurea cohesive and effective team to care forwounded warriors and prepare them forthe next level of medical attention.

Proactive ApproachThe 126th FST from Fort Hood, TX, ispreparing for a deployment in 2014 andare honing their critical care skills with afive-day pre-deployment training at theU.S. Army Institute of Surgical Research(USAISR) Burn Center, the sole facilitycaring for combat burn casualties within

the Department of Defense. Since March2003, the Burn Center at Joint Base SanAntonio-Fort Sam Houston, TX, hascared for more than 1,200 woundedwarriors who sustained severe burnsand/or associated injuries, most directlyin support of Operations Iraqi andEnduring Freedom. Burn care treatmentis a specialized and complex skill set thatrequires months of hands-on training thatthe majority of FST nurses and medicsdo not possess. The training at the BurnCenter provides realistic scenarios that

prepares the FST to treat and care for burncasualties until they are t ransferred to thenext level of care and ultimately to theBurn Center.

Major Scott A. Phillips, Burn CenterSenior Critical Care Nurse Specialist andChief of the USAISR Clinical EducationDepartment, helped design the training toexpose the FST on crucial care for combatwounded burn casualties. Everything wedo is to benefit soldiers on the battlefield,said Phillips. Our job is to get [FSTs]

trained on burn care since they providecritical medical treatment as forward aspossible in a war zone.

Phillips, who has firsthand experiencein a deployed war zone setting, set as agoal designing realistic hands-on training.Burn patients have to be properlyresuscitated within the first 72 hours ofinjury, he said. Too much or too [few]fluids can be fatal. Our goal is to trainFSTs who do not have much experiencewith working on burn casualties on how toproperly resuscitate them.

Intuitive TrainingOne of the tools used to accomplish properresuscitation is the incorporation of theBurn Navigator in the training. The BurnNavigator (Burn Resuscitation DecisionSupport System) is designed to assist non-burn care providers with recommendationson how to properly resuscitate a burncasualty and assist in avoiding problemsrelated to over- or under-resuscitatingby medical care providers who do notroutinely care for such patients.

The 126th FST Chief and CriticalCare Nurse Specialist, Major (P) JodelleSchroeder, said that the exposure to burncare training is important for her team. Itserves two purposes, she noted. First, itgives us an opportunity to work together asa team for a quick evaluation of treatment,and it exposes us to burn patients sothat we will know how to care for a burnpatient.

More info: usaisr.army.mil

Major Scott A. Phillips, left, the U.S. Army Institute of Surgical Research (USAISR) Burn Center Senior Critical Care Nurse Special-ist and Chief of the USAISR Clinical Education Department, demonstrates how to use the Burn Navigator to assist with resuscitat-ing burn patients to Major (P) Jodelle Schroeder during pre-deployment training. (USAISR)

Forward

MovingBurn Care

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Immediate Response Improved Kits

Fully AfieldThe kit is already in Afghanistan in smallnumbers, as part of a previously initiatedlimited user evaluation involving 4thBrigade, 3rd Infantry Division, out ofFort Polk, LA. In September, units at FortBragg, N.C., received the kits through theRapid Fielding Initiative in advance oftheir own deployment.

Stambersky said the Army added theTactical Combat Casualty Care card anda small Sharpie marker to the kit as away for soldiers who have administeredfirst a id to a fellow soldier to indicate tofollow-on medical professionals the kindof assistance that was rendered. The card,once marked, is meant to be attached tothe uniform of the afflicted soldier. Thenew method, he said, is better than the oldway.

What you would do if you foundme on the battlef ield and you applied atourniquet to me is you would write thaton this card and attach this to my body,

Stambersky said. In the old days, thetechnique was to take blood and writeT on your forehead. But that wil l getsmudged with sweat or water; itll rub off.

Also included in the new kit is arubber seal that looks much like a stopperto put over a sink drain, but with a valvein it to let out blood. The seal is meantfor soldiers who are suffering a suckingchest wound. That happens when a bullet,for instance, has pierced their chest andlung, and as a result of the new hole theyare unable to properly draw air into their

lungs. In the past, soldiers might havebeen directed to bandage a soldiers IDcard or other piece of flexible plastic overthe wound to cover the hole. The new sealnow fills that role.

Pouches inside the IFAK II are leftempty so that soldiers may also be issuedQuickClot Combat Gauze when theyreceive their kit. The gauze, due to its shelflife, is not distributed with the kits.

Eye on the Fly Also in the kit is an eye shield, whichis a small, curved aluminum disk withpadding on the edges that can be placedover a soldiers wounded eye. The shieldis meant to keep pressure off a woundedeyeball when a soldiers injured head issubsequently wrapped with bandages.

The eye shield is an addition, aboveand beyond what was in the IFAK II,Stambersky said. Eye shields are on thebattlefield now in the MOLLE (ModularLightweight Load-carrying Equipment)

medic set and in the combat lifesaver bags.But now every soldier has one, to preventfurther injury to the eye socket and to theeyeball.

The addition of the eye shieldcame after the members of the Armyophthalmological communityeyedoctorsrecognized that somethingneeded to be done in theater to givesoldiers who administer first aid totheir injured buddies the tools neededto prevent fur ther, perhaps irreparabledamage to eyes.

One such doctor is Dr. RobertMazzoli, an ophthalmologist andretired Army colonel. He now servesas the director of education, training,simulation, and readiness at theDepartment of Defenses Vision Centerof Excellence. Mazzoli said the Armymedical community had identified thateye injuries were not being treated withan eye shield, which is the appropriateimmediate treatment. He added that theytracked why that was not happening, andfound the eye shield was not availablewhere the injury was happening.

When we elevated that as a concernto the [U.S. Army Medical Department]Center and School, the logist ics peopleand the Committee on Tactical CombatCasualty Care, they latched on to that,Mazzoli said.

He added that the eye shields star tedmaking their way into various medicalkits on the batt lefield, and most recentlythey were included in the IFAK II.

Practice Makes PerfectWhile Mazzoli said its a great moveon the part of the Army to include eyeprotection in first a id kits, he noted itsimportant too that training on how to usethe new equipment is also provided, Wealso have to make sure they know.

One of the good news stories thathas come out of the recent wars in Iraqand Afghanistan is the advancementsin medicine and combat care, Mazzolisaid. It shows how we are doing thingsdifferently in this war than any previouswar that we have fought, in that we aremaking rapid changes to not just howwe are taking care of causalit ies, butto the stuff we are able to take care ofcasualties withlike the eye pro, like thetourniquets, and the development of newbody armor systems, he said.

Stambersky said the new IFAK II isdesigned to provide to soldiers only themost basic tools needed to save lives, atthe place where injuries occur: Whatthe IFAK II gets at is life, limb, eye sight,immediate point of injury carewhatneeds to be done immediately to keep thatsoldier alive.

More info: vce.health.mil

Opposite page and above: The Army is now issuing to soldiers the more robust, more streamlined Individual First Aid Kit II asreplacement for the older kit, which was built inside an ammunition pouch for a Squad Automatic Weapon. (C. Todd Lopez)

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An Army Special Forces medicturned physician designed afellowship program to improvethe survival chances ofbattleeld casualties.By David Vergun, U.S. Army Staff Writer, incoordination with San Antonio Military MedicalCenter, AMEDD

The aim of the Mi litary EmergencyMedical Services and DisasterMedicine Fellowship Program isto train physicians for the challenges ofpre-hospital care on the battlefield, indefense of the homeland, or wherever elsetroops may be, according to Lt. Col. (Dr.)Robert Mabry, the fellowships programdirector, at San Antonio MilitaryMedical Center.

Pre-hospital care is that criticaltime between a traumatic event and when

care is received at a military treatmentfacility, or MTF.

Mabry and his colleagues authored astudy of service members injured on thebattlefield in Iraq and Afghanistan, from2001 to 2011. The study found that of the4,596 battlefield fatalities analyzed, 87.3percent died of their injuries before everreaching an MTF.

Of those pre-MTF deaths, 75.7percent were classif ied as non-survivable,meaning they would have died evenhad they reached the MTF earlier, and24.3 percent were deemed potentiallysurvivable. That study, the first of itskind, was published in the Journal ofTrauma and Acute Care Surgery in 2012.

No Single Point of CareAlthough battlefield medicine has vast lyimproved during every war since WorldWar II, Mabry said that the 24.3 percent

statistic cited in his studythose whodied who might have been salvagedkept nagging him. Thats where we canmake the biggest difference in improvingpatient outcomes, he said.

What Mabry found is that no oneowns responsibility for battlefield caredelivery, meaning that no single seniormilitary medical leader, directorate,

division, or command is uniquelyfocused on battlefield care. The diff usionof responsibility is a result of multipleagencies, leaders, and units of t he servicemedical departments each claimingbits and pieces with no single entityresponsible for patient outcomes forwardof the combat hospitals, he said.

Commanders on the ground do ownthe assets of battlefield caremedics,battalion physicians, physician assistants,fl ight medics, and al l the equipmentbutthey are neither experts in, nor do they

Evolving Practices Pre-hospital Care

BridgingTHE SURVIVAL GAP

( U . S . A

r m y )

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have the resources to train, their medical providers for forwardmedical care, he said.

Commanders rely on the medical departments to providethe right personnel, training, equipment, and doct rine, hecontinued, but the medical departments defer responsibilityto line commanders, Mabry said. While this division ofresponsibility may at first glance seem reasonable, the netnegative effect of line commanders lacking expertise andmedical leaders lacking operational control is analogous to theaxiom when everyone is responsible, no one is responsible.

One of the main dif ficulties in addressing pre-hospital

care, Mabry said, is that we know very little about what care isprovided before casualties reach the combat hospital.

Ranger-style Combat CareMabry noted that only one military unitthe Armys 75thRanger Regimenttracks what happens to every casualtyduring all phases of care. Ranger commanders routinely usethis data to improve their casualty response systems, Mabrysaid, adding that the Rangers are the only U.S. military un itthat can demonstrate no potentially preventable deaths in thepre-hospital setting after more than a decade of combat.

While only the 75th Rangers did pre-hospital tracking, oncethe wounded arrived at a combat support hospital, or CSH,according to Mabry they were met with robust surgical supportand had less than a two percent chance of dying. Those whodid die at the CSH generally had a severe head injury or were inprofound shock due to the loss of blood when they arrived -- yetsome of those deceased had conditions that were potentiallysalvageable, had they had some aggressive resuscitation in thefield, he added.

But the culture of mil itary medicine is hospital based, hereiterated, and no one owns battlefield medicine.

Fast Forward to Today The hospital-based mentality has its roots in the Cold War.

During Vietnam and later, the idea was to put as many patientsas possible in a helicopter and fly them as fast as you can to getthem off the battlefield to the field hospital, Mabry said.

After Vietnam, those doctors, nurses and medics returnedto the U.S., took off their un iforms and built our civiliantrauma systems, he continued, noting that before Vietnam,EMS, trauma surgery and emergency medicine didnt exist aswe know them today. As a result of the war experience, sick orinjured civilians in the U.S. today get transported to a traumacenter by helicopter, accompanied by a critical-care flightparamedic and a critical-care f light nurse, both of whom arehighly trained and very experienced.

Civilians took the ball, ran with it, and significantlyevolved their processes to an advanced standard of care,Mabry said. But we stayed with our Vietnam model, focusingon speed. So the two models are incredibly different. ForMabry, speed became a problem in Afghanistan. When I wasdeployed in 2005, I would have to wait three hours for medevacssometimes and if it were a host-nation casualty, sometimes evenlonger, he explained.

And then the level of care in-f light was less than premium.The medics, through no fault of their own, were still trained atthe basic medic level, Mabry said. At that time, flight medics

had no requirement to provide any hands-on care to an actualpatient during t heir training. For many, their first encounterwith a seriously injured casualty was during the first f light oftheir first deployment.

Commanders on the ground do own the assets of battlefield care but they are neither experts in, nor do they have the resourcesto train, their medical providers for forward medical care.

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Closing the GapWhat Mabry concluded from his studiesand field experience was that the solutionto the gap in care cannot be addressed witha single-bandage approach. A solution, heclaimed, would require evidence-basedimprovements in tactical combat casualtycare guidelines, data-driven research,remediation of gaps in care, and updatedtraining and equipment. And to supervisethose medics, their training and themedevac equipment and procedures, therewould need to be a specially trained andqualified physician in charge of that pre-hospital phase, he said.

Mabrys own experience includes 11years as an enlisted solider, starting out inthe infantry and then becoming a SpecialForces medic with a tour in Mogadishu,Somalia, in 1993, during the battle madefamous in the book and film Black HawkDown. He said those experiences had aprofound impact on him and shaped hisdesire to become an Army doctor, which

he did. He later returned to Special Forcesas a battalion surgeon and served tours inAfghanistan, in 2005 and 2010.

There Mabry illustrated the power ofpatient outcome data and how it can drivechanges in military medicinesomethinghe hopes to do with his fellowship program.His team tracked down a National Guardmedevac unit from California whosemembers were mostly all critical-caretrained paramedics in their day jobs whoworked for the California Highway Patroland other stateside EMS agencies.

They deployed to Afghanistan aboutfour years ago, taking their civilian EMSmodel with them, he said. I comparedtheir patient outcomes to the standardmedevac outcomes and found a 66 percentreduction in mortality using the civilianmedic system, he said. As a result of thatoutcome, the Army revamped its trainingof flight medics.

Seeing the PatternsAnother example of how patient outcomedata can drive procedural changes is inairway treatment. If you get an airwayinjury in the field, youre usually shot inthe neck or in the face and have a traumaticdisruption of the airway. We did a studyshowing that when medics perform acricothyrotomycutting an incision inthe neck so patients can breathewefound they fai led at that procedure about30 percent of the time, Mabry noted.

Its a very high-risk, high-stress,yet ultimately life-saving procedure, he

continued. So armed with that data, wewent back and figured out a way to makethe procedure smoother and simpler.And now medics have a tool that willmake them more proficient at doingcricothyrotomies.

So thats what Im trying to get at,he said. Training physician leaders whocan look at problems or opportunitiesfor improvements in the field, who havethe ability to articulate how to improvesystems, give medics better training,better tools, and so [on] to improve patient

outcomes. We want doctors who can lookat the data and training and protocols, anduse research to solve those battlefield pre-hospital problems.

Examples of what those physiciansmight do include understanding the injurypatterns for a particular unit and locality,analyzing the trauma transfer system, andseeing where the medics might need moretraining, Mabry suggested. The physiciancould also look across the medical researchenvironment and determine which newtherapies to incorporate for patientoutcome improvements.

The sort of system Mabry said hesdescribing is similar to what civilian EMSdirectors do stateside.

Training

This summer, the first fellow will graduatefrom the two-year curriculum. Thefirst year is the civilian EMS fellowship,accredited by the American Council onGraduate Medical Education and theAmerican Board of Emergency Medicine.Were one of the first EMS programs inthe U.S. to be accredited, so were excitedabout that, Mabry said. The program wasaccredited in October 2012.

During that first year, the docs workat a big-city EMS agency, learning thesystem of systems of EMS. By system ofsystems, Mabry refers to the overall EMSsystem which is composed of other systems(ambulances, helicopters, personnel,training, protocols, trauma destinations,communications, medical equipment, andso on). This understanding enables them tobe able to direct a military EMS system, heexplained.

The second year is the military portion,which is non-accredited. Each service hasits own unique requirements, he said. Inthe Army, for example, the doc would work

with the battalion medical officers at theTactical Combat Medical Care course,participate in medic training at the combatmedic school house, and see how this allworks at the strategic level at the Instituteof Surgical Research and Joint TraumaSystem in San Antonio.

Additionally, the fellows will learnabout homeland security medicalprocedures and integrate with local,regional, and national disaster planners,Mabry said. And, they learn aboutinternational disaster supportthings like


Army Staff Sgt. David Edens, an aerial combat medic assigned to 1st Forward Support Medical Team, wraps a blood pressuremonitor around an injured Iraqi soldiers arm during a medical evacuation mission in Iraq on 17 July 2006. (Staff Sgt. Jacob N. Bailey)

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Sked

Complete Rescue System

* A litter for evacuating wounded soldiers.* A carrier for dragging equipment (mortar rounds, ammos, etc.)

* Also used for breaching concertina wire

www.skedco.com Tel: 1-800-770-SKED (7533)

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Made in USA to save our troopswherever they are.

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earthquakes and tsunamis that the servicesmight be called upon to support. As if thatwerent enough, during this entire two-year period the fellows are studying fora Masters of Public Health degree in theevenings.

The Masters of Public Healthdegree gives [fellows] the ability to useepidemiology, statistics, and a public healthmodel to go in and say hey, look, heres thechallenge we have in this particular area.They can then articulate from a policy levelhow this affects the population or healthproblem, conduct an analysis and then[know] how to make a case for resources,policy changes, and things like that, hesaid.

Real World Ready

As for the fellow who graduates thissummer, his curriculum looked like this:His first year was with the San AntonioFire Department EMS. For his secondyear, he attended the National Park ServiceSearch and Rescue course and did hispublic health practicum with the JointTrauma System. He has also worked withthe Army Medical Departments Centerand School as well as participating in anumber of policy and research projects.

Now at Johns Hopkins Universityattending the Health Emergencies in LargePopulations Course, designed primarilyfor international disaster relief work, hes

working with some of the worlds leadingexperts in the field. Next, he goes to theflight surgeon course. Upon completionof his fellowship June 30, hes projected togo to Afghanistan for six months to workin the Joint Trauma System as the pre-hospital director. His follow-on assignmentwill be in the Armys Critical Care FlightParamedic Training Program in SanAntonio.

Other than Mabry, there are currentlythree fellows going through their firstyear: one Air Force and two Army doctors.For next year, Mabry said he hopes to geta Navy doc in the fellowship. (The Navy

currently is not providing the funding forthe fellowship.) So the idea is to get threefellows a year, representing each of theservices, he said.

Once the physicians complete theirfellowships, Mabry said the goal is to getthem in positions where their trainingwill make a difference: division surgeons,brigade surgeons, Special Forces groupsurgeons, directors of trauma systems, andtraining programs, among others.

While military doctors are alreadyhighly trained and motivated, Mabrysaid hes looking for those who thinkoutside the box, see problems from uniqueperspectives and perform at all levels:leadership, research, training, problemsolving.

Eventually, Mabry hopes to build a

cadre who collaborate across the services toshed light on that battlefield blind spot ofpre-hospital care and change the mindsetfrom hospital-centric care to one thatprovides state-of-the-art care across theentire chain of survival, starting in the pre-hospital setting at the point of injury.

More info: www.bamc.amedd.army.mil

One of the maindifficulties inaddressing pre-

hospital care, Mabrysaid, is that weknow very little aboutwhat care is providedbefore casualtiesreach the combathospital.

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More Than Just A Monitor - Now FDA 510k Cleared & CE Marked

TMTM

The smallest, lightest and most rugged fully-featured pre-hospital vitalsigns monitor that is CE marked and FDA 510k cleared to market.

www.rdtltd.comTP A 1013Tempus Pro and More Than Just a Monitor are trademarks of Remote Diagnostic Technologies Ltd Remote Diagnostic Technologies Ltd 2013.

Call us now for more information:Tel: (757) 416 4090 / (843) 532 3708

or e-mail: [email protected]

More than just a monitor, Tempus Pro is smallenough to hold in one hand yet sophisticatedenough to use throughout the enroute caresystem, from transportation to the ICU.

It has all the integrated features and capabilitiesexpected in a market-leading vital signs monitor including: 3/5 Lead ECG; 12-Lead diagnosticECG; impedance respiration; Masimo Set SpO 2; NIBP; integrated capnometry; contacttemperature and invasive pressure.

Tempus Pro is over 2 lbs lighter than similar transport monitors, offers a multi-mode display,10-hour battery life, is NVG-friendly and has adedicated tactical switch.

A combination of interface elements includinga glove-friendly touch screen and dedicatedfunction keys mean Tempus Pro is uniquelyintuitive and easy to use, enabling you to inputdata, manage settings and reconfigure thedisplay easily.

Tempus Pro leverages over 10 years of datacollection and sharing expertise. Changingoutcomes is achievable through RDTs unique,rich trauma record interface, perfected to buildfrom far forward transportation use back to the

CSH and into the long term record of care.

8/10/2019 EMT.Mag.Q1.2014


Commanders Corner

Optimizing Healthcarefor a Maritime Force

RDML Brian S. PechaThe Medical Officer of the Marine CorpsHeadquarters USMC, Health Services

Arlington, VA

RDML Brian S Pecha received his Bachelors degree in 1983from the University of San Francisco and a medical degree fromStanford University School of Medicine in 1988. He completedresidency training in Internal Medicine at Naval Hospital SanDiego, where he served as Chief of Residents.

He entered civilian practice in 1994 and re-affiliated with theNavy Reserve the following year. In 2002, he was recalled to activeduty and assigned as senior medical officer for the Branch MedicalClinic at Marine Corps Air Station Yuma. In 2006, he was recalledwith 1st Battalion 14th Marines, deploying to Anbar Provincein Iraq as the Surgeon for Task Force Military Police, a majorsubordinate command of the 1st Marine Expeditionary Force. InMarch 2013 he was brought to active duty as the Force Surgeon forMarine Forces Reserve in New Orleans, and upon promotion inOctober was recalled again as The Medical Officer of the MarineCorps.

RDML Pecha graduated in 2004 with distinction fromthe Naval War College distance education program.

He earned the Fleet Marine Force Officer WarfareQualification in 2006. In 2010, he completed Phase IIof Joint Professional Military Education at the JointForces Staff College in Norfolk.

His personal decorations include the MeritoriousService Medal (2 awards), Navy and MarineCorps Commendation Medal (3 awards), Navy andMarine Corps Achievement Medal (2 awards), Navy UnitCommendation Medal, Meritorious Unit Citation, and variouscampaign and service medals.

RDML Pecha was interviewed by C&CC Editor Kevin Hunter.

C&CC: Please talk about your role as USMC MedicalOfficer, HQ USMC Health Services.

RDML Pecha: The Medical Officer of the Marine Corpsis informally known as TMO. Its a great position,not only for me, but for any of those asked to fill the rolebecause it requires regular interaction with top Marine

leaders. Theres just something different and exciting aboutwatching leaders of Marines go about their business, a certain

esprit, a certain ethos. So for me, its a real privilege.At the same time, its a real challenge because as a Navy medical

officer I work closely with BUMED and my Navy colleagues. Unlikethe Marine Corps, where essentially all the physician positionshave a direct operational component, BUMED has the huge task of

operating and managing a worldwide hospital system. Thats a verydifferent mindset and it requires a different skill set and lot of businessacumen. So Im working every day in two cultures. And today, withthe standup of the new Defense Health Agency, theres even morecomplexity.

My role essentially is to act as the advisor to the Commandant andthe Assistant Commandant on any and all issues related to the healthcare of the force. I represent the Marine Corps to BUMED and to theDHA. I assist in developing policies related to the provision of carefor the operating forces. I oversee the very skilled action officers inthe Health Services department here at Marine Corps Headquartersas they deal with daily issues and with the long-term projects wereworking.

C&CC magazine sat down with RDML Pecha in order to givereaders insights into how USMC Health Services views it challengesfor the present and future. Though significantly smaller than theArmy, RDML Pecha reminds us the Marine Corps is neverthelessan important expeditionary force always prepared to be sent abroadon short notice for combat operations, and as such faces its ownbattlefield medicine challenges. Like other services, the USMCmust also address trials on the home front. To this end, the admiralalso discusses the continued health and healing of garrisonedMarines and Wounded Warriors and the programssome ofwhich are in partnership with civilianshis office is working on toimprove their lives.

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C&CC: Please discuss USMC Health Services background,mission, and role as part of the USMC medical and greaterDoD medical community.

RDML Pecha: The Marine Corps is Americas Expeditionary Forcein Readiness. Health Service Support to this expeditionary force ismade up of: Corpsmen (5,735), Medical Corps (315), Medical ServiceCorps (248), and Nurse Corps (20).

We provide organic health service support and force healthprotection to Marines wherever theyre engaged. Whether in garrison,forward-deployed, or forward-engaged, Navy medical profession[al]s,officer and enlisted, are directly involved in supporting the warfightersas they respond to all manner of crises and contingencies.

Our primary focus is on ensuring world-class care to Marinesand sailors, no matter where they may be. That entails providingthe best trained and equipped medical personnel to Marine unitsin increasingly complex environments, finding and retaining menand women with diverse backgrounds, cultures, and skills whileimplementing new capabilities that enhance our effectiveness.

C&CC: What are some of the primary advances that arehelping USMC HQ HS address the needs of Marine Corpspatients at home and in facilities worldwide?

RDML Pecha: Our biggest initiative from the individualwarfighters perspective is the rollout of Marine-Centered Medical

Home (MCMH). This is a joint BUMED/USMC effort to improvethe delivery of care to the operational forces in garrison and waslaunched in January 2013 in a pilot program. Following a patient-centered concept, the program has already demonstrably improvedaccess to and quality of care delivered by the organic HealthService Support assets of the USMC. For example, the 5th MarineRegiment was able to decrease the number of Marines on [limitedduty] by 70 percent through the improved coordination providedby their robust medical home capabilities.

The program delivers enhanced staffing, for example adding billets

for clinical nurses, clerks, care coordinators, and embedded behavioralhealth providers. At the same time, were improving the environmentof care, to get out of the old battalion aid station model and intomodern clinical facilities. Marines enrolled in one of our MCMHs cannow access medical care from their aid station 24/7 via phone, secureemail messaging, or in person. Were looking to expand MCMH overthe next five years to the entirety of Marine Corps operational forces;this year were working to open sixteen more sites.

C&CC: How is USMC HQ HS working to promotepartnering with industry in delivering more effective andefficient know-how to the DoD medical community?

RDML Pecha: Keeping faith with healthy Marines, WoundedWarriors, and their families is of paramount importance to bothMarine Corps and Navy Medicine leadership. In order to provide thefinest care and support for them today and in the future, we need toleverage cutting edge medical research. Health Services and NavyMedicine have partnered with top educational institutions such asUCLA, Johns Hopkins University, Wake Forest, Cleveland Clinic,Rutgers, and the University of Pittsburgh. Together, were looking forways to provide todays Wounded Warriors with the best care possible,while ensuring tomorrows injured receive better careand fastercarebefore and after injury.

We live in austere fiscal times for the DoD. Caring for catastrophic

injuries like amputations, burns, and genitourinary trauma is not onlycostly, it can be highly specialized. So were trying to develop robustmilitary-civilian partnerships to ensure Marines and sailors receivenot only the best care but also experience the best quality of life duringtheir treatment, regardless of whether it resides inside or out of theDoD healthcare system. Creating lines of communication with thebusiness and academic worlds is essential.

C&CC: How are you addressing challenges regardinglessons learned on todays asymmetric battlefields?

RDML Pecha: Youre right that the battlefield of today is differentin many ways from those of previous conflicts. Weve had to adapt

RDML Pecha and Master Chief Hospital Corpsman John Rollinger discuss goals and priorities ata weekly staff meeting. (USMC)

Were trying to develop robust military-civilian partnerships toensure Marines and sailors receive not only the best care but alsoexperience the best quality of life during their treatment, regardlessof whether it resides inside or out of the DoD healthcare system.

Commanders Corner

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to different injury patterns and weve worked to incorporateadvances in trauma care right up to the point of injury.

The signature injury of these conflicts, mild Traumatic BrainInjury (mTBI) associated with IEDs, has required new ways tointegrate medical knowledge with mission readiness and follow-on care and rehabilitation. In addition, this kind of cooperationis leading to major advances in [protective equipment]forexample, Kevlar undergarments. So the whole way we delivermedical care in the operational setting needs to adapt, and thePivot to the Pacific is going to require new ways of looking atthis as well. Most of the knowledge gained is a capability thatwill be invaluable regardless of whether the threat is asymmetricor conventional.

Its critical to preserve the lessons learned throughout theseconflicts, but its equally important to keep the processes ofextracting those lessons quickly and disseminating them to thefield. Its a daunting task, but were convinced that pushing thebar higher will save lives.

C&CC: Feel free to discuss any accomplishments or

objectives USMC HQ HS has achieved or is working tobring to fruition.

RDML Pecha: In 2013, we conducted a comprehensive Poly-Pharmacy Quality Assurance initiative to look at the careprovided to Marines on three or more chronic medications. Wefocused on narcotic and psychotropic medications. We learnedthat less than 0.65 percent of the force are on three or more ofthese medications, and that the affected patients unit MedicalOfficers were aware of the individuals and were tracking themappropriately. For 2014, were going to be focusing on referraltracking from the deployment health assessment program.

Were working with the Naval Health Research Centerto use their Expeditionary Medical Encounter Database toenhance patient care, inform and improve services, and to allowfor a ready database for research. For similar reasons, DoD is

partnering with the [Department of Veterans Affairs] to developa registry of all military personnel diagnosed with TBI and/orPTSD, in order to hopefully better inform care from diagnosisthrough separation/retirement and beyond.

Weve worked closely with the Navys Bureau of Medicineand with the Intrepid Fallen Heroes Foundation to establishsatellite National Institute Center of Excellence for TBI andPsychological Health on Camp Pendleton and Camp Lejeune.These centers provide state-of-the-art comprehensive diagnosticand rehabilitative care capabilities for Marines with chronic TBIor PTSD. These satellites also provide resource information andreal time support to Marine Corps Health Service Support assetsin theater or garrison.

XT-M Extrication

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The XT-M is made from high-performance carbon ber construction and providesoperators with a lightweight, durable and versatile spinal immobilization and

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Commanders Corner

What USMC HealthServices DoesWhile not all-inclusive, Health Services currently supports

deployments worldwide for Medical Contingency/StabilityOperations (MCO/MSO), Stability, Security, Transition,and Reconstruction Operations (SSTRO), Humanitarian

Assistance/Disaster Relief (HA/DR), Detainee operations,and Homeland Defense/Homeland Security(HLD/HLS).In addition to enhancing interoperability with naval, jointand coalition partners, Health Services is also engagedin leveraging the capabilities of government agencies andnon-governmental organizations (NGOs)/private voluntaryorganizations (PVOs). USMC Health Services is alsoinvolved in informing Congressional & DoD requirements toimprove force protection, health surveillance, and casualtycare through the Quadrennial Defense Review (QDR) andits Medical Readiness Review (MRR), as well as in the

drafting of Service-specific guidance and instructions.

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Expanded-use Junctional Tourniquet ClearedThe FDA recently cleared new indications forAbdominal Aortic Tourniquet use againstseveral rapidly lethal injuries. Junctionalhemorrhage is bleeding where the limbs meetthe body. It presents a difficult treatmentproblem due to the ineffectiveness oftraditional tourniquets. These areas includesome of the largest blood vessels in the body,causing injured patients to bleed to deathwithin minutes.

The new FDA clearance includes severalkey changes. The device was renamed toreflect what it does. It is now known as theAbdominal Aortic and Junctional Tourniquet(AAJT). It is approved for use on the groinand the axilla to stop bleeding for three hours.It is now the only junctional device to havean indication for pelvic bleeding. A relative

contraindication was removed for penetratingabdominal trauma at the request of themilitary and with the approval of the FDA.The new clearance comes as CompressionWorks releases a new ruggedized device. Thegauge assembly on the device is hardened atkey connections. Compression Works LLC,the company behind the AAJT, continues toimprove upon design that to date has a 99.4percent reliability rating.

The AAJT uses a wedge shapedpneumatic bladder that covers a large surfacearea. Research at Georgia Health SciencesUniversity showed that the AAJT workswhile exerting lower tissue pressures on thegroin and axilla than the other junctionaldevices on the market. These lower pressuresaccount for increased comfort and decreasedrisk to muscle and nerve tissue. A study ofthe Combat Ready Clamp by the Instituteof Surgical Research this summer showedconcern for nerve and muscle damage fromthe high pressures utilized by the device.

More info: speeroptech.com

TCCC Med Pack InsertThe Rescue Essentials TCCC MedicalPack Insert is built on the TCCC platform,addressing the three leading causes ofpreventable death on the battlefield and in thestreets.

Constructed of 1000 Denier Cordurafabric and capable of use both as a pack insertand a mini trauma panel, the TCCC MedicalPack Insert has multiple supplies to addressmajor hemorrhage, tension pneumothorax,and airway issues. Additional bandagingsupplies, saline locks, and casualty recordinground out this offering. With rip away, see-

through vinyl pouches,the kits bandagingmodules can be pulledand deployed to otherpersonnel. Airway andbreathing supplies aremounted on rip-away

panels, as are the toolsand tourniquets. Hookand loop allows forcustom configurationof pouches, panels, andname tapes.

Moreover, aluminous MED patchidentifies this insert forits intended purpose.The webbing handlesmake for easy extractionfrom the pack and quickmounting when used as amini trauma panel.

More info: rescue-essentials.com

Best Practice Award forClinical Video Telehealth

Anticoagulation ProgramThe Veterans Affairs (VA) Maryland HealthCare Systems Pharmacy Service, among fiveother health care organizations nationwide,is the recipient of the American Society of

Health System Pharmacists (ASHP) 2013Best Practice Award presented duringtheir recent national mid-year meeting inOrlando, FL. Sharing the honor with theVA Maryland Health Care System are theUniversity of North Carolina Hospitals inChapel Hill, N.C.; Harper University Hospitalin Detroit, MI; Denver Health Medical Centerin Denver, CO; Hospital of the Universityof Pennsylvania in Philadelphia, PA; andFroedtert Memorial Lutheran Hospital inMilwaukee, WI.

The ASHP Best Practices Award inhealth system pharmacy is an annual

recognition program developed andawarded by ASHP and sponsored by Amgen,a pharmaceutical manufacturer. Since1999, this award program has recognizedoutstanding practitioners who havesuccessfully implemented innovative systemsthat demonstrate best practices in healthsystem pharmacy.

Pharmacy Service at the VA MarylandHealth Care System was recognized by theASHP for the implementation of clinical videotelehealth (CVT) anticoagulation servicesfor Veteran patients in remote locations.

The new technology allows pharmacists tomonitor a course of drug therapy for Veteransat their local VA outpatient clinics from otherlocations such as a VA medical center through videoconferencing. Medical information canbe transferred by way of specially designedtelecommunications equipment. VA research

results suggest that CVT is an effectivealternative to face-to-face visits withoutcompromising the quality of medicationtherapy management services.

More info: maryland.va.gov

Academic Boot CampsThe Warrior-Scholar Project (WSP) is nowaccepting applications from eligible militaryand recently separated veterans planning onattending four-year colleges for its growingacademic boot camp program. New courseswill take place at Harvard University and theUniversity of Michigan, joining the existingeffort at Yale and allowing for more eligible veterans to attend this no cost opportunity toprepare them for academic success.

Initially launched at Yale in 2012, WSPhosts academic boot camps at Americastop universities in order to prepare veteransto succeed in college and become leaderson campus. During WSP, veterans attend16 hours per day of intensive courses anddiscussions led by prominent professors,administrators, and current student-veteranson topics including:

- Academic reading and writing,

- Adapting to changed social circumstances,- Translating skills used and acquired in themilitary to the college environment, and

- Overcoming and embracing many otherchallenges that are inevitably confrontedby non-traditional college students,especially veterans.Active duty personnel and recently

separated veterans with an actionable planto attend a four-year university are eligibleto apply. Up to 24 veterans will be acceptedto the WSP at Yale, and up to 12 veteranswill be accepted to the newly launched WSPprograms at Harvard and University of

Med Tech

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Industry Partner Skedco

THROUGH PRECISION IMMOBILITY By Kevin Hunter, C&CC Editor

S kedco Inc. was founded onDecember of 1981 for the purposeof manufacturing and marketingthe Sked Stretcher System, the first-evercasualty evacuation (CASEVAC) kit. It wasand still is a litter in a carrying case with allnecessary accessories for rope rescue, a spineimmobilizer, the Oregon Spine Splint, anda flotation system that floats the Sked in anearly vertical position and is self-righting if

capsized.Since the Sked System was introducedand standardized, Skedco has producedmany new and innovative products (over200 and counting). The Sked system wastested for nearly two years before it wasstandardized in 1986. It is currently thestandard battlefield litter.

Light, Strong, VersatileThe Sked is made from a proprietary easyglide medium density polyethylene plasticthat is very abrasion resistant, unbreakable at

-120 degrees Fahrenheit, and very functionalin desert and jungle applications. It hasgrommeted holes with straps sewn into themto secure the patient. The addition of Cobrabuckles has been very well received, and nowSkedco produces Cobra buckle kits to retrofitexisting Skedco litters to save money. TheSked body weighs 11 pounds, while the basicsystem weighs just over 16 pounds.

MEDEVAC EnhancedDesigned with CASEVAC in mind,Skedcos Oregon Spine Splint (OSS) SkedCombination had to be small, light-weight, and very efficacious. Addingthe Cobra buckles to the Sked in 2005made it possible for one soldier to deploythe Sked and package a patient in aslittle as one minute. If a spinal injury issuspected, the OSS is used to immobilizethe patient. Possibly the only short

spinal immobilizer that meets all ofthe criteria established by Pre-hospitalTrauma Life Support (PHTLS) of theNational Association of EmergencyMedical Technicians, among others, forimmobilizing a seated patient, the OSSwhen used with a Sked litter is equal to along backboard. It is more compact andcomfortable, able to assist with virtuallyany kind of rescue. Sked is the only roll-up litter that has an airworthiness release.It can be dragged, carried, and hoisted forrope rescues or into helicopters.

EFFECTIVE MOBILITYEFFECTIVE MOBILITY

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Industry Partner Skedco

The OSS fits inside a rolled Sked insideits carrying case. It is deployed and appliedin minimal time. It allows immobilizationof the spine and can retract the shouldersin the event of a clavicle fracture. TheOSS comes with a shoulder board that fitsbehind the patients shoulders to preventthe flexible Sked from rolling the shouldersforward and placing pressure on them,thus eliminating unnecessary pain whenbeing carried or hoisted. The OSS is thechoice of the U.S. Army and militaries ofseveral other countries around the world.Below deck in ships and submarines animmobilized patient in a Sked and OSS caneasily pass through 16-inch scuttles andother very small spaces.

The OSS has shoulder straps thatprevent the patient from moving upwardon the device that can be reconfigured toretract the shoulders. Groin straps prevent

downward movement and also never over-tighten when the patient is taken fromsitting to supine position and two bodystraps. The straps and buckles are all colorcoded for easy use. The design allows totalaccess to the anterior torso for any pre-hospital diagnosis or treatment withoutcompromising the immobilization, whichis not possible on other devices. Oneperson can quickly immobilize a spinalinjured patient if he follows the Skedcotechnique that was blessed by PHTLSyears ago.

All Float, No BoatThe Skeds flotation system consists of twofloat logs that attach to slots in its sidesusing beefy plastic side-release buckles forsafety. The f loat position keeps the patientshead above water when it is being towed,with the chest pad self-righting the litterin case of capsizing; the ballast causes theSked to float in a nearly vertical position.If the system is in a rapid deploymentbag, it can be deployed in as litt le as 30seconds ready to receive a patient. It can bepre-rigged with a tag line to prevent litterspin when hoisted by helicopter. Patientpackaging in the water can be accomplishedby one person in as little as 20 seconds.(Add another 40 seconds to prepare forhelicopter hoist if the tag-line is pre-riggedprior to deployment).

CASEVAC and Safety

Skedco also manufactures a full capabilityCASEVAC Kit that will attach very securelyto a vehicle using a very strong super-size MOLLE-type attachment. It featuresan attachment sleeve that contains thedetachable litter carrier with a litter and allnecessary medical equipment. Pockets onthe inside secure patient litter straps, littertiedown straps, carabiners, and aviationsnap hooks. There is a shroud to protect itfrom weather that doubles as a carrier forthe patients gear. It is mounted inside oroutside the vehicle.

The Skedco-designed tag-line isattached to the Sked or other litters whenhoisting into helicopters to prevent litterspin. A V-strap is connected to the litterusing carabiners. It is attached to the ropeusing two screw links with a weak link thatbreaks at 150 pounds to insure safety of theaircraft and crew.

State Of The Art ForwardSkedco manufactures medical equipmentset bags for helicopters that have, like theother Skedco products, been battle provento make rescue and medical treatmenteasier. Skedco produces medical packsand bags such as our revised PringleCLS Chest bag and the Maltz medicalassault pack, both of which can double asa hanging panel in vehicles and aircraft.Skedcos individual first aid kit featuresthe tourniquets on the outside for quick

access and the patented Tactical ReleaseMOLLE attachment. Lastly, the SkedcoMout Lifeline can be connected to a Velcro-faced MOLLE attachment, with the endof the rope attached to the drag handleon body armor; so if a soldier is down inthe line of fire, it is thrown (tangle-free) tosomeone who pulls him to safety withoutexposing himself.

More info: skedco.com

Above: Air Force Pararescue Jumpers (PJs) secure a wounded war ghter. Opposite page: PJs hoisting a Skedco litter. (Air Force photos)

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A look at institutions of higher learning offering courses for servicemembers and veterans

Online & In CombatOnline & In CombatOnline & In Combat

Easing Transitionthrough Education

By Col. (Ret.) Garland Williams, Vice President of Military Relations,University of Phoenix

University of Phoenix works directly with active-duty servicemembers, their spouses, and veterans to help them balancefrequent deployments, relocations, and training scheduleswhile fulfilling their education goals. The Universitys militarystudents access classes online or at more than 100 University ofPhoenix locations, giving them an opportunity to choose thelearning environment that is most conducive to their educationalsuccess. University of Phoenix offers accredited degree programsin business, criminal justice and security, information systemsand technology, nursing, health care administration, andpsychology. Degree programs range from associate to doctoral, inaddition to various certification specializations.

University of Phoenixs military students work withmilitary-specific enrollment, academic and finance advisors.Many of the advisors have prior military service or aremilitary spouses and can identify with the unique challengesactive-duty military members, their spouses, and veterans face

when pursuing a degree.In addition to helping service members and their familiesreach their education goals, University of Phoenix is dedicatedto helping the military community successfully transitionfrom active-duty to the civilian workforce. The University hasresources through the Phoenix Career Guidance System thatallows service members to research jobs and degree programsin specific areas, as well as take a career interest assessmentto discover areas that align with the service members currentmilitary career.

More info: phoenix.edu/military

Fostering a Culture forMilitary Education

By Scott Stratton, Military Liaison and Senior Executive Advisor,DeVry University

DeVry University assists with the transition from combatto college through administrative, academic, and peer- veteran support. Year-round flexible scheduling anddegree programs available in online formats help make highereducation a reality for many military and veteran students andprovide a solid foundation for their career success.

One of DeVry Universitys most unique offerings for veteransis the DeVry Military Resource Club (DMRC), headquarteredat the DeVry University campus in Addison, IL. Established in2008, the DMRC strives to build a healthy camaraderie and keepmilitary traditions alive by engaging DeVry students with servicebackgrounds in group activities and team building exercisesincluding sporting events, movies, concerts, paint ball matches,and classroom help. The DMRC also acts as a liaison betweenstudent veterans and the Veterans Affairs (VA) office. In fact, arepresentative from the health outreach office of the VA visits theAddison campus twice a month to address benefits issues and

answer any questions.DeVry University also provides services to aid in the educationof those that are currently deployed. For example, DeVryUniversitys Student Central service model offers specialiststrained to work with military students studying online. Inaddition, DeVry University encourages military students to usethe ASPIRE Veterans Assistance Program, a one-stop centerfor resources about dealing with post-traumatic stress disorder,transitioning from service to civilian life, adapting to school, andmore.

More info: devry.edu

( M i l i t a r y

R e s o u r c e

C l u b / D e

V r y

U )

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Battleeld MedicineBattlefield logistics are a challenge regardless of the mission.Adversaries, terrain, and the environment can all serve to complicatethe process of delivering supplies to warfighters. The current DoDapproach to medical supply logistics is limited in its reach to far-forward emergency settings, response to emergent in-theater threats,and utility for bio-preparedness stockpiling. It can often take weeksto months to manufacture and airlift organic pharmaceuticals andprotein therapeutics to battlefield frontlines, meaning that criticalmedical supplies often do not arrive in time where they are neededmost. Furthermore, the need to prepare medical supplies in advancebased on an anticipated, specific threat can result in wasted materials,labor, and money when that threat is not realized.

DARPAs Battlefield Medicine program seeks to address thiscapability gap through two integrated research thrusts: the Pharmacyon Demand (PoD) and Biologically-derived Medicines on Demand(Bio-MOD) initiatives. The combined efforts seek to developminiaturized device platforms and techniques that can producemultiple small-molecule active pharmaceutical ingredients (APIs)and therapeutic proteins in response to specific battlefield threats andmedical needs as they arise. Additionally, the platform would havebuilt-in flexibility to produce multiple types of therapeutics through itsmodular reaction design. The ultimate vision for Battlefield Medicineis to enable effective small-batch pharmaceutical production thatobviates the need for individual drug stockpiling, cold storage, andcomplex logistics.

Surviving Blood LossThe Surviving Blood Loss (SBL) program is developing novel strategiesto radically extend the time injured warfighters can survive criticalblood loss on the battlefield before initiation of fluid and bloodresuscitation. Achieving this goal will allow increased timeas muchas hours or daysfor evacuation, triage, and initiation of supportivetherapies. An interdisciplinary effort is underway to developcomprehensive understanding of energy production, metabolism, andoxygen use and to identify and control the protective mechanisms thatpreserve cellular function despite critically depressed oxygen del ivery.

Investigational focus areas include mechanisms to control themetabolic state on demand, including induction of a hibernation-like state, and development of low-volume therapies that reducetissue demand for oxygen and metabolites when full resuscitationis not available.

Significant progress has been made achieving program goalsincluding metabolic rate reduction using hydrogen sulfideexposureto low levels of hydrogen sulfide were shown to induce a hibernation-like state in mammals, which is highly protective against blood loss orlow-oxygen environments.

Wound Stasis SystemUncontrolled blood loss is the leading cause of death for warfighterson the battlefield, according to the U.S. Army Institute of SurgicalResearch. The vast majority of such fatalities are from wounds thatare not accessible by combat medics for traditional treatments, likedirect compression. For example, in the case of internal injuries to theabdominal cavity, medics can neither visualize the damage nor accessit to provide treatment. As a result, rapid and uncontrolled blood lossoften leads to death before transport from the battlefield to a surgicalsetting can occur.

DARPA created the Wound Stasis System (WSS) program topursue a stabilizing treatment that would keep injured warfighters

alive until they could be delivered to a surgical setting. WSS beganas a basic research program to identify biological mechanisms fordistinguishing between healthy and wounded tissue, with the goal ofcontrolling bleeding by binding to the wound. Currently, the focusis on a foam material as the primary hemostatic agent, with an aimto develop a stasis material and delivery system, suitable for use bycombat medics at the point of injury for wound stabilization priorto medical transport. Such a system would effectively treat non-compressible wounds, regardless of geometry or location within theabdominal cavity, and would not require direct visualization of thewound by the medic.

More info: darpa.mil

Programs Spotlight

Scalable, On-Demand BloodRed blood cells are the most transfusedblood product in battlefield trauma care.Unfortunately, they are sometimes inlimited supply in a battlefield environment.DARPA created its Blood Pharmingprogram to potentially relieve this shortageby developing an automated culture andpackaging system that would yield a freshsupply of transfusable red blood cells fromreadily available cell sources. If the programis successful, it will eliminate the existingdrawbacks of laboratory grown red bloodcells, including cost, production efficiency

and scalability, compared to those growninside the human body. Pharmed bloodcould also offer additional benefits. Thesepotential benefits include eliminating therisk of infections from donors, on-demandavailability, avoiding the detrimentaleffects of storing donated blood, andcircumventing the issue of matching bloodtypes between donor and recipient.

Under the Blood Pharming program,DARPA has decreased the cost of thechemical stock required to support bloodgrowth for one unit of blood from more

than $90,000 per unit to less than $5,000per unit. DARPA believes that futurereductions in the cost of chemical stock forunmodified red blood cells will eventuallymake pharmed blood practical for basictransfusions. Recently, in addition toreducing production costs, DARPAperformers have been investigating howpharmed red blood cells can potentially bemodified to serve as vessels that can holda variety of medical payloads, including vaccines, anti-toxins, diagnostics, andantibodies to neutralize pathogens.

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Command Profile USAF 6th Medical Group

The U.S. Air Forces 6thMedical Group, 6th Air MobilityWing, MacDill AFB, FL, is theonly medical installation inDoD supporting two UniedCombatant Commandheadquarters.By 6th AMW/Public Affairs

The origins of medical serv ice atMacDill Ai r Force Base (AFB)date back to the very beginningof the base itself. The area surroundingthe current base was fi rst used in amilitary manner as a staging area duringthe Spanish-American War. Later, theland at the southern tip of the southTampa peninsula was donated by thecity of Tampa to the United States WarDepartment in 1936 and construction onbase began in September 1939.

The MacDill Hospital was establishedin 1940. Sixteen years later, a new facilityopened that would operate until 2009. Thecurrent and primary facility has been opensince then, along with our GeographicallySeparated Unit, the MacDill Community.

Focused MissionThe 6th Medical Group (MDG) supports

a globally-focused active duty AirMobility Wing, an Air Force ReserveCommand Air Refueling Wing, twoCombatant Commands, the HurricaneHunters of the National Oceanic andAtmospheric Administration, and theJoint Communications Support Element.The over 700-person team executesits daily mission at more than a dozenfacilities on and off base. The 6th MDGmission statement, Prepare, Prevent,Heal, Deploy, serves as a foundationfor achieving a vision of becoming the

U.S. Air Forces premier patient-centeredmedical home.

Daily TaskingsThe 6th MDG supports the largest single-unit catchment area of eligible beneficiariesanywhere in the country. In 2013, MDGfilled more than 624,000 prescriptionsand had 165,000 patient encounters, while

ensuring thousands of soldiers, sailors,airmen, and Marines deployed to locationsaround the globe.

MDG relies on partnerships with localcommunities to extend its capabilities,including connections with St. Petersburg,Bay Pines, and James A. Haley VeteransAdministration hospitals and severalcivilian hospitals. These partnershipsenable Air Force medics to train anddevelop the skill sets needed to ensurepremier healthcare is available to thosewho defend the nation.

6th Medical Group:Robust and Ready

Airmen assigned to the 6th Medical Opera-tions Squadron, MacDill Air Force Base, FL,and soldiers from 10th Mountain Division, FortDrum, N.Y., conduct litter movements during anexercise in 2009. (SrA Jimmy L. Dang)

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Command Profile USAF 6th Medical Group

For more information, visit marinemilitaryexpos.com

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Squadron Breakout The 6th Medical Group comprises four squadrons

The Medical Support Squadron balancesour budget; oversees managed care andenrollment missions; and ensures safe andeffective facility operations, an on-timelogistics mission, and that our robustpharmacy, lab, and diagnostic imagingmissions keep up with our growingdemand. The squadron also ensures ourreadiness mission is fully aligned withexpectations from the 6th Mobility Wingup to the DoD.

The Dental Squadron providescomprehensive dentistry, dental labservices, prosthodontics, endodontics,and oral surgery to our active dutyforce and plays a significant role inensuring the overall medical readinessof our joint military force.

The Medical Operations Squadron executes the patient care mission to

include family medicine, our BrandonClinic, pediatrics, internal medicine,a growing specialty clinic, and anexpanding surgical service.

The Aerospace Medicine Squadron consists of flight and occupationalmedicine services, optometry, publichealth, bioenvironmental engineering,and the health and wellness center.Each of these flights administers toour readiness mission.

More info: www.macdill.af.mil/units/6thmedicalgroup

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A. U.S. Navy Petty Of cer 3rd Class Briana Bartholomew, assigned to the 13th Marine Expe -ditionary Units Air Combat Element, conducts cardiopulmonary resuscitation (CPR) duringmedical training aboard the amphibious assault ship USS Boxer (LHD 4) underway in the

Paci c Ocean on 17 June 2013. The Boxer is conducting amphibious squadron and marineexpeditionary unit integrated training. (Seaman Apprentice Veronica Mammina)

D. Navy Petty Of cer 3rd Class Caleb T. Carlson, left, Navy Petty Of cer 3rd Class Ruben E.Ramirez, center, and Navy Lt. Chad B. Craft, right, monitor the vital signs of a wounded Marineduring Exercise Steel Knight 2014 on Marine Corps Air Ground Combat Center, Twentynine Palms,CA, on 13 December 2013. Carlson, Ramiraz, and Craft, hospital corpsmen, are assigned to Head -quarters Company, 1st Battalion, 5th Marines. (Cpl. Justin A. Bopp)

B. Afghan Commandos from 2nd Company, 7th Special Operations Kandak, compete atcorrectly evaluating and treating simulated casualties during combat medic training in Washerdistrict, Helmand province, Afghanistan, on 16 March 2013. The commandos, along withtheir coalition force mentors, review basic combat medical skills to increase survivability andcombat effectiveness. (Sgt. Benjamin Tuck)

C. Two 10th Mountain Division soldiers assess the damage of a Humvee that was struck by asimulated road side explosive. The soldiers are tasked with safely extracting any casualties from thevehicle and stabilizing them for a medical pickup. (Sgt. Steven Peterson)

A

B

C

D

Photo Essay Training in 2013

Documenting Preparedness A look at those training for the challenges of combat medicine

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Aerospace Medical Association ..................................28asma.org

Air Shunt ......................................................................23airshunt.com

Association of the U.S. Army ........................................3ausaannualmeeting.org

Athena GTX ...................................................................9athenagtx.com

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Ferno Military Systems ................................................15fernomilitarysystems.com

Marine Military Expos ..................................................25marinemilitaryexpos.comRDT .............................................................................12

rdtltd.com

Skedco Military ............................................................11skedco.com

SPIE Defense and Security Symposium .....................25spie.org/dss1

TechConnect World .....................................................28techconnectworld.com

Techline Technologies Inc. ......................................... C3techlinetrauma.com

USAA .......................................................................... C4usaa.com/annuity

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Calendar of EventsMarch 30-April 2Trauma Critical CareLas Vegas, NV

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May 20-22SOFIC

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3 YOUR OWNVOICE TRACKS

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