m2va 18 3 final

Degrees in Health O Burn Care O DefibrillatorsVA Acquisition O Disease in Africa

Global Facilitator

Dr. Jonathan WoodsonAssistant Secretary of Defense for Health Affairs

August 2014Volume 18, Issue 3

www.M2VA-kmi.com

Dedicated to the Military Medical & VA Community

Defense HealtHagency

combat casualty care


Exclusive Interview with:

Medical Organizer

craig robinsonAssociate Deputy Assist.Secretary, National Acquisition Center

Experience CountsZOLL, with over 25 years of experience

manufacturing resuscitation technologies

for the military, understands that to meet

today’s demands, you require more than just

the best monitoring technology available. The

ZOLL Propaq M, in addition to providing the

trusted and proven vital signs you have come

to expect from Propaq, now has signifi cantly

enhanced data communications allowing you

to capture patient care data from the point of

injury through defi nitive care.

© 2014 ZOLL Medical Corporation, Chelmsford, MA, USA. ZOLL is a registered trademark of ZOLL Medical Corporation. Propaq is a trademark of Welch Allyn.

For more information, call 1-800-804-4356 or visit us at www.zoll.com/nextgen.

Propaq:The Standard

You’ve asked, we’ve delivered.Your next-generation Propaq® is here. The standard in vital signs monitoring, now with advanced capabilities for all levels of care.

MCN MP 1402 0005

Dr. Jonathan WooDson Assistant Secretary of Defense

for Health Affairs

16

Departments Industry Interview2 EDitor’s PErsPEctivE3 Program notEs4 PEoPlE14 vital signs27 rEsourcE cEntEr

grEg BorEckiVice President of Strategic National AccountsStanley Healthcare

5Programs in thE hEalth sciEncEsThere are a number of degree programs in the health sciences available to veterans of the services or active duty military members. Many of the classes offered are online, which works for students seeking a more flexible schedule or who are stationed onboard a ship or deployed in a far off location.By Chris MCCoy

8trEating thE BurnThe symptoms presented by burn patients seen by the U.S. Army burn center in San Antonio, Texas, changed over the years as the focus of U.S. military actions shifted from Iraq to Afghanistan.By Peter BuxBauM

11automatED ExtErnal DEfiBrillatorsThe most common abnormal heart rhythm for spontaneous cardiac arrest is ventricular fibrillation. This is essentially when the heart is beating totally ineffectively and erratically at a rapid rate and produces no output of blood. It is almost always fatal if it proceeds for too long.By Chris MCCoy

21sPEcial sEction: comBat casualty carEThe decade-plus that the United States has been at war has produced dramatic advancements in tactical combat casualty care. The military itself has developed new structures and strategies through which to provide the quickest and best possible care to wounded warriors.By Peter BuxBauM

August 2014Volume 18, Issue 3Military Medical & Veterans affairs foruM

Features

28

“Cooperation missions provide

excellent opportunities

for the U.S. military abroad, as they revolve

around building upon or

creating new relationships

with other nations’

militaries, agencies and

NGOs.”

–Dr. Jonathan Woodson

19M2VA presents a pictorial review of the leaders of the Defense Health Agency.

Who’s Who: DEfEnsE hEalth agEncy

Cover / Q&A

13 25

mEDical organizErAssociate Deputy Assistant Secretary for National Healthcare Acquisitions Craig Robinson discusses the work of the Office of Acquisition and Logistic/National Acquisition Center.

facing DisEasECaptain David K. Weiss, command surgeon, AFRICOM, discusses disease prevention and elimination in sub-Saharan Africa.

The new Secretary of Veterans Affairs Robert A. McDonald is continuing the VA’s largely successful program of ending veteran home-lessness.

A new VA award of approximately $300 million in grants will help approximately 115,000 homeless and at-risk veterans and their families. The grant money will go out to 301 community agencies in every state and the District of Columbia, the Virgin Islands and Puerto Rico.

VA grant money is flowing through under the Supportive Services for Veteran Families (SSVF) program. These grants are going to private non-profit organizations and consumer cooperatives that provide services to very low-income veteran families living in—or transitioning to—permanent housing.

“By working with community non-profit organizations, we have enlisted valuable partners in our fight to end homelessness,” said McDonald. “The work of SSVF grantees has already helped thousands of homeless veterans and their families find homes and thousands more have been able to stay in their own homes.

We want to make sure our veterans receive the care and support that they have earned and deserve,” McDonald added. “This is a program that, indeed, makes a difference.”

Another major item in military medical is the development of a promising malaria vaccine that is the first vaccine of its kind. Malaria remains a major issue to military servicemembers and to military health missions abroad in Africa.

The quest for a malaria vaccine has gone on for quite some time with little result. The disease is a major killer of children in sub-Saharan Africa.

Until now, combating malaria has focused on prevention and treatment. The focus has been on destroying the mosquitos and their environments that carry disease, employing mosquito nets, devel-oping preventative drugs—the most famous of which has been quinine—and developing other drugs used once the illness has been contracted.

Of 1,000 children administered the newly developed vaccine, 800 did not contract the illness.As usual feel free to contact me with questions or

comments for Military Medical & Veterans Affairs Forum.

Christopher McCoyeditor

editor’s PersPectiVe


EditorialEditorChris McCoy [email protected] Editorharrison donnelly [email protected] Editorsean Carmichael [email protected]. Bissell • Peter Buxbaum • Henry Canadayhank hogan

art & DesignArt DirectorJennifer owers [email protected] and Materials ManagerJittima Saiwongnuan [email protected] Graphic DesignerScott Morris [email protected] Designers andrea herrera [email protected] Paquette [email protected]

advertisingAccount ExecutiveCasandra Jones [email protected]

kmi media groupChief Executive OfficerJack Kerrigan [email protected] and Chief Financial OfficerConstance Kerrigan [email protected] McKaughan [email protected] Castro [email protected] Show CoordinatorHolly Foster [email protected]

operations, circulation & ProductionOperations AdministratorBob Lesser [email protected] & Marketing AdministratorDuane Ebanks [email protected] Gill [email protected] Woods [email protected] Specialistraymer Villanueva [email protected]

a Proud member of:

subscription informationMilitary Medical &

Veterans Affairs Forumissn 2325-2383

is published five times a year by KMI Media Group. All Rights Reserved. Reproduction without permission is

strictly forbidden. © Copyright 2014.Military Medical & Veterans Affairs Forum

is free to qualified members of the U.S. military, employees of the U.S. government and non-U.S. foreign

service based in the U.S. All others: $75 per year. Foreign: $159 per year.

corporate officesKMi Media Group

15800 Crabbs Branch Way, Suite 300Rockville, MD 20855-2604 USA

Telephone: (301) 670-5700Fax: (301) 670-5701

Web: www.M2VA-kmi.com

Military Medical & Veterans Affairs Forum

Volume 18, Issue 3 • August 2014

KMI MEDIA GROUP LEADERSHIP MAGAZINES AND WEBSITES

www.GCT-kmi.com

UAS Leader

Col. Tim BaxterU.S. Army Project Manager UAS Project Office

Technology & Intel for the Maneuver Warfighter

May 2014Volume 5, Issue 3

www.GCT-kmi.com

Rapidly Deployable ISR O Tactical UAS O Enduring REFArmy Aviation O Wheeled Vehicles O Ammo

SPECIAL SECTION:MANNED-UNMANNED TEAMING

Ground Combat & Tactical ISR

www.M2VA-kmi.com

Military Medical & Veterans Affairs

Forum

www.GIF-kmi.com

Geospatial Intelligence Forum

www.MT2-kmi.com

Military Training Technology

www.MAE-kmi.com

Military AdvancedEducation

www.NPEO-kmi.com

Navy Air/Sea PEO Forum

www.MIT-kmi.com

Military Information Technology

www.SOTECH-kmi.com

SOCOM Leader

Adm. Bill H. McRaven

CommanderSOCOM

Diver Gear O 3-D Training O Protective Gear Mulltinational Partnerships

May 2014 Volume 12, Issue 4

www.SOTECH-kmi.com

World’s Largest Distributed Special Ops Magazine

Program Management Updates

SOCOM2014

Special Operations Technology

www.MLF-kmi.com

Reverse Auctions O Defense Transportation O Afghanistan RetrogradeILS O Supply Chain Efficiencies O DMSMS O Senior Logisticians

The Publication of Record for the Military Logistics Community

Resource Aligner

Vice Adm. William A. “Andy” Brown Deputy CommanderU.S. Transportation Command

SPECIAL PULL-OUT SUPPLEMENTUSTRANSCOM

www.MLF-kmi.com

November/December 2013Volume 7, Issue 10

Exclusive Interview with:

GAIL JORGENSONAcquisition Director USTRANSCOM

Military Logistics Forum

www.CGF-kmi.com

U.S. Coast Guard & Border Security

Compiled by KMI Media Group staffProGraM notes

In response to the Office of Special Counsel’s recent recommendations for the Department of Veterans Affairs, Acting Secretary of Veterans Affairs Sloan Gibson announced VA will restructure the Department’s Office of Medical Inspector (OMI) to better serve veterans.

“At VA, we depend on VA employees and leaders to put the needs of veterans first and honor VA’s core values of integrity, commit-ment, advocacy, respect and excellence,” said Gibson. “Given recent revelations by the Office of Special Counsel, it is clear that we need to restructure the Office of Medical Inspector to create a strong internal audit function, which will ensure issues of care quality and patient safety remain at the forefront.”

On June 23, 2014, the Office of Special Counsel sent a letter to President Obama

regarding VA whistleblowers. Following the letter, Gibson directed an immediate review and subsequent briefing of OMI’s operation, process and structure. As a result of the briefing, the acting secretary determined a clear need to revise the policies, procedures and personnel structure by which OMI oper-ates, and has directed a restructuring of the organization.

As long-term restructuring moves forward, the acting secretary has directed that, effective immediately, VA will appoint an interim director of OMI from outside the current office to assist with transition, and VA will suspend OMI’s hotline and refer all hotline calls to Office of Inspector General.

With the June 30 retirement of the indi-vidual who has served as the Medical Inspector

of the Veterans Health Administration for more than a decade, this restructuring will occur with the input of the team of individuals that the secretary has brought to VA to assist in addressing systemic issues and rebuilding veteran trust.

On June 13, 2014, Gibson sent a message to all VA employees regarding the importance of whistleblower protection and has met with employees at VA Medical Centers across the country to re-emphasize that message.

“As I told our workforce, intimidation or retaliation—not just against whistleblowers, but against any employee who raises a hand to identify a problem, make a suggestion, or report what may be a violation in law, policy or our core values—is absolutely unaccept-able. I will not tolerate it in our organization.”

VA to Restructure Office of Medical Inspector

The Department of Veterans Affairs released its bi-monthly data update showing progress on VA efforts to accelerate access to quality health care for veterans who have been waiting for appointments.

Acting Secretary of Veterans Affairs Sloan D. Gibson announced that VA outreach has now extended to nearly 140,000 veterans across the country to get them off of wait lists and into clinics for medical appointments. VA also released the latest updated, facility-level patient access data.

“In many communities across the country, veterans wait too long for the high quality care they’ve earned and deserve,” said Gibson. “As

of today [July 3, 2014], we’ve reached out to nearly 140,000 veterans to get them off wait lists and into clinics, and there is more work to be done. As we continue to address systemic challenges in accessing care, these regular data updates enhance transparency and provide the most immediate information to veterans and the public on improvements to veterans’ access to quality health care. We are fully committed to fixing the prob-lems we face in order to better serve veterans. We must restore the public’s trust in VA, but more importantly, we must restore the trust of our veterans who depend on us for care.”

The latest patient access data is available at www.va.

gov/health/access-audit.asp.

New burial regulations now allow the Department of Veterans Affairs to automatically pay the maximum amount allowable under law to most eligible surviving spouses more quickly and efficiently, without the need for a written application.

Under former regulations, VA paid burial benefits on a reim-bursement basis, which required survivors to submit receipts for relatively small one-time payments that VA generally paid at the maximum amount permitted by law.

“VA is committed to improving the speed and ease of delivery of monetary burial benefits to veterans’ survivors during their time of need,” said Acting VA Secretary Sloan Gibson. “The recent changes allow VA to help these survivors bear the cost of funerals by changing regulations to get them the benefits more quickly.”

This automation enables VA to pay a non-service-connected or service-connected burial allowance to an estimated 62,000 eligible surviving spouses out of a projected 140,000 claimants for burial benefits in 2014. Surviving spouses will be paid upon notice of the veteran’s death using information already in VA systems. The burial allowance for a non-service-connected death is $300, and $2,000 for a death connected to military service.

This revised regulation will further expedite the delivery of these benefits to surviving spouses, reduce the volume of claims requiring manual processing, and potentially make available resources for other activities that benefit veterans and their survivors.

Acting Secretary Gibson Continues to Provide

Transparency on Wait Times

New Regulations Automate Burial Payments

for Veterans’ Survivors

www.M2VA-kmi.com M2VA 18.3 | 3

Navy Captain David A. Lane has been selected for the rank of rear admiral (lower half), and will be assigned as medical officer of the Marine Corps and as director, Health Services, Headquarters Marine Corps, Arlington, Va. Lane is currently serving as commanding officer, Naval Hospital Camp Lejeune, N.C.

Brigadier General James H. Mason, U.S. Army Reserve, deputy commander of troop program unit, 807th Medical Command (deployment support), Camp Parks, Calif., has been assigned as deputy commander (troop program unit), 807th Mission Support Element, Camp Parks.

Compiled by KMI Media Group staffPeoPle

Compiled by KMI Media Group staffProGraM notes

Capt. David A. Lane

Acting Secretary of Veterans Affairs Sloan Gibson met with Carolyn Lerner, special counsel of the United States Office of Special Counsel, following the office’s letter to the president regarding VA whistle-blowers.

Following through on recent recommendations for the Department of Veterans Affairs, the acting secretary committed to VA working to achieve compliance with the OSC 2302 (c) Certification Program, and also reaf-firmed his focus on ensuring protec-tion from retaliation for employees who identify or report problems. Gibson updated the special counsel on the ongoing review of all aspects of the Office of Medical Inspector’s operation, which he ordered upon release of the letter. He re-empha-sized his commitment to earn the trust of veterans who VA is privileged to serve.

Special Counsel Lerner and Acting Secretary Gibson identified in their July 1, 2014 meeting ways to streamline the organizations’ work together to ensure whistleblower protection during the course of an OSC investigation.

Leigh Bradley accompanied the acting secretary to the meeting. She has temporarily joined VA effective Monday, July 7, on a detail from DoD to serve as special counsel to the acting VA secretary. Bradley is a former VA general counsel, former principal deputy general counsel of the Navy, and current director of the Department of Defense Standards of Conduct Office where she is respon-sible for DoD’s ethics program and policies. She is a veteran of the U.S. Air Force.

Acting Secretary of Veterans Affairs Sloan D. Gibson released the following state-ment after President Obama’s announce-ment that he intends to nominate former Proctor & Gamble chief executive Robert A. McDonald to be the next secretary of Veterans Affairs.

“Today [June 30, 2014], after a careful search, President Obama announced his intention to nominate former Proctor & Gamble chief executive Robert A. McDonald to be the next secretary of Veterans Affairs.

“I have been close friends with Bob McDonald for over 40 years; I welcome his nomination with the utmost enthusiasm. He is an exceptional person—a great leader, a skilled manager, an extraordinarily talented executive of great experience and a man with the strongest moral compass.

“All of those attributes contributed to his rise through the ranks to the top spot at P&G, a Fortune 50 company with more than 120,000 employees. Under his stewardship, P&G consistently ranked among the best companies in the world for leadership devel-opment, being twice named best company for leaders by Chief Executive magazine.

“Bob graduated from West Point in the top 2 percent of his class and served five years in the U.S. Army. He was a captain in the 82nd Airborne Division before leaving the Army to join P&G. He is a life member

of the U.S. Army Ranger Association and the 75th Ranger Regiment Association.

“His commitment to veterans is deeply personal. His father served in the Army Air Corps just after World War II. His wife’s father was shot down over Europe during World War II and ended the war as a POW. Her uncle was exposed to Agent Orange in Vietnam and still receives treatment from VA.

“With his years of executive success and principled leadership philosophy, stressing caring for others and personal ethics—choosing ‘the harder right instead of the easier wrong,’ in words he often quotes from the West Point Cadet Prayer—he is an inspired and inspiring choice to lead VA through this period of restructuring and reform.

“The planned nomination of Bob McDonald to be the next secretary of Veterans Affairs is a very positive step. I will do everything I can to help him be successful, and I expect the same to be true for our dedicated VA workforce.

“Personally, professionally, and on behalf of veterans and all of our VA employees, I look forward to Bob’s speedy confirmation—and to working closely with him and the rest of our VA leadership team toward restoring the public trust in VA by providing veterans and their families the very best in timely care and benefits.”

Acting Secretary Gibson Meets with Special Counsel on

Whistleblower Protections

Statement from Acting Secretary of Veterans Affairs Sloan D. Gibson

www.M2VA-kmi.com4 | M2VA 18.3

There are a number of degree programs in the health sci-ences available to veterans of the services or active-duty military members. Many of the classes offered by schools are online, which works for students seeking a more flexible schedule or who are stationed onboard a ship or deployed in a far off location. Some of the degree programs available to servicemembers and veterans are examined here, alongside the schools that offer them.

Kaplan University

Kaplan University views the completion of higher academic credentials as collaboration between the skills earned in the military and those needed to fulfill the requirements of a college credential.

“We place great value on the training that is received. Our culture is not to provide a generalized amount of credit without really understanding how that training stacks up against the skills needed for the degree,” said Brian Sayler, the executive director for Military Affairs at Kaplan University.

For the Associate of Science in health science (ASHS), Kaplan mapped specific military occupations and created specialties within the degree corresponding to those occupations. This provided a higher education credential that mirrored service-members’ and veterans’ military work, collectively demonstrating a comprehensive mastery and application of the curriculum. It in some cases significantly shortens the time to gain the credential, sometimes requiring as few as five courses.

“The ASHS program was launched in November 2012 with great success and is one of the more popular programs at Kaplan

University,” said Sayler. “Many of our graduates go on to achieve their bachelor’s degree, which often can also have additional earned credits applied to the degree within upper electives.”

Tuition at Kaplan is reduced within the amount afforded by the GI Bill in most cases. Tuition is reduced by 38 percent for veter-ans and 55 percent for active duty for undergraduate programs at Kaplan University. The school also waives technology fees. In addi-tion, books are provided at no additional cost.

“We also waive fees for our veteran students. Veterans also have the benefit of military experience as well as the challenges of adult learners, often hold-ing down jobs and raising families,” said Sayler. “We provide service to our veterans through our military student support center to make the most of the mili-tary training, and help them navigate through the issues facing adult learners. Our online format allows for flexibility and is often critical to their success.”

The majority of Kaplan’s military students attend online, and the school has broad diversity within this population in gender, race, and the civilian and military mix.

“In fact, almost 24 percent of our student body has military experience or is the spouse of a military member,” said Sayler. “This diversity improves the interaction within our virtual classrooms and provides the military perspective to students not often exposed to this point of view at many traditional schools.”

Key areas where veterans can receive service credit for creden-tials include medical, combat arms, legal studies and business.

“We also do a transcript analysis of all veteran students, regardless of occupation, to identify possible credits. A course is

a nUmber of schools offer perKs to servicemembers and veterans seeKing a career in the health sciences.

brian sayler

by chris mccoy, m2va editor


also offered that allows them to identify additional skills that can be awarded credit [that are] not present on their military tran-script. In total, up to 75 percent of credit can be earned through a combination of all these sources,” said Sayler. “Kaplan University also accepts transfer credit from other accredited schools and Ser-vicemembers Opportunity Colleges Consortium members.”

Since the Kaplan virtual campus is online, the school reaches all corners of the word.

“While our physical campuses reside in states such as Iowa, Maine, Maryland, and Nebraska, the majority of military students study online so can they reside virtually anywhere,” said Sayler.

a.t. still University

The vision of A.T. Still University’s College of Graduate Health Studies (ATSU-CGHS) is to be the preeminent online school for leaders in the health professions, focused on academic excellence and innovation.

“We provide a contemporary and flexible cur-riculum that empowers our students to translate knowledge to meet the growing needs of domestic and global health and wellness,” said Mike Jackson, Ph.D., MPH, chair and professor of public health at ATSU-CGHS. “Building off that vision, our program works with graduate students who are focused on expanding their knowledge and leadership abilities for responsible public health practice, policy and access to care.”

ATSU-CGHS’s Master of Public Health (MPH) degree is earned entirely through online study and course completion.

“As a part of the larger A.T. Still University of Health Sciences, our aim and focus is to educate current and future leaders in the health professions. As such, we prepare students to work in the public health profession through the MPH general emphasis degree,” said Jackson. “For those students who have an interest and education in the dental profession, we offer an innovative MPH degree with a dental emphasis. For those students who are currently enrolled in either of the university’s medical or dental schools, it is possible to earn the MPH degree concurrently with their Doctor of Osteopathic Medicine or Doctor of Dental Medicine.

“The MPH program began in 1999 and is earned online, there-fore the MPH/public health campus is virtual,” said Jackson. “A.T. Still University offers medical, dental and health sciences graduate degrees on campuses in Kirksville, Mo., and Mesa, Ariz. These are the physical locations of the administrative offices for ATSU’s Col-lege of Graduate Health Studies, which is the home of the MPH program.”

One of the benefits for veterans attending the school is reduced tuition rates.

Johns hopKins University

Johns Hopkins Bloomberg School of Public Health is based in east Baltimore on the historic Johns Hopkins Medical Campus, which also includes the hospital and the schools of medicine and nursing as well as research libraries. The campus is only one mile from the waterfront and Baltimore’s Inner Harbor and provides a shuttle service that also stops at Baltimore’s Penn Station; there

also is a subway stop a few blocks from the school’s main buildings.Johns Hopkins MPH students come from diverse backgrounds

such as physicians, nurses, lawyers, health educators, social scien-tists and more. They have included a number of current and past military personnel.

Some of the military students go through the two-year Occu-pational and Environmental Medicine Training Program at Johns Hopkins, which includes the MPH as the first year. Others com-plete the MPH as part of the NASA-funded Aerospace Medicine training program. In addition, approximately two to three stu-dents per year complete the MPH as part of their military surgical residency programs.

“Our MPH program is flexible,” said Marie Diener-West, Ph.D., chair, Master of Public Health Program and Abbey-Merrell Profes-sor of Biostatistics. “Our full-time MPH program is 11 months long. Since the 1990s, we have offered a part-time MPH program that can be completed over two to three years and includes selec-

tions from more than 100 online courses, as well as intensive format courses held over one to three weeks.”

The Johns Hopkins MPH program has been noted as one of the best in the world. Consistently ranked the number one school of public health by U.S. News and World Report, Johns Hopkins Bloom-berg School of Public Health was founded in 1916 and is the largest and oldest program of its kind in the world.

Approximately 35 percent of the MPH student body is international, coming from 80 different countries. All students take courses in the core

areas of epidemiology, biostatistics, public health biology, man-agement sciences, environmental health and social behavioral sciences. However, they can specialize in concentration areas that include health in crisis: humanitarian assistance, health leader-ship and management, among others.

“Although there is no academic credit for military experience, the background and experiences of the former or current military students contribute so much to the collective student environ-ment, both in and outside of the classroom,” said Diener-West.

the University of maryland University college

The University of Maryland University College’s (UMUC) Mas-ter of Science in health care administration is an applied degree designed for mid-career professionals in health care who are seeking to focus their studies in health care administration in areas such as financial management, information technology, legal and policy, and population health. The degree program dates back to 2002.

“The Master of Science in health care administration [MSHCA] can prepare students for a leadership role in one of today’s fastest-growing fields,” said Diane Bartoo, associate chair and program director for the MSHCA.

Students learn how to produce effective health care outcomes and impact ethical decision making in health care settings while solving complex health care challenges.

“While our program is offered fully online, we also offer some courses on-site at various military facilities in Europe and Asia, as well as hybrid (half online and half face-to-face) and on-site courses in the Maryland /D.C./Virginia area,” said Bartoo. “All of our faculty,

Mike Jackson


including several current and former military servicemembers, are experienced health care professionals who work or have worked within many different health systems. They bring their extensive and practical knowledge and skills into our classes.”

UMUC offers graduate students the opportunity to earn dual health care and MBA degrees. In addition to a Master of Science in health care administration, UMUC also offers a Master of Sci-ence in management (MSM) with a specialization in health care administration, a master’s degree in health informatics adminis-tration, and a number of certificates and joint degrees, such as a dual MBA joined with either the MSHCA or the MSM with a health care specialization.

While students in both the MSHCA and MSM take some similar coursework, the MSHCA requires the educational and/or experiential background in health care or health care administra-tion for students to be successful.

UMUC also has specially trained advisors that can help veterans plan their academic journey and work directly with them to under-stand their benefits and how they can best be used to accomplish their academic goals. UMUC also has a Veterans Certification Office which helps veteran students in applying for their veterans benefits. For students, UMUC offers a Veterans Success Club.

“More than half of our approximately 90,000 students are active duty military, their dependents and veterans,” said Bartoo. “The typical MSHCA student is in his/her mid-30s. Seventy-five percent are female. Approximately 50 percent of students are

African American, 24 percent are Caucasian, 6 percent Hispanic and 5 percent Asian.”

For undergraduate studies, students may receive credit for prior learning in the military. UMUC has advisors specially trained to help plan an academic program for students who have military backgrounds. Advisors work with the student, assess prior learn-ing, and evaluate the student’s record to determine what credits might be awarded.

For graduate students, UMUC also has specially trained advi-sors who will assist military students. Up to six graduate transfer credits from an accredited institution can be considered.

All veterans living in Maryland are entitled to the resident rate for tuition. For those veterans entitled to the full benefits of the Post 9/11 GI Bill benefits, UMUC fully subscribes to the Yellow Ribbon program that splits the cost between the Veterans Admin-istration and UMUC for the cost above the in-state rate, so there is no cost to the veteran.

Altogether, veterans and active duty servicemembers have a lot of options when picking a program in the health sciences. Reduced tuition and the GI Bill are two perks to help jumpstart a career in the health sciences. O

For more information, contact M2VA Editor Chris McCoy at [email protected] or search our online archives for related stories at www.m2va-kmi.com.

For comprehensive consumer information, visit www.kaplanuniversity.edu/student-consumer-information.aspx.

Kaplan University is accredited by The Higher Learning Commission (HLC) and a member of the North Central Association of Colleges and Schools (NCA). For more information, visit their website at hlcommission.org. Use the links under “Contact Us” to reach the Commission.

* Based on a full-time active-duty student who transfers in 65 quarter credit hours (the maximum amount of credit). Credits transferred may vary according to your previously completed MOS/NEC, current military status, or affiliation (active, veteran, member of the National Guard, or reservist).

† Military tuition reductions cannot be combined with any Kaplan University scholarships or tuition discounts/vouchers.

Medical personnel: you may be as few as 5 courses from a degree in health sciences.*

• 42 military occupations have been evaluated for credit

• Associate’s, bachelor’s, and master’s degree programs available

• Tuition reduced 55 percent for servicemembers†

Find out more and enroll at militarymedical.kaplan.edu or call 877.809.8445.

Online | Accredited | Servicemembers Opportunity Colleges (SOC) Member


The symptoms presented by burn patients seen by the U.S. Army burn center in San Antonio, Texas, changed over the years as the focus of U.S. military actions shifted from Iraq to Afghanistan.

“In 2003, most of those patients were from Iraq,” said Colonel Dr. Booker T. King, director of the U.S. Army Institute of Surgi-cal Research Burn Center at Joint Base San Antonio-Fort Sam Houston.

“The vast majority of them were travel-ing in a vehicle that hit an improvised explo-sive device when the IED exploded and the vehicle caught fire.”

As the war in Iraq wound down and the conflict in Afghanistan surged, a different kind of patient showed up at the burn center. “By 2009 or 2010, most of our patients were coming from Afghanistan. Most of these were dismounted soldiers on foot patrol. When they hit an IED they would have not only significant burns, but also soft tissue trauma,” said King. As a result, the burn center had to broaden its capabilities to treat all of the symptoms and injuries exhibited by these newer patients.

The burn center doesn’t treat only mili-tary patients injured in theaters of opera-tions. For that matter, the center doesn’t treat only military patients. “We receive military patients who have suffered burns anywhere in the country or the world,” said

King. “In the last year or so, we haven’t received any patients from Iraq or Afghani-stan. We treat civilians because we are the regional burn center for southern Texas. We also treat civilians who are military retirees and veterans as well as their beneficiaries.”

Treating burn patients, whether in the immediate aftermath of an incident or up the line in the course of lon-ger-term care, requires adher-ence to established protocols. The immediate concern after a burn injury has been inflicted is the cooling down of the area to minimize the de-vitalization of tissue and to provide comfort to the patient before moving them on to the next line of care. It is also important that healing be facilitated through a process called debridement, which involves the removal of dead tissue and the facilitation of healthy tissue growth. At all times, the burn site must be kept clean. Companies in the private sector have introduced products that help clinicians accomplish these aims.

“The military scenario is completely different than

the civilian scenario,” said Patrick Bourke, clinical educator at Water-Jel Technologies International. “With civilian patients, the primary concern would be for the burn. An injured patient from the military is likely to have suffered burns as a result of an IED blast or some other explosive. In these cases, the burns are usually secondary to injuries

such as traumatic amputa-tion. In cases where the burn is of greater concern, one of the big problems is the kill-ing of the flesh in the area of the burn. That is the reason for having an effective burn management protocol.”

Debridement of the burn is one key to its effective treatment. “Debridement is the process of removing dead tissue from a wound until the surrounding healthy tis-sue is exposed, allowing it to advance the wound through the healing process,” said Beth Joy-Dougherty, direc-tor of corporate market-ing at Derma Sciences Inc. “Debridement is indicated for any wound when necrotic tissue, foreign bodies or infected tissue is present. The

the military continUes to advance its bUrn care

technologies.

by peter bUxbaUm

m2va correspondent

col. Dr. booker t. King

Patrick bourke


presence of necrotic tissue or foreign bodies within a wound can lead to more serious consequences involving infections and even limb amputation. It is imperative that an effective wound management strategy be structured.”

Because of the complexity of the cases presented by military patients, the Army burn center has acquired advanced technologies to deal with the other injuries warfighters often show in addition to their burns. “These patients usually have multiple injuries,” said King. “Kidney failure and respiratory prob-lems are two of the most common condi-tions they exhibit. We have different kinds of technologies for kidney failure and advanced ventilators for respiratory problems. The new bypass ventilators can oxygenate the blood while the lungs are healing. We have used this capability for patients with severe inhala-tion injuries as well as medical patients with advanced respiratory illnesses that couldn’t be treated by conventional means.”

The first step in a burn control protocol is to stop the burning process by cooling the injury. “It is important to remove the heat source in the first place and to keep the area clean as the patient is prepared for transport,” said Bourke. “The heat produces pain. Once the heat is taken away it will stop attacking the nerve endings and provide some comfort to the patient.”

Water-Jel products have been on the market for over 30 years and were originally designed with the military in mind, noted Bourke. “The primary requirement was for something that could absorb the very high

temperatures that the human flesh was exposed to,” he explained. “Water-Jel can absorb over 2,000 degrees Fahrenheit of heat irrespective of the offending medium. It is also certified clinically to clean the burn injury and to kill microorganisms that attack the burn within the first [few] hours.”

Water-Jel is a mixture constituting 96 percent deionized water, 0.4 percent tea tree oil and 2 percent food-grade gelling. This mixture is impregnated into dressings that can be applied to a wide variety of wounds. The dressing itself is made of medical grade woven polyester that can carry up to 13 times its own weight.

“The gelling agent is there to keep it all together,” said Bourke. “If the burn is cooled with water alone, it is not as effective because the water will evaporate quickly. Water-Jel cools by a convective process that takes excess heat into itself. The gel warms up and then radiates heat off its top. The cooling mechanism is critical.”

The Water-Jel products can be left on the patient for four to six hours and are non-adherent, so that a medic can lift the dressing to observe the wound. “It works well in harsh environments and is effective in a broad spec-trum of uses,” said Bourke. “Water-Jel is the only burns product tested and approved as effective for treating white phosphorus burn injury patients in the emergency setting. It works whether the burn is concave—that is, there is a hole in the tissue—or convex—in which the tissue is blistering. The gel fills the aperture and in the case of a blister bursting it provides constant and continual cooling.

The key is that the cooling agent must be in contact with all aspects of the burn. If not, the cooling will not be constant and certain areas will continue to burn.”

The company produces a universal dressing specifically designed to treat burns on the hands and face. “Military surgeons say that 70 percent of burns occur on the hands and face,” said Bourke. “The armor that warfighters wear protects much of the rest of their bodies.”

Water-Jel also produces a line of fire blankets that double as a quick method of administering emergency first aid burn care. “The U.S. military has been using these in transport vehicles because they are facing armor-piercing weapons that can create a heat source and start a fire within a vehicle,” said Bourke. “Since the blankets are gel soaked, they can function as a burn dressing, easing the pain, cooling the burn, and helping to protect against airborne contamination, as well as a fire blanket that can be used to extinguish flames on a victim and put out small fires.”

Derma Sciences produces two lines of products used in the treatment of burn injuries. The company’s Medihoney line is a natural product that aids in the process of autolytic debridement of burns, in which the body’s own enzymes are used to soften and liquefy necrotic tissue so that it can be easily removed. The company’s Bioguard line incorporates an active agent in the substrate level of a dressing that kills patho-gens within the dressings, keeping the burn site safer.


“Medihoney has been on the market since 2007 and has had positive clinical out-comes for first- and second-degree burns,” said Dougherty. “It naturally helps promote autolytic debridement and a clean burn environment. During autolytic debridement enzymes present in the wound have the effect of liquefying non-viable tissue. By maintaining a moist wound environment, the body is able to use its own processes to eliminate devitalized tissue.”

Honey has been documented to have healing properties for thousands of years. During the 1970s, scientific investigations discovered the specific factors in honey that promote healing. “When it comes to burn care, we are talking about a specific type of honey,” said Dougherty. “We produce medi-cal grade honey from manuka plants that have been pollinated by bees in New Zea-land. Ordinary honey can be used to clean burns and to promote debridement but it is not as high in the active ingredients and the properties that make medical grade honey more effective.”

Medical grade honey has a high sugar content, which facilitates the movement of fluid from an area of higher concentra-tion to an area of lower concentration. Additional fluid is drawn from the deeper tissue to the wound surface, which helps the body’s natural processes to cleanse the wound, removing debris and necrotic tissue.

Medihoney also has lower, or acidic, pH levels. “The failure of a chronic wound to heal has been correlated with alkaline pH levels,” said Dougherty. “The honey helps to reduce the pH of the wound environment and contributes to the acidic environment that promotes healing. Lowering the pH also aids the body’s natural processes for removal of necrotic tissue.” Studies have down that each 0.1 decrease in pH was associated with an 8.1 percent reduction in wound size.

In addition, honey has an off-label use as an antimicrobial. “Medihoney is sold and promoted as an antimicrobial everywhere outside the United States,” said Dougherty. “We don’t have FDA clearance to promote it as such here, but the literature supports that assertion.”

Medihoney comes in a full line of prod-ucts, including a tube form that contains 100 percent Medihoney. There is also a gel that contains 20 percent Medihoney mixed with natural emollients and goes on like a cream. It has also been impregnated into a variety of dressings.

The U.S. military was among the first to study Medihoney. “One of the first articles published on Medihoney was by a U.S. mili-tary surgeon in Iraq,” said Dougherty. “We also work with VA and military hospitals.”

Derma Science’s Bioguard line of dressings includes a strong cationic bio-cide known as poly diallyl dimethyl ammo-nium chloride, or pDADMAC. “PDADMAC is applied to the dressing substrate during the manufacturing process,” said Dougherty. “It prevents bacteria from proliferating within the wound and also reduces the risk of cross contamination that could come about from the release of bacteria into the air.”

Use of this biocide in wound dressings, along with the bonding techniques utilized to intrinsically bind pDADMAC to wound dressing substrates, is covered by nine U.S. patents and patents pending. The Bioguard product was launched in 2010. “This product received de novo clearance from the FDA, which means that there is no other dressing like it on the market,” said Dougherty.

King expects further advancements in burn care to come from the area of rejuve-native medicine. “We are in involved in FDA studies that are looking at substitutes for skin,” he said.

In one FDA study, some patient skin is removed and dissolved in a solution that can be sprayed on the patient. “The advantage

is that you can take a small piece of the patient’s skin and use it to cover a much larger surface area,” King explained. “This is still in the study phase. The results of testing are looking pretty good and we hope it will be approved by the FDA and made available for general use.”

King expects other advancements in the area of organ support, an often necessary accompaniment to caring for burn patients. “What often happens with burn patients is that, because of the severity of the injury, they tend to develop organ failure,” he said. “One common condition is kidney failure. One of our doctors is heading a study on a support system for kidneys called continual renal replacement therapy. We are looking into that for burn patients.”

Developments that grew out of the con-flicts in Iraq and Afghanistan have provided the Army burn center greater capabilities in the treatment of critically ill patients, King noted. “Many of the advancements that have come about and the research that is now being conducted will benefit not only our military population but also burn patients as a whole,” he said. O

A burn victim undergoes surgery to remove skin from his legs that will be grafted over his burn in the emergency room at Brooke Army Medical Center. [Photo courtesy of Brooke Army Medical Center/by Petty Officer 2nd Class Jhi Scott]

For more information, contact M2VA Editor Chris McCoy at [email protected] or search our

online archives for related stories at www.m2va-kmi.com.


The most common abnormal heart rhythm for spontaneous cardiac arrest is ventricular fibrillation. This is essentially when the heart is beating totally ineffectively and erratically at a rapid rate and produces no output of blood. It is almost always fatal if it proceeds for too long. CPR alone will not stop the process and early defibrillation is required. The most effective and easy way to deliver defibrillation is through an automated external defibrilla-tor (AED). These devices vary, but they all analyze the rhythm of the heart and if appropriate (i.e., if the patient is in ventricular fibrillation) provide a shock automatically with the push of a but-ton. The operator does not need to do any analysis—they simply follow the directions.

“Contrary to popular belief, defibrillation does not restart the heart. Defibrillation is the process of using electricity to stop the heart completely. If the heart has enough metabolic substrate (energy) left, it will restart,” said Dr. Jeffrey Leggit of the Uni-formed Services University of the Health Sciences. “The longer a cardiac arrest proceeds, the less energy is left to restart the heart. Thus the sooner an AED can be applied, the better the chance of survival. This is why it is important to have AEDs available in pub-lic places as well as within medical facilities.”

a history of resUscitation

Zoll Medical Corporation has provided resuscitation products for militaries worldwide for over 25 years.

“As the only defibrillator company to be awarded the Corporate Exigency Defibrillator Contract from DLA-Troop Support twice, we take our responsibility to meet surge military operational and humanitarian requirements seriously,” said Brenda M. Butler, vice president of government sales.

All of Zoll’s military products are designed to meet the rigors of front line combat casualty care.

“Our air-worthy certified products, manufactured in Chelms-ford, Mass., go through rigorous testing to meet all necessary military standards. Lessons learned from recent conflicts point to a growing desire for merging patient monitoring and cardiac defibrillation into smaller/single devices,” said Butler. “Unique requirements dictate the need for improved clinical parameters, a third integrated invasive pressure and advanced data commu-nications for electronic health records and future telemedicine

solutions. The result of Zoll’s efforts to close those capability gaps is the Propaq MD.”

The Propaq MD is the smallest, lightest and most robust full-featured defibrillator/monitor on the market. The Propaq MD offers advanced monitoring parameters, life threatening arrhythmia alarms and full AED functionality. Moreover, CPR support is avail-able with the company’s CPR Dashboard that displays CPR quality in real time. The Propaq MD also features See-Thru CPR, which minimizes the duration of pauses in CPR by enabling rescuers to see the underlying rhythm without stopping chest compressions.

“Weighing just over 11 pounds, it has quickly gained favor with all manners of medical providers, including aeromedical evacuation, special operations, in-garrison care and those across the continuum of en route care,” said Butler.

Battlefield medics assigned to medevac and ground compo-nents units are seeking AEDs in smaller form factors that are capable of providing lifesaving medical care at the point of injury. The Propaq MD provides the patient monitoring and cardiac defi-brillation capabilities necessary for health care support operations from role 1 through role 4.

Designed to be used with patients of all ages, its monitoring capabilities include 3-, 5- or 12-lead ECG monitoring, non-invasive blood pressure (NIBP), EtCO2, SpO2, SpCO and SpMet, as well as three invasive blood pressures and two temperatures.

“The navigation-friendly display, six-hour battery run-time and unparalleled ingress rating of IP55 best meet the military’s unique needs. Zoll also offers the Propaq M, an identical vital signs monitor without the integrated defibrillator/pacemaker,” said Butler.

The Propaq MD also has a dedicated communications proces-sor that offers both wired and wireless data connectivity, including integrated WiFi, bluetooth, Ethernet and USB options. USB-based cellular modems designed for the Propaq platform are also available.

“As data communications and electronic patient care records become more important, Zoll’s open data architecture allows patient data to flow from our device into a number of different EHR systems or telemedicine solutions,” said Butler. “Should a cardiac event take place during transport, code data is available for docu-mentation, debriefing and quality improvement initiatives using Zoll’s RescueNet Code Review.”

The Propaq MD also provides the capability to easily integrate new parameters. As an example, the company recently signed an

by stopping ventricUlar fibrillation, a heart can be restarted.

by chris mccoy, m2va editor


agreement with Reflectance Medical Inc. to incor-porate a ruggedized version of the Mobile Care-Guide sensor into the Propaq MD and Propaq M via USB port. The Mobile CareGuide has the abil-ity to simultaneously and continuously measure muscle oxygen saturation and pH noninvasively.

“A key design criterion of the Propaq MD was to maintain backwards compatibility,” said Butler. “With today’s fiscal constraints and the need for joint service standardization, the Propaq MD can utilize the majority of both Zoll M Series CCT and Propaq 206 Encore accessories currently in theater, thereby reducing costs and improving logistical efficiencies.”

two types of defibrillators

Philips Healthcare provides both AEDs and advanced life sup-port (ALS) monitor/defibrillators.

“The original Philips AED helped trigger the public access defibrillation movement more than 18 years ago. Philips not only recognizes developments in defibrillation therapy, we engineer their evolution,” said Bob Peterhans, general manager, emer-gency care and resuscitation at Philips Healthcare. “Our ALS devices unite Philips’ industry-leading monitoring technologies with superior diagnostic measurements and our patented Smart Bipha-sic resuscitation waveform in single, thoughtfully designed, lightweight devices.”

According to Peterhans, Philips’ products com-bine advanced defibrillation and monitoring tech-nology. This technology includes pulse oximetry, NIBP, invasive blood pressure, capnography, con-tinuous temperature monitoring, DXL 12-lead ECG algorithm and ST/ arrhythmia analysis, ST-segment elevation myocardial infarction clinical decision support tools and Q-CPR technology.

The company’s Q-CPR technology offers medical professionals corrective feedback on the rate and depth of chest compressions, as well as the frequency and quality of ventilations, encouraging them to adjust their technique as needed to comply with American Heart Association guidelines.

Philips Healthcare defibrillators are also rug-gedized. The HeartStart MRx monitor/defibril-lator and HeartStart FR3 AED have received aeromedical certification from the U.S. Army and Safe to Fly Certification from the U.S. Air Force.

“Our HeartStart defibrillators are on two federal contracts: VA Federal Supply Sched-ule V797P-2238D and DLA contract SPM2D1-09-D-8349,” said Peterhans. “These contracts are accessible to customers through the usual methods such as GSA Advantage, ECAT, FedBid and prime vendor agreements.”

So far, Philips Healthcare has sold over 1 million units.

specific applications

Cardiac Science offers AEDs in three models designed for spe-cific applications. The company’s Powerheart AED G3 Plus Auto-matic is designed for public-access use. The Powerheart AED G3 Plus Semi-automatic is used by first responders but is also used in some public-access applications. And the Powerheart AED G3 Pro is designed to be used by professional rescuers with ALS training,

as it incorporates an ECG display, manual override and monitoring capabilities.

“Each Powerheart G3 AED model incorporates the highest levels of automated self-testing available in the industry, maximizing their levels of reliabil-ity,” said Ted Rioux, Cardiac Science’s director of distribution. “The lithium ion battery technology, developed for use in the Powerheart G3 lineup, is highly advanced and supports this high level of automated self-testing.”

Cardiac Science also utilizes the Self-Tracking Active Response biphasic truncated exponential waveform technology in its Powerheart AEDs, which

enables the delivery of variable escalating energy based on imped-ance levels of the patient.

“Key ease-of-use features minimize the number of operations required of users, thereby minimizing the opportunity for human error. In addition, advanced audio prompts incorporated into Car-diac Science’s RescueCoach technology provide advanced instruc-tion on how to deploy the AED and also instruct the user on how to deliver effective CPR,” said Rioux.

Powerheart AEDs are also ruggedized so they can be used in the most strenuous of environments by clients such as the U.S. military and Canadian Coast Guard. The G3 Pro has also earned air-worthiness certification from the U.S. Army.

The company’s total worldwide installed number of AEDs exceeds 600,000 units and the Powerheart G3 Plus Automatic for public access use is the most popular model.

Although the number of manufacturers of AEDs is small, it’s readily apparent that those manufacturers offer a number of customized machines to serve the purpose of ending ventricular fibrillation. O

bob Peterhans

The Propaq MD offers advanced monitoring parameters, life threatening arrhythmia alarms and full AED functionality. [Photo courtesy of Zoll Medical Corporation]

For more information, contact M2VA Editor Chris McCoy at [email protected] or search our online archives for related stories at www.m2va-kmi.com.The HeartStart MRx monitor/defibrillator has received aeromedical certification from the U.S. Army

and Safe to Fly Certification from the U.S. Air Force. [Photo courtesy of Philips Healthcare]



Q: What is AFRICOM’s medical mission in Africa?

A: The U.S. Africa Command Office of the Command Surgeon medical team works to synchronize with global partners to preserve the health and well-being of our forces, support ongoing operations and activities, and build partner military medical capacity and capability. The goal is to foster a stable and secure

environment in Africa. The AFRICOM Office of the Command Sur-geon is comprised of a joint team of civilian and military medical specialists, which includes medical planners, international health specialists, environmental and public health officers, and an infec-tious disease specialist.

Q: Could you tell us about the development of a malaria vaccine and its importance?

A: There is no vaccine currently available for the prevention of malaria in travelers, although we are aware of research in this area. The Centers for Disease Control and Prevention (CDC) has made available extensive information about the prevention of malaria in travelers: http://www.cdc.gov/malaria/travelers/index.html.

Q: With the outbreak of Ebola in West Africa recently, what has been AFRICOM’s response? Have you been partnering with national and regional health care providers? Can AFRICOM have a role in treatment options with pharmaceutical companies and national and regional health care providers?

A: The AFRICOM Office of the Command Surgeon is monitoring the situation, and our primary effort is to protect U.S. forces. The Department of Health and Human Services is the lead agency at this point. Much of the partnering with national and regional health entities in Africa is also being done via the CDC and U.N. AFRICOM is prepared to assist the interagency in a coordinated,

whole of U.S government response to the Ebola outbreak in West-ern Africa.

Q: What are the benefits and challenges of conducting joint medical exercises with friendly African nations?

A: A significant benefit of these medical capacity and capability building engagements is that they do not only benefit host nation militaries, but also the medical care of the general population, as many receive health care at military medical facilities on the African continent. All our lines of effort are in direct support of the theater strategic objectives established by the AFRICOM commander. Opportunities are created whenever we interact with partners. By working with our African partners, we cre-ate relationships to help build and support medical capacity and capability. O

Marines take doxycycline once per day in accordance with a weekly dosage of mefloquine to prevent the spread of Malaria. Symptoms of malaria include nausea, headaches, chills and uncontrollable fevers. [Photo courtesy of the U.S. Marine Corps/by Lance Corporal Timothy L. Solano]

capt. David K. Weiss

disease prevention and elimination in sUb-saharan africa.

In an exclusive interview, AFRICOM Command Surgeon Captain David K. Weiss discusses AFRICOM’s medical mission in sub-Saharan Africa.


Vital siGns

The U.S. Food and Drug Administration allowed marketing of the Deka Arm System, the first prosthetic arm that can perform multiple, simultaneous powered movements controlled by electrical signals from electromyogram (EMG) electrodes.

EMG electrodes detect electrical activity caused by the contraction of muscles close to where the prosthesis is attached. The electrodes send the electrical signals to a computer processor in the prosthesis that translates them to a specific movement or movements.

The EMG electrodes in the Deka Arm System convert electrical signals into up to 10 powered movements, and the system is the same shape and weight as an adult arm. In addition to the EMG electrodes, the Deka Arm System contains a combination of mechanisms including switches, move-ment sensors and force sensors that cause the prosthesis to move.

“This innovative prosthesis provides a new option for people with certain kinds of arm amputations,” said Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health. “The Deka Arm System may allow some people to perform more complex tasks than they can with current prostheses in a way that more closely resembles the natural motion of the arm.”

The FDA reviewed clinical information relating to the device, including a four-site Department of Veterans Affairs study in which 36 Deka Arm System study participants provided data on how the arm performed in common household and self-care tasks. The study found that approximately 90 percent of study participants were able to perform activities with the Deka Arm System that they were not able to perform with their current prosthesis, such as using keys and locks, preparing food, feeding oneself, using zippers, and brushing and combing hair.

The Deka Arm System can be configured for people with limb loss occurring at the shoulder joint, mid-upper arm or mid-lower arm. It cannot be configured for limb loss at the elbow or wrist joint.

Data reviewed by the FDA also included testing of software and electrical and battery systems, mitigations to prevent or stop unintended movements of the arm and hand mechanisms, durability testing (ability to withstand exposure to common environmental factors such as dust and light rain), and impact testing.

The FDA reviewed the Deka Arm System through its de novo classi-fication process, a regulatory pathway for some novel low- to moderate-risk medical devices that are first-of-a-kind.

Red Llama Inc. announced that the SimPraxis surgical simulation platform appli-cations now available on iOS include the SimPraxis Laparoscopic Cholecystectomy and SimPraxis Laparoscopic Nissen Fundoplication

procedures. These apps are authored by University of Washington surgeons Mika Sinanan, M.D.; Carlos Pellegrini, M.D.; and Roger Tatum, M.D.

These trainers, and the SimPraxis Total Laparoscopic Hysterectomy Trainer, can be

purchased from the iTunes App Store on a computer, from the App Store on an iPad, and at http://appstore.com/redllamainc on a Web browser.

“We are excited to be able to offer general surgeons and general surgery residents the flexibility of using the SimPraxis Trainers on both the Windows and iOS platforms. The ease of downloading and the video quality on the iPad, iPad Air and iPad Mini continues to exceed our expectations,” said David Robison, MLIS, Red Llama vice president of product management.

The learning objectives of the SimPraxis Trainers are to orient the user to the roles of the surgical team; learn the relevant anatomy; learn the specific steps of the procedure; under-stand the required port placements; become familiar with the necessary instruments; and master the key risks of the laparoscopic hysterectomy. Users also have the opportunity to review the potential errors, injuries and complications associated with each step.

All actions and decisions made in each trainer are captured for complete formative tracking and summative scoring in order to provide meaningful and accurate assessment.

Prosthetic Arm Translates Signals from Muscles to Perform Complex Tasks

Surgical Simulation Platforms Available on iOS


Compiled by KMI Media Group staff

Analytic Services Inc. of Falls Church, Va., is being awarded a $6,490,089 modifica-tion to a previously awarded firm-fixed-price contract to provide the following support to the Office of the Under Secretary of Defense for Acquisition, Technology, and Logistics: medical program support; physical program support; planning, programming, budgeting, executing and financial support; interna-tional and interagency strategic relations support; science and technology support; and

operations and administrative support. Work will be performed in Arlington, Va., with an expected completion date of December 31, 2016. Fiscal 2014 research, develop-ment, test and evaluation funds in the amount of $6,490,089 are being obligated on this award and will expire at the end of the current fiscal year. This contract was competitively procured, with three proposals received. Washington Headquarters Services, Arlington, Va., is the contracting activity.

ASM Research, an Accenture Federal Services company, has been awarded a three-year, $162 million contract from the U.S. Department of Veterans Affairs to support the Veterans Health Information Systems and Technology Architecture (VistA) clinical application and enter-prise core services. VistA is the VA’s award-winning health information technology system, providing an integrated inpatient and outpatient electronic health record to optimize quality medical care for veterans and their families.

The VistA Core project work is designed to strengthen and expand veteran health care services. Work under the contract enables greater interop-erability of systems and health care records and will meet the highest secu-rity standards.

ASM also will update VistA’s Computerized Patient Record System (CPRS), providing a modern, Web-based access to patient records. CPRS is a crit-ical component of VistA that provides clinicians, managers, support staff and researchers an integrated patient record management system which provides a single interface for physicians to manage patient care and records.

Work under the contract also will help improve data sharing across the VA, including care transitions and imple-mentation of standards of care. ASM will deliver technical architecture, clinical analysis, software development, engi-neering management and training to support VistA modernization. This work will help the VA build the next level of patient care capabilities within VistA.

The U.S. Pacific Command has invited Mutualink to demonstrate its interoperability platform at Pacific Endeavor (PE14), which will take place this summer in Kathmandu, Nepal. Pacific Endeavor is an annual multi-national, multiservice workshop in which independent countries learn how to support disaster relief operations by using a broad range of technologies to coordinate inter-country communications. Critical communication systems such as satellite, video, radio, telephone and other technologies are included.

More than 20 nations’ military forces in the pacific area of operations will participate in PE14, which is the capstone event of the Multinational Communications Interoperability Program (MCIP).

The aim of MCIP and Pacific Endeavor 2014 is to enhance interoperability between participant nations, non-government organizations, and the international humanitarian community for effective and rapid collab-oration during humanitarian assistance and disaster relief operations.

Disaster relief operations often experience interoper-ability shortfalls because of diverse military and civilian participants’ systems and equipment. Mutualink’s interoperability solution enables users with dispa-rate systems to quickly, easily and securely establish a communications backbone to share vital information and increase situational awareness.

Mutualink’s platform bridges all forms of multi-media resource sharing—to include radio, telephony, video, text, file and data—so participants can securely collaborate with each other, operations centers, and with partner nations in real time. Moreover, Mutualink is the only solution on the market that does not use a central server, or switch; thus, allowing participants to maintain complete control of their respective resources.

Avon Protection announced an order of 135,000 M50 mask systems from the U.S. Department of Defense under the additional requirements option of its sole source U.S. Joint Services General Purpose Mask (JSGPM) program contract.

The order is valued at $33 million and brings orders for the JSGPN mask system under this program to a total of 1.4 million systems.

Last year the company won a contract with DoD to develop a modified version of its M53 mask

to provide protection to a wide range of operators in its fleet of fixed wing aircraft. The modified full face mask will provide the DoD aircrew commu-nity with upgraded CBRNE respiratory protection under the Joint Service Aircrew Mask program.

Peter Slabbert, CEO of Avon Rubber PLC, commented: “This $33 million order demon-strates DoD’s continued commitment to Avon’s market-leading, high-technology M50 mask to meet their complex opera-tional requirements.”

$6.4 Million Contract Modification

Veterans Affairs Selects Company to Modernize Electronic Health Records

Interoperability for Disaster Relief Operations

135,000 M50 Mask Systems Ordered


Establishing an Inclusive Coalition and Framework for Global Health EngagementQ&AQ&A

Dr. Jonathan WoodsonAssistant Secretary of Defense for

Health Affairs

Dr. Jonathan Woodson is the assistant secretary of defense for Health Affairs (ASD (HA)). In this role, he administers the more than $50 billion Military Health System (MHS) budget and serves as principal advisor to the secretary of defense for health issues. The MHS comprises over 133,000 military and civilian doctors, nurses, medical educators, researchers, health care providers, allied health professionals and health administration personnel worldwide, providing our nation with an unequalled integrated health care delivery, expeditionary medical, educational and research capability.

Woodson ensures the effective execution of the DoD medical mission. He oversees the development of medical policies, analy-ses and recommendations to the secretary of defense and the undersecretary for Personnel and Readiness, and issues guidance to DoD components on medical matters. He also serves as the principal advisor to the undersecretary for Personnel and Readi-ness on matters of chemical, biological, radiological and nuclear (CBRN) medical defense programs and deployment matters per-taining to force health.

Woodson co-chairs the Armed Services Biomedical Research Evaluation and Management Committee, which facilitates over-sight of DoD biomedical research. In addition, Woodson exercises authority, direction and control over the Defense Health Agency (DHA); the Uniformed Services University of the Health Sciences; the Armed Forces Radiobiology Research Institute; the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury; the Armed Forces Institute of Pathology; and the Armed Services Blood Program Office.

Prior to his appointment by President Obama, Woodson served as associate dean for Students and Diversity and professor of surgery at the Boston University School of Medicine, and senior attending vascular surgeon at Boston Medical Center. Woodson holds the rank of brigadier general in the U.S. Army Reserve, and served as assistant surgeon general for Reserve Affairs, Force Struc-ture and Mobilization in the Office of the Surgeon General, and as deputy commander of the Army Reserve Medical Command.

Woodson is a graduate of the City College of New York and the New York University School of Medicine. He received his postgraduate medical education at the Massachusetts General Hospital and Harvard Medical School, and completed residency training in internal medicine, and general and vascular surgery. He is board-certified in internal medicine, general surgery, vas-cular surgery and critical care surgery. He also holds a master’s degree in strategic studies (concentration in strategic leadership) from the U.S. Army War College.

In 1992, he was awarded a research fellowship at the Asso-ciation of American Medical Colleges Health Services Research Institute. He has authored/coauthored a number of publications and book chapters on vascular trauma and outcomes in vascular limb salvage surgery.

His prior military assignments include deployments to Saudi Arabia (Operation Desert Storm), Kosovo, Operation Enduring Freedom and Operation Iraqi Freedom. He has also served as a senior medical officer with the National Disaster Management System, where he responded to the September 11 attack in New York City. Woodson’s military awards and decorations include the Legion of Merit, the Bronze Star Medal, and the Meritorious Service Medal (with oak leaf cluster).

In 2007, he was named one of the top vascular surgeons in Bos-ton, and in 2008 was listed as one of the top surgeons in the United States. He is the recipient of the 2009 Gold Humanism in Medicine Award from the Association of American Medical Colleges.

Q: Before we talk about your experience at the U.S. President’s Emergency Plan for AIDS Relief Conference last month, could you give the readers a quick breakdown of what global health engagement means, and what it looks like at DoD?

A: Global health engagement is the provision of aid, support, humanitarian assistance, disaster relief, or training and education

Global Facilitator


to foreign nations that lack the necessary capabilities to combat health crises, epidemics, or other emerging issues.

Global health engagement is a strategy within DoD that has a distinctive lens and set of goals that are tied to our overall national security strategy.

Within DoD, global health engagement supports both of our medical readiness goals—maintaining a medically-ready force and a ready medical force. It elevates the visibility of the United States and increases our influence in positive ways, and it can provide our country’s political and military leaders with strategic opportuni-ties to engage other nations and leaders that may have been oth-erwise uninterested in working with the U.S. military. Collectively, these aims are achieved through three primary initiative lanes.

The first core initiative focuses on stabilization, which encom-passes a wide array of targeted missions. Stability operations are authorized to contribute to social well-being, rule of law, gover-nance, sustainable economy and safe and secure environment. All are vital facets of a well-functioning society, and pivotal to avoid-ing discord within a nation, region or the world.

The second core initiative is called a cooperation engagement. These operations are centered on mutually-beneficial collaborative efforts and interoperability, predominantly with foreign militaries. Many of these missions are focused on humanitarian preparedness or military-to-military exercises.

The third core initiative is called a capacity development. If a nation has an underdeveloped capacity in certain medical areas, we can leverage our expertise to develop or enhance partner capa-bilities—helping increase self-reliance.

We bring comprehensive capabilities to carry out the three core missions. Our ability to serve for the global good by provid-ing vital assistance to allies and partners increases security and stability.

There are three important points I would want readers to understand about this description of global health engagement. First, even though we outline three core types of initiatives, any given mission may include one, two or all three initiatives. Sec-ond, our advanced capabilities are not a guarantor of success. Cooperation and partnership are the critical elements. Whether it’s cooperation between U.S. government agencies, partner-nations or non-governmental organizations (NGOs), cooperation is fundamental to a successful global health engagement mission. Finally, it’s important to remember that in most global health engagement efforts, DoD takes a supporting role—while other government agencies have the lead—making collaborative rela-tionships even more essential. This is the crux of the U.S. global health engagement strategy, and it’s conferences like this one that elevate its importance to a rightful place.

Q: You went to South Africa for an important conference—the PEPFAR annual meeting. Can you give some background as to what PEPFAR is, and what role you, as well as DoD, took in the conference?

A: PEPFAR is short for the U.S. President’s Emergency Plan for AIDS Relief, and it’s the largest program within the president’s Global Health Initiative. It’s a U.S. government-wide project, featuring close collaboration among the U.S. Agency for Interna-tional Development (USAID), the Department of State, the Depart-ment of Health and Human Services, Peace Corps, DoD and other

U.S. government agencies. The goal is to help stop the spread of HIV/AIDS and other diseases, and alleviate the suffering of those afflicted with said diseases.

Over the course of four days, project heads and leaders from the various U.S. government agencies involved in PEPFAR came together to share what progress they’ve all made, and what can be done to improve our collective efforts. As with all global health engagement efforts, cooperation and communication between all actors involved isn’t just a best practice, but also a necessity for the success of any program. We covered a number of topics in a short period of time—everything from working with NGOs, imple-menting partners and partner nations, to family planning and treatment methods. As always, all of the presenters from other U.S. government agencies, the U.N. and African nations were impres-sive and deeply committed to creating an HIV/AIDS-free world.

DoD took on various roles within the conference itself, as speakers, moderators and participants in each session. Dr. Vienna Nightingale, the deputy principal of the DoD PEPFAR program moderated a compelling panel on integration models for family planning and maternal health. Our Angola expert Bilibela Billy Paul spoke on the utilization of long-term strategies and technol-ogy in countries for sustainability efforts. The Navy’s Director of Prevention, and Education and Training for HIV/AIDS prevention, care and treatment programs, Dr. Michael P. Grillo, led the panel on the impact, efficiency and sustaining efforts in HIV prevention. Antonio Langa and Anne Thomas were both involved with the

Defense Strategies Institute presents:

7th DoD/VA and Gov Health IT Summit

“Leveraging IT Solutions to Broaden the Context of

Connected Health”

October 14—15 , 2014 Alexandria, VA

REGISTER TODAY http://healthit.dsigroup.org

Call us at : 917.435.1266


voluntary medical male circumcision program panel. Dr. John Kahemele presented on tuberculosis and HIV integration models in his resident expert host-nation, Tanzania. And I was pleased to moderate a panel on transparency and oversight. In addition, our group of DoD experts met for our own special breakout session.

With experts in more than 18 countries working tirelessly on PEPFAR projects, we rarely have the opportunity to sit down together to discuss progress, address concerns and find new, unique ways to collaborate across the enterprise. This is what we accomplished in South Africa—the opportunity to take a step back and see how our community was performing across the continent. The feedback and insights that I heard help me in my role as ASD (HA). For that, I’m extremely grateful.

Q: Beyond the conference itself, what kind of capabilities does DoD provide to this important mission?

A: DoD brings both extraordinary logistics capabilities, and leading medical research and health care delivery expertise in almost any environment imaginable. DoD’s global presence also contributes in more indirect ways. DoD also brings unique military-to-military relationships that can be utilized where other relationships may not exist.

We have a surveillance system in place for HIV/AIDS monitor-ing called the Defense HIV/AIDS Prevention Program (DHAPP)—specifically for military hospitals in Africa—which is under the PEPFAR umbrella of relief efforts. This system is unique to DoD as other U.S. agencies are not provided with access to most host-nation military hospitals. Under DHAPP, we train more than 3,000 health care workers a year about HIV/AIDS preventive measures, such as safe sex education, and debunk myths surrounding the disease. Circumcision procedures are provided for more than 50,000 men annually; over 500,000 military and family members are tested for HIV/AIDS; and more than 4,000 women received antiretroviral drugs.

Q. Could you expand on some of the surveillance programs that the department has, and why they mainly fall under stability-focused missions?

A: Whether we are talking about HIV rates, SARS, bird flu or a few hundred other potential health scenarios, DoD recognizes that the security threats from health catastrophes are real, and the spillover effects from breakdowns in health systems can often be harder to contain than armed conflicts. In such a globally interconnected world, it’s essential that we continuously monitor disease threats (again, along with our federal health partners, as well as global organizations). The sophistication and capabilities of our six overseas DoD laboratories contribute mightily to helping us detect, prepare, prevent and respond to crises.

These laboratories conduct routine and emerging disease surveillance and response missions through regional partnerships with local ministries of agriculture, defense, health and academia. In conjunction with our partners, we are able to monitor and plan how best to respond to emerging threats before they become global epidemics.

Now, I am sure that all sounds fine when you read it. But, I can’t stress enough the gravity, the importance of what these men and women do overseas and at home. One of our surveillance

centers held the first reference case of Middle Eastern Respiratory Syndrome, also known as MERS-CoV, which has been a big news item recently. Our network has worked tirelessly to monitor the new breakouts of ebola. It was the first to isolate the Rift Valley fever virus, and identify new strains of dengue fever. In San Diego, Calif., our lab was the first in the world to characterize H1N1, commonly called swine flu, which helped the rest of the world truncate the effects of the subsequent H1N1 epidemic. It is truly a cutting-edge network that benefits us all.

An advancement of particular pride to the military health sys-tem resides with our doctors at another one of our health labs in Africa. These members of the military enterprise were the first in the world to conduct a successful HIV/AIDS vaccine trial. This is particularly relevant to our conversation as the lab was part of our Defense HIV/AIDS Prevention Program.

Q: You said before that global health engagement is more than strictly a stabilization mission. Can you explain to readers what cooperation initiatives look like?

A: Cooperation missions provide excellent opportunities for the U.S. military abroad, as they revolve around building upon or creating new relationships with other nations’ militaries, agencies and NGOs. However, the benefits are two-fold; cooperation initia-tives also provide our military medical forces with field training, which is essential to maintaining a medically prepared force. As we draw down forces in Afghanistan, opportunities for our medi-cal forces to have real-life trauma and crisis experience are more important than ever.

Our military hospital ships, the USNS Mercy and the USNS Comfort, are at the forefront of cooperation efforts for U.S. military humanitarian missions. Secondary to its wartime medical support mission, our hospital ship often deploys, providing relief and medical support to nations in times of crisis or with under-developed medical capabilities. The USNS Mercy has expanded in its collaborative efforts over the past few years. New policy has granted the USNS Mercy permission to allow NGO medical staff on board to help provide care, a huge benefit to all groups involved. NGOs don’t have the capabilities that the U.S. military has in resources and transport methods, and our military medical forces don’t have the same level of nuanced knowledge of certain nations or populations that NGO staff spent decades creating. The USNS Mercy has been, and continues to be, a hub for collaboration and an access builder for the U.S. military. It’s interesting to note that China has implicitly acknowledged the value of such platforms, and has created their own hospital ship—the Peace Ark.

Speaking of China, for the first time, in July of this year, China participated with the Peace Ark in the Rim of the Pacific Exercise alongside our hospital ship, the USNS Mercy. We conducted cross-deck operations that consisted of patient movement, personnel best practice exchanges and general relationship-building initia-tives. These medical exercises performed with China were mutu-ally beneficial—elevating each other’s medical knowledge, while building mutual respect. Increased interaction like this during RIMPAC can help in the mitigation of future disagreements—which is vital to our nation’s security.

One last great example of a cooperation effort is Southern Command’s Beyond the Horizon & New Horizons missions. From April through June 2014, U.S. military personnel deployed


DEFEnsE HEaltH aGEnCy

2014

Lt. Gen. Douglas Robb

Director

David BowenDirectorHealth IT

Rear Adm. Raquel Bono

DirectorNational Capital Region Medical

Rear Adm. Bruce DollDirector

Research & Development

VacantActing Director

Business Support

Allen MiddletonDeputy Director

DirEctors

Maj. Gen. Richard Thomas

DirectorHealthcare Operations

Rear Adm. William Roberts

DirectorEducation & Training

to Belize, the Dominican Republic and Guatemala to conduct comprehensive humanitarian and civic assistance. During the exercises, U.S. troops worked with a variety of government orga-nizations and NGOs to build important relationships with partner nations, while receiving valuable deployment training in civil-mil-itary operations through medical aid, dental care and engineering support to local populations.

It’s important to remember, however, that even though DoD and partner nations are able to provide vast resources for global health, one of the key tenants of our global engagement is to empower host-nations through capacity-building domestically.

Q: Since you brought up the idea of self-reliance and capabilities, I know that most DoD missions address capacity needs. Can you go into some detail about why these projects are important, and why this kind of engagement is central to the other keystone projects?

A: I think the more important point you make here surrounds the issue of self-reliance. When we send our medical forces and military members to help a host-nation build capability, we don’t just do it because it’s the right thing to do; we do it because it helps create a far more stable global environment for our troops and citizens. Every time another nation is able to support itself during a natural disaster or medical catastrophe, it means the United States is safer. Extremism can be cultivated in societies unable to manage natural disasters effectively; diseases can spread like wildfire globally. A more medically capable world makes for a safer United States.

Q: Could you give a couple of examples of these kinds of capacity programs?

A: There are three programs in particular that come to mind for me when I discuss programs revolving around capability-building: the pandemic and disaster response planning programs, aeromedi-cal/patient movement capacity building, and blood safety health engagement. To better highlight each of these capacity programs, it’s best to highlight individual projects themselves from each to show how interconnected they are to the DoD global health mission.

Though they are technically two separate programs, the pan-demic and disaster response planning programs run in tandem with each other, and take place in the same countries. Led by Africa Command, these programs exist in 19 African countries and focus on teaching national and regional institutions our best prac-tices in pandemic and disaster response. The programs work on a five-year timeframe, which allows the host-nations adequate time to adapt our models to fit their needs and develop a structuralized response framework. Not only does this approach build strong relationships for our military with civilian groups in host-nations, it also fosters regional capabilities throughout the participating countries that could avert unrest during times of outbreak or catastrophe.

The strength of the U.S. Air Force isn’t just measured in tacti-cal strikes, but also number of lives saved on the battlefield. Dur-ing the past 13 years we’ve become experts at aeromedical lifts due to our interventions in Iraq and Afghanistan. U.S. and coalition forces knew that when we started leaving Afghanistan, their medi-cal abilities would be weakened by a lack of patient-movement

assets. The decision was made to introduce military medical men-tors who trained the Afghan Air Force to develop an entire aero-medical system as well as casualty evacuation standards. A huge success, the program has been credited with increasing confidence within Afghan ranks, decreasing desertion, and creating a more able medical force in lieu of a U.S. medical presence.

Another example of a successful aeromedical program is our work with the Royal Thai Air Force. It’s one of my favorite examples to bring up, not only because it strengthened the bonds between our militaries, but because of the tremendous job the Thais did applying this knowledge in the face of tragedy. In 2011, Bangkok was severely flooded during a terrible storm—leaving citizens stranded and injured throughout the city. The members of Royal Thai Air Force were able to utilize their patient movement training with U.S. medical forces, and airlifted more than 110 patients to local hospitals—some of whom were critically ill. Their success will only grow as they build on this experience.

Some of the most impressive innovations we’ve developed internally through our wartime efforts in Iraq and Afghanistan have been ways to transport and maintain blood for transfusions. Our blood safety program led by the Pacific Combat Control Cen-ter is a multi-year collaborative effort with the Centers for Disease Control and Prevention and USAID. The program works to build sustainable blood programs in support of disaster response within the nations of Laos, Cambodia and Vietnam. All of these programs have been successful, and have aided much-strained U.N. and relief capabilities in the host-nations due to their increased capacity. It was also an important program because it opened the door for future engagement with Laos, a nation we haven’t partnered with in any capacity prior to blood safety engagement.

As you can see, all of these programs not only relax some of the burden from the shoulders of the U.S. military and NGOs, but they also directly impact our national security by increasing both access and influence.

Q: Now that you’ve given us background on what global health engagement is, what DoD wants to accomplish, and examples of stability, cooperation and capacity missions—do you have any final words on why global health engagement should be at the forefront of the defense community’s mind?

A: The importance of global health engagement to our national security can’t be understated. It’s one of the department’s most effective tools in securing strategic access, maintaining a medi-cally-ready force, elevating U.S. visibility, and increasing global influence internationally.

Helping medically stabilize foreign nations prevents possible uncontainable spillovers of conflict or disease. In our cooperation with other nations and NGOs we are able to build bridges of mutual understanding where once there could be conflict. When we build medical capacity of other nations, our forces and resources are freed for other emergencies or needs. All of these initiatives are also beneficial to the readiness of our medical forces, making all of our forces medically-ready.

The benefits of our involvement in global health engage-ment are irrefutable. DoD’s breadth and depth of mobile medical assets—people and equipment—are unique in the world, and indispensable to the protection of our military personnel and the American people—and that mustn’t be overlooked. O


The decade-plus that the United States has been at war has produced dramatic advancements in tactical combat casualty care. These improvements can be seen on two fronts: The military itself has developed new structures and strategies through which to provide the quickest and best possible care to wounded warriors. And the private sector has made its contributions by developing products never seen before on the battlefield.

Among the products that have been introduced in the last few years, multi-func-tional monitors record vital signs and help medics and other personnel perform their jobs better; gauze impregnated with sub-stances helps stop bleeding; and litters and other similar products help personnel move

patients safely and efficiently. All of these products are subject to processes involving continuous improvement.

“In some ways we adopted the clinical care system we were familiar with in the United States for civilian care and took it to the battlefield,” said Colonel Todd Rasmussen, director of combat casualty care at the U.S. Army Medical Research and Materiel Com-mand (USAMRMC).

One of the key advance-ments in tactical combat casualty care was the estab-lishment of the Joint Trauma System (JTS). “JTS is an

overarching system that coordinates the care of those injured in combat,” said Ras-mussen. “JTS functions to reduce morbid-ity and mortality from combat wounds by getting the right patient in the right facility

for the right treatment at the right time and to institute processes to improve care-giving.”

JTS was not in place when the U.S. military went to war 10 or 12 years ago. “We recognized when we were fighting in two theaters of war that we needed to bet-ter coordinate patient care,” said Rasmussen.

advances in combat care are saving the lives of the woUnded warrior.by peter bUxbaUm, m2va correspondent

sPecIal sectIoN

col. todd rasmussen


Recent advancements in combat casualty training have resulted in thousands of lives saved. This success is attributable to the advanced and innovative training of military medics and surgeons, and training for tactical combat casualty care has increasingly made use of simulators.

CAE’s Caesar manikin was developed for the Army’s TCCC course. Caesar comes out of the box with an amputated leg and with a fully-functional airway for training on trikes, inserting needles in the chest, and other such procedures.

“Caesar is suitable for TCCC training because it is rug-gedized,” said Paul Bernal, director, global business develop-ment government & military at CAE. “Most of the components are housed in steel casing. That way it can be dragged around ad exposed to the elements without adverse effect.”

CAE manikins can be ordered with different types of injuries, such as traumatic amputations, so that they can be used to practice TCCC. The physiology of the manikins can be adjusted to mimic trauma and the manikin’s vital signs respond when fluids are administered.

“We are in the process of enhancing Caesar to provide more realism and to provide a more feature-rich product,” said Bernal. These enhancements are planned for the end of this year.

Operative Experience Inc. produces simulations for training of specific pro-cedures likely to be encountered by military medics and surgeons. “Amputation is a major procedure downrange,” said Bob Buckman, the company’s vice president for sales and marketing. “Our manikins can also simulate blast and

fragment injuries on various parts of the body. The simulations allow training on procedures that are not seen every day. These are situations a medical resident is not going to learn hanging around the hospital.”

Skedco recently entered the market with a simulation for hemorrhage control. “This is a simulation meant to be worn by a live actor,” said Calkin. “The patient can be screaming and combative. This is something new med-ics have to go through before they head for the battlefield. They don’t have

time to panic there.” Using the simulation, new medics have reduced their procedure times from 30 minutes to two min-utes in short order, according to Calkin.

Strategic Operations also markets a human-worn simu-lation, known as a Cut-Suit. That product was on full display last May when the company hosted students from the Rocky Vista University College of Osteopathic Medicine, an institution that trains many military medical personnel, at its fully-equipped emergency room in San Diego. The ER was inundated with trauma casualties from overturned cars, shooters, and improvised explosive devices as well as sick patients requiring surgery.

The exercise was designed to provide hands-on experi-ence through the use of the Cut-Suit in an immersive atmosphere. Rocky Vista is the first medical school to incorporate the Cut-Suit into medical student education.

Many live-action simulations were created, immersing the participants from point of injury all the way through the ER and OR. “Medical students commonly

Medical Simulation

Kit lavell

sPecIal sectIoN

The products designed and manufac-tured by private-sector companies have also served to improve casualty care, Rasmussen noted. “Some of these products have come out of our research programs,” he said. “They represent some of the advances that have come out of the wars in Afghanistan and Iraq.”

JTS operates on three levels. JTS operates the Joint Trauma Registry, which collects injury and injury management information from the battlefield and all the way through higher levels of care in Landstuhl, Germany, and eventually the United States. “This elec-tronic registry is the largest repository of injury and injury management information ever assembled,” said Rasmussen. “It has information on 60,000 injured service per-sonnel who have been stewarded or overseen by the Joint Trauma System.”

Another operational pillar of JTS is its active process improvement activity. “JTS monitors the care of every U.S. service person injured in combat,” said Rasmussen. “Each week we go through the list of those injured and in a methodical and intentional way troubleshoot that care. If a patient

wasn’t given his meds on time or if a patient was moved at the wrong time, we discuss how this can be corrected immediately and in real time.”

These reviews take place in a teleconfer-ence that has been convened every week since 2004. “It lasts 60 to 120 minutes, and all representatives of the whole spectrum of combat casualty care are on the line,” said Rasmussen. “They hear from everyone who has cared for a patient from the point of injury to the forward surgical team to medevac personnel and all the way to Land-stuhl and Walter Reed. The intent is not to find fault or to be critical, but to find areas for improvement.”

JTS also issues clinical practice guide-lines. “There are over 30 of these and we con-tinually update them,” said Rasmussen. “The guidelines are based on evidence presented by research and inform caregivers how to perform procedures in an optimal fashion.”

On the products side of the ledger, monitors come to automate both the mea-surement and the recording of vital signs. These monitors are moving past the area of vital signs to automate and facilitate a

range of other important combat casualty care procedures.

“The RDT Tempus Pro vital signs moni-tor has the ability to easily document and share all patient data electronically from the battlefield across the continuum of care back to CONUS,” said Barnie Howell, U.S. military director of business development at RDT. “Tempus Pro software enables the creation of an electronic version of the TCCC card that is automatically populated with vital signs. The touch display facilitates entering of drugs, fluids, interventions and notes.”

The patient record of care can then be transmitted to the next level of care before the patient arrives. “When the patient arrives at the battalion aid station, combat support hospital, or back in the United States, there is often no record of the patient’s vital signs data, encounters or interventions,” said How-ell. “Studies have shown that patient out-comes can be improved if the full patient data is transmitted to the receiving facility prior to patient arrival.”

RDT has applied for clearance from the Food and Drug Administration to incor-porate ultrasound and video laryngoscopy


capabilities into the Tempus Pro. Ultrasound and video laryngoscopy can help ensure and document proper tube placement. In addi-tion, RDT has also applied to incorporate algorithms into its device that would calcu-late the necessary level of fluids for patients experiencing blood loss or suffering with burns.

“We expect these new clearances in the very near future,” said Howell. “It is our philosophy to grow the device based on the Tempus Pro platform. The capabilities of the platform are growing so that the military doesn’t have to replace its devices every three to five years.” The Army is currently conducting a competition for the acquisition of a new vital signs monitor. The Tempus Pro is one of three finalists currently undergoing evaluations.

Research has shown that a many as 25 percent of those killed in action in the recent wars had survivable injuries, and that most of those deaths occurred due to bleeding before the casualty made it to a hospital. “Based on this data, one focus must be controlling hemorrhage at the point of injury outside of the hospital setting,” said Rasmussen.

Z-Medica introduced gauze impregnated with kaolin, an inert mineral substance, to deal with that very situation. Z-Medica’s products, known as QuikClot and Combat Gauze, have been available to the U.S. mili-tary since 2008.

“Kaolin activates two of the clotting fac-tors in the blood, and this reduces the time in which bleeding can be stopped,” said Scott

Garrett, vice president for military and tacti-cal programs at Z-Medica. In studies at the U.S. Army Institute of Surgical Research, QuikClot caused hemostasis, or a stoppage of bleeding, typically in five minutes, according to Garrett.

Z-Medica came up with the idea of using kaolin toward the beginning of recent con-flicts, when warfighters were subject to IED

A team of multinational special operations forces medics from Hungary, Croatia and Ukraine evacuates simulated casualties to a Croatian Mi-17 helicopter during a field training exercise as part of the Tactical Combat Casualty Care course held in Udbina, Croatia. [Photo courtesy of the U.S. Army/by Master Sergeant Donald Sparks]

state that they do not truly understand or recognize a textbook description of a disease or a syndrome until they experience the clinically applicable version of it,” said Kit Lavell, executive vice president of Strategic Operations.

Laerdal Medical develops simulators that run the gamut of combat pro-cedures applicable both to first responders to clinicians delivering services at higher levels of care. “We make ruggedized simulators for tactical combat casualty care,” said Mark Owens, a military strategic account manager at Laerdal Medical.

Laerdal manikins come with modules designed to teach specific tasks such as treatment of gunshot wounds and performing amputations and chest decompressions. “the learner goes through the vital procedures and the manikin responds based on what he or she does or doesn’t do,” said Owen. “Once the learner completes the task, the simulation can be stopped to allow for a debriefing or after-action review.”

Laerdal is currently developing a unified instructor application that will be able to control all high-fidelity simulations regardless of vendor from a single device.

SimIS takes a mentoring approach to simulated training through the use of the Microsoft Kinect camera used in gaming systems. SimIS uses Kinect to compare the actions of a trainee against those of an expert performing the same procedure. SimIS records procedures executed by established experts and its software maps the actions of a trainee against those of the expert.

SimIS is currently working with U.S. Navy personnel to develop a simula-tion of endotracheostomies, according to Justin Maestri, product manager for health care simulations at SimIS. The company also plans on leveraging developments to smartphones and tablets to allow its simulations to be con-trolled by those devices.

Aptima is approaching casualty care from somewhat of a different angle by developing ACLAMATE, the Automated Cognitive Load Assessment for Medical Staff Training and Evaluation, funded by the USAMRMC. The thrust is not to record whether learning objectives have been met but to measure the

effectiveness of the training experience.“Most simulation-based training is

very linear,” said Jeff Beaubien, ACLA-MATE principal investigator for Aptima. “Participants go through a scenario, but some teams might be overwhelmed by the exercise and others underwhelmed.”

ACLAMATE analyzes data such as heart rate, brain activity and conversation patterns during a medical scenario to measures trainees’ cognitive workload. These are processed through algorithms to assess individual and team workload.

The instructor is automatically alerted to changes in cognitive load and can adjust the exercise accordingly.

Aptima is awaiting a Phase 2 decision from the Telemedicine & Advanced Technology Research Center that will allow it to proceed to full research and development and prototype building.

Jeff beaubienJustin Maestri


attacks that tore tissue apart and caused profuse bleeding. “Kaolin has been known to stop bleeding as far back as the 1950s and 1960s,” said Garrett. “We tested kaolin against other options and found it to be far superior than anything else we were looking at.”

One advantage of Quick Clot and Combat Gauze is that they look, feel and work like normal gauze. “People already know how to use it,” said Garrett. “There is not much of a learning curve on how to use it correctly.”

Z-Medica continues to investigate ways to enhance its products to meet military requirements. “The military is looking for a gauze that can break down naturally over time,” said Garrett. “They are also look-ing for products that can control bleeding when it is impossible to apply or tourni-quet or pressure.”

Skedco’s Tactical Sked has become a staple of battlefield care because of its ability to handle patients efficiently. The stretcher weighs 9 pounds with all its accessories.

The Tactical Sked is secured across a ruck and is made of rugged plastic for durability in extreme environments. “When it is carried or hoisted, it keeps the patient’s body straight,” said Bud Calkin, the company’s vice president and founder. “It will not bend in the middle. Because it is narrow, it forms an anatomical splint around the legs when the straps are pulled tight.”

Skedco also produces other types of products used for casualty care. The com-pany has sold several thousand of its Mout Lifeline Bags. “It contains 30 feet of rope in a small bag and is worn on the chest,” said Calkin. “If someone goes down in the line of fire they open the flap and with a flick of the wrist can throw the rope 30 feet. Then someone else can drag the casualty out of the line of fire without exposing himself.”

“I am a physician, surgeon and researcher,” said Rasmussen. “Products like these are an important part of the material solutions for patients. We can’t operate on a patient without moving them.”

As the military winds down from the conflicts in Southwest Asia, it must con-sider how it will confront the next conflict with which it will be challenged. The same is true of tactical combat casualty care.

Time factors in the care of battlefield casualties will likely be different in future. If the U.S. military deploys small units in dispersed areas of the world, it will take lon-ger for casualties to be evacuated to higher echelons of care. This requires thought on how battlefield casualty care will have to adapt to these changing conditions.

“Medics will have to control bleeding, manage airways and be capable of handling more complex injuries, as they will be with the patient for longer periods of time,” said Garrett.

“We are actively pursuing research efforts on how best to treat more dispersed and smaller units of injured troops,” said Rasmussen. “If we envision longer trans-port times for wider dispersed troops in small units a long way from traditional care, then we need to find a way to being critical care to the patient.” O

Traumatic brain injury emerged as a major military medical concern in the conflicts in Southwest Asia. One U.S. Army study indicated that 22 percent of injured warfighters suffer from TBI, and 10 percent of those have moder-ate to severe cases.

According to research conducted by the Brain Trauma Foundation, TBI occurs when a blast causes a rapid rotation in the neck and head, leading to the tearing of tissue in the brain’s interior and resulting in a reduced ability to con-centrate.

Colonel Dallas Hack, up until recently the Army’s direc-tor of combat casualty care, recently took on a new assign-ment of running the Army’s brain health program.

“We spend a lot of time in the military on physical fitness,” said Hack. “But research shows that we also can do things to train the brain to function better. This can help with things like memory, attention span and reaction time.”

Hack’s efforts include, but are not limited to, helping those who have suffered brain injuries in combat. “Brain fitness helps servicemembers perform their jobs better,” he said. “If they should be injured, brain fitness will help them recover quicker. The physically fit recover from illness and injury quicker. The same is true of the brain.”

Hack’s job is essentially to integrate the activities of the various components of Army medicine that deal with brain health so that they all advance a common strategy. “By integrating those, we can achieve some power that the port-folios themselves are not able to achieve without integration,” he explained.

Brain health concerns are currently spread over three areas: physical injury, which includes neural damage and TBI; the psychological aspects of TBI, such as post-traumatic stress disorder; and brain fitness.

“There is so much overlap between the physical and psychological in terms of pathology, symptoms and effects,” said Hack. “We are likely to achieve better results with those who have injuries by looking at all these things together.”

among hack’s goals in his new job is to help execute on the National Research Action Plan for TBI, a document which he helped author. “Federal agencies were directed by executive order to start making things happen,” he said. “I’m going to be working hard to start making major progress on this effort.”

One key to jump-starting the search for TBI therapies is

to standardize a definition of TBI so that clinical trials of potential therapies can be more suc-cessful. “Right now we have such gross mea-sures of classifying mild, moderate and severe brain trauma that we don’t know which patients to enroll in a study,” said Hack. “Developing standards will allow us to study homogeneous groups with a common trajectory so that we can measure the effects of the interventions being studied.”

Potential pharmaceutical advancements are being held up by this lack of organization in the clinical studies. “Several big pharmaceutical companies have called to ask about the prog-ress of this effort,” said Hack. “Once we solve this problem they can enter this arena and start developing treatments.”

Traumatic Brain Injury

col. Dallas Hack

For more information, contact M2VA Editor Chris McCoy at [email protected] or search our

online archives for related stories at www.m2va-kmi.com.

sPecIal sectIoN


Associate Deputy Assistant Secretary for National Healthcare Acquisitions Craig Robinson discusses the work of the Office of Acquisition and Logistic/National Acquisition Center.

Q: I’d like to start with an overview of Office of Acquisition and Logistics (OAL)/National Acquisition Center (NAC). Can you tell me about the size of the organization, its budget, number of contracts handled annually, variety of supply chains, etc.?

A: The NAC actually is comprised of the facility here in Hines, Ill. It’s in the western suburbs of Chicago. It’s collocated on the cam-pus of Hines Medical Center. I’m also responsible for the Denver acquisitions center in Golden, Colo.

[I have] 291 full-time equivalent employees [between those two facilities]. I have a number of vacancies right now that we’re working to fill. Our operating budget is approxi-mately $870 million. The number is a bit misleading because $830 million [of that] is for costs of goods.

We have over 2,200 active contract vehicles. Our largest commodity based on dollars is pharmaceu-ticals. We also purchase high-tech medical equip-ment including diagnostic equipment. This includes MRIs, CT-scans and a variety of different modalities that provide diagnostics.

Hearing aids and batteries are provided out of the Denver, Colo. office. That’s a very large product line for us. We probably purchase 20 percent of the total domestic market for hearing aids.

We’re also responsible for our prime vendor contract, which is our distribution type of contract for pharmaceuticals, medical/surgical and subsistence items to support VA dietary needs. Out of the Denver office we’re also responsible for non-VA health care—this means contracts for health care provided outside the walls of the VA hospital. The larger contracts there are for non-VA dialysis, which is essentially referral to an outside dialysis clinic. We have a new contract focusing on patient-centered care, and that it is for specialty care that is both in-patient and out-patient.

Q: Health care costs, both in the civilian and veteran communi-ties, are growing every year. What is OAL/NAC’s biggest con-tribution to helping manage those costs at an institutional and individual level?

A: Let’s look at this from a couple of fronts. From the perspective of cost of goods, we try to make sure we have competitive contractual instruments wherever possible. We have found [that competition] is

the largest single factor that lends itself to and contributes to price reductions.

Another factor that is specific to NAC is that we administer Public Law 102585, which is the Veterans Healthcare Act of 1992. In Section 603 of that act, the law applies to prices that certain agencies pay for pharmaceuticals, and we administer that part of the law. The law gives very favorable pricing to four governmental entities. They are VA, DoD, Health and Human Services (to include the Indian Healthcare Service), and the U.S. Coast Guard.

It’s a law that helps us administer pricing for covered drugs—FDA drugs that have not come out of protection yet. They are drugs that do not have generic equivalents.

Additionally, another way we drive down costs for the department is by putting national contracts in place. It helps reduce the amount of work done by VHA contractors going out and soliciting new con-

tracts. Instead, they can look at the existing contracts and place delivery orders based on those contracts. This is less administratively burdensome for them.

Q: Looking out over the next 12 months, what are the major contracts you expect to be issuing or awarding?

A: The biggest group of contracts that we’re working on over the next 12 months will put primary care con-tracts in place to support access to care issues that the department is currently experiencing.

I mentioned the patient-centered care contract for specialty care for in-patient and out-patient services. It

covers the gamut of gastroenterology, cardiology and psychiatry. It’s all specialty care. What it doesn’t include is primary care. Specifically, what we’re working on now is for veterans to have the ability to seek primary care in the community through contracts.

Q: Tell me about the contracting process. Is the timeframe from start to time of award the right amount of time or are you looking for ways to make the process more efficient and therefore shorter?

A: The contracting process takes the form of two major types of con-tracts. We are responsible for Federal Supply Schedules. Those are multiple award schedules that are similar to the contracts done by the General Services Administration (GSA).

As a matter of fact, our authority to do schedules is a delega-tion from GSA and we are the only governmental entity that does schedules besides GSA. We were delegated the federal supply classes related to medical. In those situations we have open and continuous allowance for the submission of offers. Vendors, manufacturers and

managing health care acqUisitions for the department of veterans affairs.

craig robinson


suppliers are allowed to come in and offer the same commercial offer-ings that they provide to the commercial community.

They’re required to submit commercial sales practice data and our intent there is to award contracts for commercial items that give us most favored pricing for like customers in the commercial market. For example, if we’re going to buy medical/surgical supplies from a provider like Cardinal Health, we look to see if they deal with a similarly-sized group purchasing organization that represents hospital systems, and then do a price comparison to make sure they’re selling products to us at the same price or lower.

When it comes to awarding contracts, we shoot for 180 days from receipt of the complete and properly submitted offer. Addi-tional time may be required depending on the estimated dollar value, and some of the submissions require a pre-award pricing audit. Anything that exceeds an estimated $5 million a year cost will require a pre-award pricing audit.

We also have commercial contracting where the customer has identified a requirement. We solicit the requirement, we have ven-dors compete for it and then we award it. Those contracts also have a timeframe of 180 days.

For the most part, the things we do on the national level are always going to be in the millions of dollars. In some situations where we have more complex, high-dollar items, 180 days is not the norm. We sit down with our customer and in the acquisition plan-ning process develop milestones to create the expectation for both parties for what the lead time will actually be.

For us the biggest single factor for reducing the timeframe is being adequately staffed. As I mentioned before, we have numerous vacancies that we continue to work to fill. There is a lot of competi-tion out there for people with the right kind of background and qualifications.

Q: How does NAC contract for outside hospital staff and how do you meet the Department of Veterans Affairs’ staffing needs and fill them on a short- or long-term basis?

A: As I mentioned before, we’ve awarded and are going through the implementation stage of the patient-centered care contract that will allow VA hospitals to refer care out to our contractors so that veterans can get care. It’s very similar to an HMO. We have two con-tractors who received awards to work throughout the United States.

Additionally we have national contracts for professional and allied services that allow for medical centers to place orders for spe-cialty care providers. In some situations, those providers are work-ing within the walls of the hospital. It’s a way to supplement VA staff.

Q: How does OAL/NAC partner with small businesses? Are they an important part of your acquisition process?

A: They are an important part of our acquisition process. There are requirements in the federal acquisition regulations that set up a pri-ority or preference for different types of socioeconomically defined small businesses. In addition to that, VA has its own unique require-ments such as Public Law 109461, which requires us to consider disabled veteran- owned small businesses whenever they’re available to provide goods and services. This public law applies to VA only.

Outside of the regulatory process we do take on several outreach efforts that include our website, where we conduct webinars to edu-cate small businesses. We also hold outreach marketing events. In

Denver we have a team that travels around the country and sets up shows at medical centers. They are also a good point for outreach.

We contribute to and participate in VA’s small and disadvantaged business plan in goal setting for the department. We are also reviewed every two years by the Small Business Administration for how we are carrying out our actions and the responsibilities we have in adhering to small business rules and regulations.

Small business standards are defined by North American Industry Class Standards. It’s not uniform when designating a business a small business since it varies by commodity class.

Q: With recently announced plans for additional staff, locations and services, how is that affecting your acquisition plan, budget and inventory forecasting?

A: We will be involved in the sense that some of those points of care will be derived based on the patient-centered care contract. As it relates to supporting and facilitating the delivery of care at those points of care, our contracts are pretty scalable. We’ve put those con-tracts in place and I don’t think there would be an increase in needs that would go beyond the scope of those contracts as it pertains to pharmaceutical, medical/surgical supplies or anything else.

As it relates to an addition of staff, we may facilitate that to a certain extent, in that they may be contracted staff, but beyond that it won’t affect our planning and budgeting. This is because we’re not the budgeting organization related to the Veterans Health Administra-tion’s dollars. Essentially, we’re a player, but we’re not the determin-ing party for the budgeting.

Q: What are your recommendations for businesses wanting to talk to you about new and innovative products they are offering?

A: I think as it relates to businesses coming in and talking to us about new and innovative products, one of the misconceptions is that you go in and talk to the contracting guys. That really is not the case at all.

What I recommend to small businesses is that they reach out to the clinical leads in the Veterans Health Administration. The clinical leads are the ones who are qualified to look at the products and say that they provide clinical benefit or meet a need that the department is not currently meeting.

One of the vehicles used for that is requests for information, or RFIs. RFIs are submitted through FedBizOpps, which is the same platform by which we advertise open solicitations.

Essentially, the RFIs go out to the world and say that we’re look-ing for companies to send commercial information related to a spe-cific item or service. Typically, the department puts out an RFI before issuing some large requirements as a part of its market research.

Q: Any closing thoughts?

A: As things change with regard to the need for more care, from an acquisition perspective we’re seeking to assist our customer. We’re here as a support mechanism. Our goal remains to support the customer and to be his or her business adviser where contracting matters exist. O



The

adve

rtis

ers

inde

x is

pro

vide

d as

a s

ervi

ce to

our

read

ers.

KM

I can

not b

e he

ld re

spon

sibl

e fo

r dis

crep

anci

es d

ue to

last

-min

ute

chan

ges

or a

ltera

tions

.

Advertisers indexAptima . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27www.aptima.com

Defense Strategies Institutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17http://healthit.dsigroup.org

Kaplan University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7www.militarymedical.kaplan.edu

NOVA Southeastern University . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9www.medicine.nova.edu/msbi

RDT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C4www.rdtltd.com

Zoll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C2www.zoll.com/nextgen

CAlendArSeptember 23-25, 2014Modern Day MarineQuantico, Va.www.marinecorpsexpos.com

October 19-22, 2014Joint Federal Pharmacy SeminarNational Harbor, Md.www.jfpsinfo.org

M2Va resource center

NEVER STOP LEARNING

• AccessallthesurveyanswersfromthehundredsofschoolsthatparticipatedinMAE’s 2014 Guide to Colleges & Universities

• Newandimproveddesignmakesiteasierthanevertofindwhatyou’relookingfor

• Searchthedatabasebyschoolname,state,onlineorbrick-and-mortarschools

• CompareandcontrastinstitutionswithalltheinfoMAEusedtoscoreanddesignateourtopschools

Consideringanewdegree?Searchingforanewcareerfield?Advisingyourtroopsontheireducationoptions?YouneedMilitary Advanced Education’s2014 Guide to Colleges & Universities!

Checkoutthesearchabledatabaseatwww.mae-kmi.comforthedetailsprospectivestudentsandadvisorsarelookingfor!

Learn more about Aptima in this edition of Military Medical & Veterans Affairs Forum:

Combat Casualty CarePage 21

Boston ▪ DC ▪ Dayton ▪ Orlando | www.aptima.com

Human-Centered Engineering


Greg BoreckiVice President of Strategic National Accounts

Stanley Healthcare

Greg Borecki is the vice president of strategic national accounts for Stanley Healthcare. Greg is a results-oriented, trusted leader with 10 years of experience working with government customers, both VA and military health.

Q: Could you tell our readers about some of the solutions Stanley Healthcare offers to the Military Health System and Veter-ans Affairs?

A: Thank you for this opportunity. We are pleased to speak to Military Medical & Veterans Affairs Forum, because our government customers are a key driver for innovation across the health care system. As our President Jason Santamaria has shared in the past, Stanley Healthcare (a division of Stanley Black & Decker) has solutions deployed across many military health and Veterans Affairs facilities to improve patient and staff safety, facil-ity security, environmental monitoring, clinical workflow, and the tracking of equipment and other high-value items. As an example, our wander management products are deployed at 52 sites across Veterans Affairs.

Q: What are some interesting new pro-grams or initiatives at Stanley Healthcare?

A: Stanley Healthcare has long been rec-ognized as the industry leading real-time location system provider through our AeroScout solutions, but our customers are ready to take these capabilities to the next level. We believe it is our responsi-bility to ensure our customers are able to leverage data in an effective way, to maximize the investment that has been made in technology solutions. As we have also seen in the civilian health care sector, putting systems in place to locate staff or patients, or to safeguard assets through improved tracking capabilities is only the first step.

Our MobileView Analytics platform features business intelligence dashboards

that include intuitive views of key perfor-mance indicators, and the ability to drill down to specific data points. The analyt-ics tools allow health care organizations to understand trends in asset utilization, temperature and humidity conditions, the flow of patients and staff, and more.

Q: How is Stanley Healthcare positioned in the market for expansion?

A: An area I would like to focus on today is in supply chain and asset management. In most hospitals, customers are continu-ally addressing the challenges of managing thousands of items to ensure that neces-sary supplies are not only available, but are also easy to store and locate when needed.

Our SpaceTRAX solution is an advanced, Web-based inventory management system, used by hundreds of hospitals worldwide to increase charge capture, reduce excess inventory and identify usage trends. With the visibility and analytics that SpaceTRAX provides, we’ve seen hospitals significantly reduce on-hand inventory, reduce labor costs for tracking inventory, minimize expired items and reduce loss charges. For example, we had a customer experience direct cost savings of $150,000 within just the first 90 days.

Q: Can you provide a few success stories?

A: Certainly. One of our VA customers recently faced a related situation in how they were managing supplies. The hospi-tal’s primary goal was to efficiently provide service areas with access to supplies they need for care delivery while still optimizing space and costs. Until recently, they had used a decentralized inventory manage-ment model—with 14 supply locations across nine floors, and much of the inven-tory duplicated across services areas. While this approach was effective for meeting clinical supply needs, it was also expensive and unwieldy to manage.

By using Stanley Healthcare’s Inner-Space Supply Chain Storage Solutions, they are now gaining additional value from their supply chain storage floor track and shelving systems; they store, manage and optimize items for nine primary services and several secondary service locations, including outpatient clinics and proce-dural areas. What’s more, the system can now store 60 percent more supplies in the same space, with at least 10 days of inven-tory on-hand at all times.

I believe it goes without saying that this brings tangible efficiencies and cost reductions for this facility, and that in turn supports improved patient care.

Q: Is there anything I haven’t asked that you’d like to discuss?

A: On a personal note, I know that many feel saddened or discouraged by some of the media reports about veterans fac-ing long waits for appointments or in the emergency department. At Stanley Healthcare, we believe that improvement to both efficiency and workflow processes, as well as reducing costs, are key drivers in improving care. And at Stanley Black & Decker, we show our support every day to soldiers and veterans through our partner-ship with Wounded Warrior Project. So we are extremely proud to work with the many professionals in the Military Health System and VA to enable a better patient experience. O

industry interVieW Military Medical & Veterans affairs forum


NEXT ISSUEDedicated to the Military Medical & VA Community

Cover and In-Depth Interview with:

Lt. Gen. Patricia Horoho

Features

October 2014Vol. 18, Issue 4

Mobile Health It The mobile health care IT market is steadily growing. Health care applications are some of the most commonly used applications on today’s smartphones.

traumatic Brain Injury More commonly known as TBI, this affliction affects both veterans and active duty servicemembers.

Careers in Health

With a little more education, veterans returning with combat medical skills have access to a wide range of careers in medicine.

sPeCIaL seCtIOn:Preventing sexual assault Senior medical leaders of the services discuss the impact of sexual assault in the military, and how it can be prevented.

WHO’s WHO:army MedicineA pictorial review of the leadership and command structure of Army Medicine.

army surgeon GeneralInvited

Insertion Order Deadline: September 23, 2014 • Ad Material Deadline: September 30, 2014

More Than Just A MonitorThe Only Field – Upgradable Transport Monitor

That You Can Change as Needs & Technologies Evolve

Ultrasound, video laryngoscope & new algorithms are the first of many new capabilities to be introduced*

TM

Easy & intuitive data collection & sharing; soon to incorporate user configurable summary record of care

& the newly adopted joint TCCC card*

Tempus Pro:• Has the longest

battery life (over 10 3/4 hoursmonitoring allparameters)**;

• Is the most compact;• Is the most durable

& rugged vital signsmonitor available.

TP A 0214 Tempus Pro and More Than Just a Monitor are trademarks of Remote Diagnostic Technologies Ltd © Remote Diagnostic Technologies Ltd 2014.* Pending FDA & CE Mark ** Default display brightness, ECG, SpO2, ETCO2, IP x 2, temp x 2 and NIBP every 15 minutes. Subject to conditions of storage and use, times are approximate.

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

or e-mail: [email protected]

m2va 18 3 final

Documents

military actions

zoll propaq

levels of care

health sciencesthere

health affairsaugust

tactical combat casualty

patient care data

best possible care