m2va 16-8 (dec. 2012)

Dedicated to the Military Medical & VA Community

December 2012Volume 16, Issue 8

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Force Trainer

Col. Peter J. Benson

Command SurgeonU.S. Army Special Operations Command

Leadership Insight:Exclusive interview with Colonel Erin EdgarCommand SurgeonCentral Command

Complex missions need fl exibility when it comes to monitoring. The Propaq MD is quickly confi gured —at the push of a button—from a simple, easy-to-use basic monitor to the most advanced and comprehensive monitor, displaying three invasive pressures and other critical physiologic data.With enhanced communication, unique plug and play technology, and over 20 years of battlefi eld experience, the Propaq is the ideal choice for the CASEVAC set.

As Basic Or Advanced As You Require

© 2012 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/propaqmd-casevac.

The ZOLL Propaq® MD is now offered as a component in the USSOCOM TCCC CASEVAC set

BASIC CONFIGURATION

ADVANCED CONFIGURATION

Military Medical & Veterans Affairs Forum

Technology Takes on Cold’s StingExamining the state of cold weather operational medicine today: How medics combat issues from hypothermia to frostbite, with a focus on preventing exposure. By Hank Hogan

6

December 2012Volume 16 • Issue 8

Features coVer / Q&a

16

Departments

2

4

14

27

Editor’s Perspective

Program Notes/People

Vital Signs

Resource Center

InDustry InterVIew

28

Colonel Peter J. BensonCommand Surgeon

U.S. Army Special Operations Command

Graham MurphyChief Executive Officer

RDT

Medical Simulation TrainingAdvancements in medical simulation and training are poised to expand the quality of health care to those on the battlefield and in underserved areas around the world. Medical simulations allow for more rapid training of health care personnel. By Peter Buxbaum21

Updating Ballistic UnderwearThe Army will soon issue an update of its ballistic underwear to prevent pelvic and genital wounds.By Chanel S. Weaver

24

Cleared for TakeoffExplaining the challenges involved in transporting the wounded and sick by air and outlining several recent medical transport advancements from the simple to the complex. By J.B. Bissell

9

Canadian Forces Health Services Over the Next DecadeAn overview of the future of health services for Canadian Forces over the next decade, including the expected changes in funding, quality of services and the prolonged mental health care consequences from the war in Afghanistan.By Major Nicole Meszaros26

Leadership Insight: A Look Inside CENTCOM Medical PoliciesColonel Erin EdgarCommand SurgeonCentral Command

12

Replacing the Pave Hawk Helicopter FleetJ. David Schairbum, chief of the rotary wing branch, Air Force Life Cycle Management Center, answers questions concerning the Air Force’s search for a new combat rescue helicopter to replace the aging HH-60G Pave Hawk helicopter fleet.

25Complex missions need fl exibility when it comes to monitoring. The Propaq MD is quickly confi gured —at the push of a button—from a simple, easy-to-use basic monitor to the most advanced and comprehensive monitor, displaying three invasive pressures and other critical physiologic data.With enhanced communication, unique plug and play technology, and over 20 years of battlefi eld experience, the Propaq is the ideal choice for the CASEVAC set.

As Basic Or Advanced As You Require

© 2012 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/propaqmd-casevac.

The ZOLL Propaq® MD is now offered as a component in the USSOCOM TCCC CASEVAC set

BASIC CONFIGURATION

ADVANCED CONFIGURATION

Although it is slowly improving, the American economy still lags significantly in terms of employment. Certain groups are in a disproportionally worse state of unemployment than others. The stark unemployment rate for our country’s veterans is the example most pertinent to this publication.

As of the time of this writing, the Bureau of Labor Statistics states that veteran unemployment is a full percentage point higher than the national average of 7.8 percent. This sorry statistic on veteran unemployment actually masks the still greater state of unemployment for veterans who served after the events of 9/11. The unemployment rate for these veterans is a stunning 9.7 percent.

The Army’s Warrior Transition Command is spearheading an effort to illustrate the advantages of hiring veterans with its “Hire a Veteran” campaign. This Army campaign is working in opposition to a perceived bias against hiring veterans among employers. The subject of discrimination against hiring veterans is an issue that demands greater publicity.

Principally, discrimination against hiring veterans is attributed to employers’ concerns regarding physical or psychological disabilities. Potential mental health issues such as PTSD and traumatic brain injury are highly stigmatized and draw a certain degree of negative attention toward those suffering from the condition. Moreover, many employers believe that the costs of accommodation for physical handicaps outweigh the benefits of hiring veterans.

The Army’s “Hire a Veteran” campaign serves to deconstruct many of the myths concerning the psychological health of troops and allays concerns about the degree of accommodations required for veterans suffering from physical disabilities.

While it can be expected that anyone exposed to a combat environment is affected by the experience, there is a large range in the spectrum of psychological illness experienced by veterans. It is far more common to have a mild case of PTSD than a severe case. Moreover, PTSD is not unique to veterans and not all veterans suffer from PTSD.

Ultimately, I think that discrimination against hiring veterans is despicable and deserves far greater media attention. I’m glad the Army has opened the floor for this debate.

Feel free to contact me with any questions or comments for Military Medical & Veterans Affairs Forum.


eDItorIal

EditorChris McCoy [email protected] EditorHarrison Donnelly [email protected] Editorial ManagerLaura Davis [email protected] Bissell • Peter Buxbaum • Henry CanadayHank Hogan • Kenya McCullum

art & DesIgn

Art DirectorJennifer Owers [email protected] Graphic DesignerJittima Saiwongnuan [email protected] Designers Amanda Kirsch [email protected] Morris [email protected] Papineau [email protected] Waring [email protected]

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Volume 16, Issue 8 • December 2012

EDITOR’S PERSPECTIVE

Christopher McCoyEditor

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U.S. Coast Guard Forum

More Than Just A Monitor™Introducing TM*

The smallest, lightest and most rugged fully-featured pre-hospital vitalsigns monitor...EVER.

www.rdtltd.comTP A 10/12 * FDA 510k pending at time of going to pressTempus Pro and More Than Just a Monitor are trademarks of Remote Diagnostic Technologies Ltd © Remote Diagnostic Technologies Ltd 2012.

Call us now for more information: Tel: (843) 766 7829 / (757) 383 8401

or e-mail: [email protected]

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

It has all the integrated features and capabilitiesexpected in a market-leading vital signs monitorincluding: 3/5 Lead ECG; 12-Lead diagnosticECG; impedance respiration; Masimo Set®

SpO2; NIBP; integrated capnometry; contacttemperature and invasive pressure.

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

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

Tempus Pro leverages over 10 years of datacollection and sharing expertise. Changingoutcomes is achievable through RDT’s unique,rich trauma record interface, perfected to buildfrom far forward transportation use back to theCSH and into the long term record of care.

Tempus_PRO_Ad_Nov-Jan_v3_Layout 1 10/10/2012 14:38 Page 1

Program Notes Compiled by KMi Media Group staff

US Family Health Plan Earns 92.6 Percent Satisfaction Rating

from Military Beneficiaries

The U.S. Family Health Plan, a Department of Defense health care option for military family members in six areas of the country, has achieved a 2012 overall member satisfaction rating of 92.6 percent. Compared to the 202 plans documented in the National Committee for Quality Assurance (NCQA) 2012 quality compass report, the U.S. Family Health Plan rating is at the 99th percentile for overall satisfaction.

“Our initiatives to ensure convenient, high-quality care for military family members have helped the U.S. Family Health Plan consistently surpass national member satisfaction benchmarks,” said Dan Wasneechak, chair of the U.S. Family Health Plan Alliance. “What’s more, our comprehensive range of care—from prevention and wellness programs to intensive disease management services for members with chronic and multiple conditions—aligns perfectly with the military health system’s quadruple aim strategy, promoting family readiness, supporting population health, creating positive care experiences and responsibly managing health care costs.”

He added, “As leaders in healthcare innovation, U.S. Family Health Plan organizations have achieved NCQA recognition for patient centered medical homes and have established transitional care programs designed to ensure continuity between levels of care and decrease hospital readmissions. The U.S. Family Health Plan is truly leading the way with DoD in providing patient-centered care.”

Dr. Chester Schmidt, chief medical officer of Johns Hopkins HealthCare LLC, stated, “U.S. Family Health Plan provides patient-focused, integrated care. It’s a privilege to serve the plan’s military families and retired servicemembers and our providers develop strong, continuous relationships with the patients. The close collaboration among the plan, medical providers and patients helps achieve optimal clinical outcomes and keep our heroes on the home front healthy.”

Rear Admiral (lower half) Kenneth J. Norton has been assigned as commander of the Naval Safety Center in Norfolk, Va. Norton is

serving as deputy chief of staff for strategy, resources, and plans, N5/N8, U.S. Naval Forces Europe/U.S. Naval Forces Africa/U.S. Sixth Fleet, Naples, Italy.

Staff Sergeant Kyle Klapperich of the 724th special tactics group has been named Commando Medic of the Year by the Air Force Special Operations Command.

Compiled by KMi Media Group staffPEOPLE

Rear Adm. Kenneth J. Norton

Bioinformatics Award From the National Institutes of Health

Northrop Grumman Corporation has been selected by the National Institutes of Health [NIH] to provide advanced information technology and bioinformatics support in the collection, analysis and exchange of scientific data for science researchers investigating immunology and immune-mediated diseases.

The five-year, multi-disciplinary bioinformatics integration support contract was awarded to Northrop Grumman by the NIH National Institute of Allergy and Infectious Diseases. It has a maximum potential value of $30 million and is a re-compete of a contract that the company has held since 2004. The contract will enable scientists to easily access and exchange interoperable complex data sets to accelerate scientific discovery.

“This award underscores Northrop Grumman’s continued commitment to help improve the health of people in the U.S. and around the world. Our team will support basic and applied research to prevent, diagnose and treat infectious, immunological and allergic diseases,” said Amy Caro, vice president, health IT programs, Northrop Grumman Information Systems.

The work will be performed primarily in Rockville, Md. Northrop Grumman’s partners are the Stanford University School of Medicine, Palo Alto, Calif., and E-SAC Inc. of Rockville. The contract is an integral component of Northrop Grumman’s biomedical informatics efforts and programs in support of the life sciences.

Zubi Anwar; [email protected]

$29.5 Million Award to Provide IT Services to

TRICARE Management Activity

Kratos Defense & Security Solutions Inc. announced that it has received the go-ahead to provide IT services in support of the TRICARE Management Activity Defense Health Information Management System.

The $29.5 million contract was awarded to Kratos in September but was held up as the Government Accountability Office (GAO) considered a protest from the incumbent holder of the contract, whose claims were rejected by GAO.

“We are honored to receive this award and are excited to begin the work of providing project management services to help the military deliver a world-class health information management system for servicemembers, their families, combatant commands and the user community,” said Michael Smith, senior vice president of enterprise technology at Kratos.

The scope of work for the IT task order includes the delivery of management, testing, integration and development services to support new and updated software applications for the Military Health System.

www.M2VA-kmi.com4 | M2VA 16.8

The hills near Bridgeport, Calif., aren’t typically alive with the sound of music. Instead, they’re often filled with the sound of Marines taking part in a three-week-long training course in the Sierra Nevada Mountains. In winter, this can mean con-ducting operations for days in sub-zero weather, which taxes body and mind.

It’s also hard on medical equipment, said Chief Petty Officer Greg Highfill, lead

for the cold weather and mountain medi-cine course. One issue is that batteries fail. Another is the retreat of blood from fingers, which makes certain diagnostics difficult. The cold turns something as simple as taking temperature using an old-fashioned thermometer into a challenge due to the danger of tissue damage. For medics, the environment forces them back to the fundamentals.

“What you see, hear and feel is basically what you get. You don’t get those high-tech readouts,” Highfill said.

The training also highlights a seeming paradox. Those engaged in cold weather operations may actually experience heat stress, thanks to exertion and layers of clothing. Indeed, it’s not uncommon to have Marines overheat just before they suffer a cold weather injury, Highfill said.

The dangers of The cold: prevenTing exposure and providing TreaTmenT. By hank hogan

m2va correspondenT


Captain Jeff Salvon-Harman, the Coast Guard’s operational medicine and medical readiness chief, said there were four general cold weather medical hazards. The first is hypothermia, or an abnormally low body tem-perature that ranges from 95 F for mild cases to as low as 68 F for severe ones.

Another hazard is frostbite, or tissue dam-age due to cold. Rounding out the list are injuries arising from loss of dexterity in fin-gers and falls on slippery surfaces. Minimizing all four threats is best done using well-known methods, Salvon-Harman said. “Prevention of the medical hazards through training, personnel protective equipment and exposure limitation far outweighs the benefits of most technologies.”

With regard to new technologies and techniques, figuring out what works—and doesn’t—is one of the tasks of the U.S. Army Research Institute of Environmental Medi-cine in Natick, Mass. The Institute’s focus is two-fold. One thrust involves studying people and their reactions to extreme cold, with this data establishing tables detailing things like recommended work and rest cycles. The other area of interest includes an evaluation of vari-ous mitigation and monitoring technologies.

The Institute’s investigations in the first area have paid off. For instance, studies have shown that exposure to cold can cut cognitive function by 25 percent. That decline in the ability to think can be substantially reduced or even eliminated if soldiers are given nutri-tional aids containing the amino acid tyrosine beforehand, said Dr. John Castellani, an Insti-tute research physiologist.

Another effect of the cold is a loss of dexterity of up to 70 percent in fingers. Gloves don’t solve this problem, because wearing them causes its own loss of nimbleness. Studies done in Canada have indicated that warming the torso can increase dexterity by getting more blood flow to the periphery. However, with current technology this approach takes a considerable amount of power and adds a significant amount of weight to the gear a soldier carries.

“What we need to do is figure out a way to either provide that same amount of power in a

small energy source, or we need to take what we have and move that heat around,” Castel-lani said of possible solutions to this problem.

Complicating the development of any technology or duty tables is the fact that people differ in their reactions to the cold. Thus, the ideal would be individual monitor-ing of soldiers in the field and a prediction of how each will respond.

Technology that might form the basis for this can be seen in the mobile human monitoring products from Zephyr Technol-ogy of Annapolis, Md., and Hidalgo Ltd. of

HH

H

H

A COMMITMENT TO OUR ARMED FORCESThe Patriot Support Programs of UHS offer a significant array of programs and services for active military personnel and their families, as well as members of the Reserve/National Guard Ready Reserve Service. Participating facilities are TRICARE®-approved and work closely with the Veterans Health Administration (VHA).

All Patriot Support Programs are designed exclusively for the Military and are staffed with psychiatrists and physicians who work collaboratively with base personnel to achieve the treatment goals established by Military Command.

Valley Hospital Phoenix, AZCedar Springs Hospital Colorado Springs, COStonington Institute North Stonington, CTEmerald Coast Behavioral Health Panama City, FLCoastal Harbor Health System Savannah, GACumberland Hall Hospital Hopkinsville, KYLincoln Trail Behavioral Health System Radcliff, KYThe Brook Hospital – Dupont Louisville, KYCedar Hills Hospital Beaverton, ORRoxbury Treatment Center Shippensburg, PALaurel Ridge Treatment Center San Antonio, TXRiver Crest Hospital San Angelo, TXUniversity Behavioral Health of Denton Denton, TXUniversity Behavioral Health of El Paso El Paso, TXSalt Lake Behavioral Health Salt Lake City, UTPoplar Springs Hospital Petersburg, VA

UHS FACILITIES WITH PATRIOT SUPPORT PROGRAMS INCLUDE:

www.patriotsupportprogram.com

TRICARE® name and logo are trademarks of the Department of Defense, TRICARE® Management Activity. All rights reserved.

We extend a warm welcome to the Freedom Care facilities, programs and staff who now further complement the Patriot Support Programs of UHS.

Mobile human monitoring technologies, such as this chest mounted system, have been used during field studies by the U.S. Army Research Institute of Environmental Medicine in Natick, Mass., to gauge reactions during operations. [Photo courtesy of USARIEM]

www.M2VA-kmi.com M2VA 16.8 | 7

Cambridge, U.K. These systems have been employed to collect data on the heart rate and skin temperature of soldiers during field exercises, with a swallowed capsule providing core body temperature. Such diagnostic tech-nologies can be beneficial in dealing with cold weather injuries.

“The monitoring technologies can be use-ful in documenting the efficacy of rewarming techniques and provide useful ways of track-ing the clinical state of individual casualties,” said Dr. Reed Hoyt, the Institute’s division chief of biophysics and biomedical modeling.

He added that other important technology advances include thermally responsive textiles so that the clothing worn by warfighters can do a better job of warming without creating chills due to trapped sweat. Satellites now have the imaging resolution to provide all important local weather data, vital when deciding how to dress.

Still other examples of technology advances come from a number of companies. TechTrade of Hoboken, N.J., for instance, has a line of air activated warming blankets. “They are the first totally portable and disposable heated blankets for treating trauma, shock and hypothermia,” said President and CEO Ted Bart.

Once exposed to air, the thermal pads in the Ready-Heat Active Warming Blankets warm up automatically. Through a combi-nation of technology and design, they then maintain a temperature intended to combat hypothermia in a very cost-effective way, Bart said.

The products are one-time use, which can be a plus when it comes to infection control. They come folded up, sealed and with a five-year shelf life.

The company is developing a new product line intended to keep intravenous fluids warm where power is impractical or unavailable. Getting warm fluids into a patient is an effec-tive way to raise core body temperature in severe hypothermia. TechTrade hopes to field a disposable IV warmer by the first quarter of 2013.

North American Rescue (NAR) of Greer, S.C., also makes warming blankets, with its initial products being a heat reflective shell with a heater employing an iron-based chemical reaction. Although this works, the approach can lead to too much heat if the blanket happens to be folded over on itself. The chemical heating method also is less effective at altitude, due to a diminished con-centration of oxygen, and when the heating pads get wet.

The company is now deploying a line of electrically powered products under the ARCºtc name. These have some unique fea-tures, said Darrel Saunders, director of engi-neering.

The thin film used to make the warm-ing blankets has a known surface resistiv-ity, and the production process embeds conductors in it to move power around. The manufacturing process also prints tiny thermostats on the heating surface.

“Across the surface of the heater, there could be 10,000 of them. What this does is it allows the heater to only come to a certain temperature and then the power is shunted away,” Saunders said.

Thus, there is precise control even when the heater material overlaps itself. This mesh layout also means that the heater works even when the material is cut. What’s more, the design of the heater means that the system works on an Army standard BA-5590 battery as well as a suite of power adapters compatible with the HMMWV, civilian vehicles, wall power outlets and the ARCºtc battery pack, which uses CR123A batteries. As for the future, NAR is working on a portable field blood/IV warmer that can deliver 500 cubic centimeters of warm fluid using an internal battery. When connected to other power sources, it can deliver more, and it is designed with safety in mind.

“It has three different sensors on the device, at the beginning, at the middle and at the end, that sample the fluid temperature 300 times per second and determines that it’s within the required parameters. It has a computer chip that actively engages and has room to expand capabilities in the future,” said Ricardo Flores-Artola, director of mili-tary products.

The IV warmer should be available toward the end of the first quarter of 2013. It is under-going regulatory approval, Flores-Artola said.

ThermoTek of Flower Mound, Texas, employs a different approach in its warming products, exploiting the Peltier thermoelectric effect that converts electric voltages to temperature differences. The company’s devices can be used to heat or cool

local sites, said Tony Quisenberry, ThermoTek president and founder.

The resulting thermal management is very precise. “We control temperature to a tenth of a degree in virtually any situation,” Quisenberry said.

The primary applications involve cool-ing a wound, which reduces swelling and thus speeds heal-ing. However, the technology is actually more efficient at heating than cooling, and so the company’s devices can, and are, used to treat hypo-thermia. Because of an FDA requirement, the machines cannot exceed 110 F, less than what’s allowed by code from a hot water heater.

ThermoTek has just released a shoulder applica-tion unit that, thanks to elec-tronic and display advances, is half the weight of the previous version. The company is also field testing a multifunction, battery-operated rapid wound closer for battlefield and clini-cal use. Regulatory approval is expected toward the end of 2013, Quisenberry said.

Finally, there’s a new twist on an existing technology that could have application

in combating cold weather medical haz-ards. Arktos Developments of Surrey, British Columbia, makes an amphibious craft that can handle operations in weather as cold as -40 C (-40 F). Oil companies are the main customers, using the vehicles for evacuation.

Other potential users include the U.S. Navy, Coast Guard and other military orga-nizations around the world. One reason for this interest is that the craft can go where helicopters and ships can’t, acting as an amphibious ambulance, said Bruce Selig-man, company president.

Arktos Developments is working on a version that rights itself in open water. It also is developing one that is air droppable, with this probably available in three years or so. In cold weather, the craft’s extreme insulation means it can keep occupants warm based on body heat alone. Seligman said, “We’re a composite igloo, a fiberglass igloo.” 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.

Darrel Saunders

[email protected]

Ricardo Flores-Artola

[email protected]


When it comes to transporting injured or fallen military personnel, doing it by air is about as close to a last resort option as it gets. “Medevac is typically requested of the Coast Guard when no other local or regional civilian assets are capable of responding or available to respond,” said Captain Jeff Salvon-Har-man, M.D., F.S. and chief of operational medicine/medical readiness at the United States Coast Guard Headquarters.

Unfortunately, in the combat theater, airlifts are much more commonplace. “Just about all rescue or medical situations in Operation Enduring Freedom call for it,” said Air Force Lieutenant Colonel Andrew Reisenweber, chief, Personal Recovery Operations Branch, Air Combat Command at Langley Air Force Base. “Ground-based movement is risky as it is … roads, if they exist at all, are often poor. Adding medical urgency compounds the risk. Aircraft are a much faster, and relatively safer, way of transporting patients.”

And while the companies that design military litters would ultimately prefer for their equipment

to be unnecessary—“We don’t want anybody to have to use our products, because that means they’re in a really bad situation,” said Matt Westra, vice president of sales for North American Rescue—they continue to make advancements in aerial transport gear so that medevac operations can be as successful as pos-sible.

As Westra said, “When they do need it, we want to make sure they’re getting the best quality product possible, and that it’s not going to fail them.”

research and developmenT

Quality products start with quality design, and North American Rescue employs a team that certainly understands the demands of battlefield medicine. “The designers in our company who work on military equipment were special operations combat medics,” said Westra. “They’re guys who have experience on the ground—they’ve got multiple deployments under their belt, they’ve used our poducts in combat in the heat of battle—and now

advances in aerial TransporT medicine.By J.B. Bissell, m2va correspondenT

ClearedFor Takeoff


they’re making our products better for the guys who are currently doing that job.”

After the initial design comes to frui-tion, the North American Rescue team moves on to some fairly realistic prod-uct testing. The company’s facility has a fully functional simulation training center where various environmental challenges can be replicated. There’s a fast roping tower, rock-climbing wall, a confined space tunnel system and more. “Without having actual gunfire coming at you, we can create a high-stress situation in the building, with smoke and sounds and flashbangs,” Westra added.

Thanks to this pragmatic testing and the knowledgeable design team, North American Rescue has made a dramatic improvement to their hypothermia pre-vention products. “On the battlefield, once you’ve treated all the main types of pre-ventable death, hypothermia is still a huge issue in the medevac process,” explained Westra. “Even if it’s 120 degrees on the ground, when you’re in the helicopter and it is at altitude with open doors, the patient is going to get cold, especially if you’ve been through a traumatic event and lost a lot of blood.”

The fairly universal hypothermia pre-vention kit (HPMK), essentially a heavy-duty space blanket warmed from the inside with a chemical-based heating ele-ment, requires oxygen and can be affected at altitude by the lower oxygen concentra-tion or when it gets wet. “So we developed our own suite of battery-powered heating solutions using our new ARCºtc line of products,” said Westra. “You can use almost any battery or power source avail-able on the battlefield or in most vehicles.

“Developing that, finding a better solu-tion to hypothermia, was one of the big things that came out of our personal testing as well as feedback from the field, because that can save lives, and that’s what it comes down to.”

in The deTails

Sometimes it comes down to a buckle. Bud Calkin, owner of Skedco, has been

outfitting the military with his Sked Basic Rescue System stretcher since about 1987. Rolled up, it fits into a pack that’s 9 inches in diameter and 3 feet long. It weighs around 18 pounds. There are two pockets on the outside of the carry bag: one to store the necessary ropes, carabiners and

handles, and the other for an available flotation system. When deployed, the polyethylene plastic Sked stretcher is 8 feet long, becomes tubular around the patient, and is capable of either horizontal or vertical hoisting (or virtually any other evacuation requirement one could think of).

For nearly two decades, that was the Sked system; Calkin changed virtually nothing. Then, four or five years ago, Skedco started using Cobra side release buckles. “They’re a machined aluminum buckle that will not allow a release when it’s under tension,” Calkin said. “So now you get a quick release buckle that won’t accidentally

release if you grab it when you’re hoisting a patient and you’re the litter attendant.”

Changing out a buckle might seem like a small detail, but those little details can be the dif-ference between life and death for an injured soldier. “With the buckle we had before, the operator had to lace the webbing through it, and when you’re under fire, it’s kind of hard to do that, especially in the dark,” Calkin said. “But I didn’t want to change it out until I found something I trusted. The Cobra buckle decreases

patient-packing time by 50 to 65 percent. It saves that much time.”

To put that number in perspective, Calkin said that an individual medic can

Tactical hypothermia prevention shown with NAR’s ARC°tc portable heating solutions. [Photo courtesy of North American Rescue]

Chinook’s MedSled VL Rescue Sled is a lightweight and durable extraction device that can be carried by a single soldier. [Photo courtesy of Chinook Medical Gear]

Bud Calkin

[email protected]




have a downed warfighter ready for trans-port in a Sked litter in a mere 20 seconds. And he knows, because in addition to sell-ing the Skedco stretchers, he still travels all over the country to handle much of the training himself. “I can do it in 20 seconds,” he said. “I’m 75 years old and I still do that routinely. If it’s going to be hoisted by a helicopter, I need another 40 seconds.”

less is more

While a few additional seconds are needed to prepare for a safe airlift, in gen-eral, when it comes to helicopter trans-port, less is actually more. “The military spends millions of dollars to save a few ounces and a few cubic inches on the heli-copters,” said Calkin. “If we use up less of that space, they have more room for other items—such as diagnostic and treatment equipment—to keep these patients alive.”

The hard fact of the matter is that “Coast Guard aircraft and vessels are multi-mission platforms that are not con-figured solely for the medevac mission,” explained Salvon-Harman. “As such, the medical escorts [aviation survival tech-nician–EMT, health services technician–EMT, or flight surgeon–physician] must bring with them any materials anticipated to be required for the mission.

“Once aboard, quarters are typically cramped as medevac is not the primary mission requirement of the vessel/aircraft. Performing necessary medical interven-tions [CPR, defibrillation, intubation, etc.] is extremely challenging in such close quarters.”

Peggy Leighton, the military account manager and clinical specialist for Chi-nook Medical Gear, echoed this circum-stance: “A key medevac product demand is to minimize weight and space,” she said.

Indeed, according to Reisenweber, “Size is probably the most important [fac-tor]. Space is always an issue in our HH-60G helicopters.”

This need for single-unit situational multi-tasking led to the development of the Med Sled Vertical Lift Rescue system (Med Sled VLR), which is distributed by Chinook. “Today’s product must be able to handle a wide range of evacuation scenar-ios under extreme conditions,” added Clif-ford Adkins, president of ARC Products, manufacturer of the Med Sled VLR. “A single product to move a downed soldier

off the field of battle, whether the battle-field is in the desert, mountains, snow, or the ocean, and with injuries ranging from broken to missing limbs.”

The Med Sled VLR certainly fills this requirement. It’s designed for both hori-zontal and vertical extraction, and is made out of high-density polyethylene so it will work as designed in weather conditions from 275 F to -87 F.

Plus, “the patented perimeter tether enables the sled to cocoon the soldier and provide maximum protection during transport regardless of the soldier’s injury,” Adkins said. “That allows for instant verti-cal lift in 60 seconds or less. This decreases the extraction time for hostile situations and time-critical injuries. The VLR also can be equipped with an additional detach-able five-point harness system to handle extreme injuries, including full and partial amputations … it’s more stable, too, and has backboard-like qualities so it does not require a backboard to prevent buckling during a horizontal lift.”

Even with all of these features, the Med Sled VLR system still weighs less than 17 pounds. Perhaps its greatest strength, though, is its ease-of-use. “This product was designed with only one objective: to make the best flexible litter VLR possible. We listened and we learned what the modern Army needed, and we built those attributes in,” Adkins said.

Built-in is the key phrase. The Med Sled VLR comes preassembled with an integrated hoist system rated to 10,000 pounds. “It’s 100 percent battle-ready,” added Adkins. “And with no assembly required, there’s also much less train-ing required. It’s very intuitive … which improves safer operations of the sled.”

This evolution in simplicity combined with durability also improves life-saving capabilities, and as Westra mentioned, that’s what it’s all about. Fortunately, even though each of these companies would prefer for the military to not have to use their products, they all are committed to improving the overall quality of aerial transport equipment. Quite simply, they’re “trying to make things smaller, lighter, faster, and finding easier and better ways to carry injured soldiers and get them to the hospital faster.” O


Colonel Erin Edgar, Central Command surgeon, is primarily responsible for ensuring that all policies regarding health information and health information systems are propagated to theater. The Cen-tral Command (CENTCOM) is one of the six geographic combatant commands, and its focus is the Middle East, where Army soldiers have been deployed to serve in Operation Iraqi Freedom and Operation Enduring Freedom.

“We work closely with the five component surgeons within CENT-COM,” said Col. Edgar. “We work with the Army, Navy, Air Force, Marines and Special Operations Forces. We want to make sure our facilities that swim upstream in the evacuation chain get accurate medical data for all deployed troopers.”

Q: As the CENTCOM surgeon, what is your overall goal with respect to the electronic medical record [EMR] policies that apply to units in support of CENTCOM?

A: Our overarching goal is to accurately document clinical care in the electronic medical record. We have sub-goals, too. One of the things for me is that I’d like it to be easy. If we’ve got an easy system that folks can use to document something that’s clinically focused and makes sense to the provider, I think they’re going to use it to document the notes—and that benefits everybody. It particularly benefits the troop-ers who may get sick while serving downrange, and we owe it to them to make sure that’s documented as accurately as possible.

Q: As a surgeon, have you ever deployed with MC4? If so, what feedback and lessons learned do you have with respect to using the MC4 system and the Theater Medical Information Program – Joint [TMIP-J] applications to improve access to care?

A: I was deployed as the commander of the 28th Combat Support Hospital [CSH] in Baghdad, Iraq, and I would occasionally put on my doctor hat and go to the outpatient clinic and interact with AHLTA-T. I thought it was a pretty good system for outpatient care. This was back in 2006 to 2007 so my surgeons working on the inpatient side had to type notes into TC2, copy them, and then log into the Joint Patient Tracking application [JPTA] and paste the notes in the JPTA application so that patient records would be visible worldwide.

I think we’ve come a long way since then, and it’s a much better [MC4] system now for providers in our hospitals. Now, when medical staff document care in AHLTA-T or TC2, those records automatically flow into the Theater Medical Data Store [TMDS] and they aren’t required to double document anymore.

Q: What are your thoughts on efforts to decrease evacuations for soldiers to be evaluated in person by consultants?

A: Getting remote access to specialists certainly helps through the telehealth initiative. Connecting providers with Department of Defense video teleconferencing so they can offer consultation to sol-diers gives them an opportunity to make diagnoses or ideally rule out diagnoses so they can avoid any unnecessary evacuation. The more we can leverage that system, the less we’ll be putting troopers and air crews at risk.

Q: What are your thoughts on CENTCOM’s current theater Telebe-havioral Health (TBH) policies, and what role have you played in its development?

A: We’ve worked hand-in-hand with the Office of the Surgeon General and with Task Force Medical-Afghanistan to come up with this policy. This goes back to our telehealth initiatives; this is just one in particu-lar that involves behavioral health.

Post-traumatic stress disorder is an epidemic in our force for a variety of reasons. Lots of other psychiatric issues are in play as well, such as adjustment disorders, depression and anxiety. It’s a big burden on the force, and we just don’t have enough trained behavioral health specialists to deploy all over Afghanistan and serve in our brick and mortar facilities back at home stations. By being able to hook up the troopers that have a need for behavioral health care with a remote technician who can give them the care that they need, we can help decrease the unnecessary movement on the battlefield.

Q: What other CENTCOM telehealth initiatives exist?

A: There are others, but not so much tele-oriented, but they basically use email to send a picture and present the clinical case to a specialist. Name a specialty and we’ve got an email hook in for that solution for the providers downrange that need a consultation with a specialist.

Q: Traumatic brain injuries [TBI] continue to be a hot topic for the Army. Are there any current policies in place that will have an impact on how Army medics will be tracking TBI data when deployed in support of CENTCOM?

A: A couple of years ago, DoD put out a directive-type memorandum regarding how we are going to deal with TBI or concussion that generated a U.S. CENTCOM Fragmentary Order. Prior to this

colonel erin edgar

command surgeon

cenTral command

A Look Inside CENTCOM Medical Policies

LEADERSHIP INSIGHT


directive-type memorandum coming out, we had a return-to-duty rate for TBI of about 50 percent; it’s unacceptable.

Ever since we got people to start following this policy, which uses concussion care centers that we have at both role 2 and role 3 facili-ties for people who are close to a blast or at risk of being concussed, it directs them to be removed from a mission for at least 24 hours so they can be evaluated. This was initially perceived by the unit line commanders as mission-hindering. They thought they were losing an asset unnecessarily, but we have increased the return-to-duty rate to 97 percent.

That’s a win in my book and the line commanders categorically are very much in favor of how we are handling TBI because they get troopers back to the fight much more than they did before.

Q: What role do you play in establishing an overall Health Informa-tion Systems [HIS] policy that affects units deployed in support of CENTCOM?

A: We are the authors of that policy. The last one was released in 2007 and we’re currently updating and looking to distribute to the field pretty soon. It is a prescriptive policy for all the Army, Navy and Air Force deployed medical units and personnel and it addresses the EMR as a whole.

Q: What is your expectation of the roles and responsibilities of subordinate component surgeons once CENTCOM has published a medical policy?

A: The component surgeons are basically my eyes and ears in the field. They go to the component hospitals and tour the battlefield to check to make sure that folks are following the CENTCOM policy and keep an eye out for lessons learned for the next iteration of the policy.

We write broad, prescriptive health policy and expect folks to fol-low it, but if they need to tailor it to their specific situation, as long as it’s not conflicting with the CENTCOM policy, that’s okay.

The first HIS policy was issued in 2007 and of course things have been moving along, but now that the software is more mature and robust it’s time to update the policy to reflect the more mature products we have. A lot of times technology is what’s driving this change. The policy on paper health records, for example, is perhaps about 40-years-old, and hasn’t been updated because the same paper records are being used; nothing’s changed. Eventually all the policies are updated as the technology becomes more dynamic.

Q: Why is a clearly articulated HIS policy so important to the mili-tary medical community?

A: That goes back to our overall goal: We want care to be docu-mented. We want it to be documented for everybody, and we want it to be very accurate. The reason these policies come from the top and are made joint is because we’ve got Army hospitals, Navy hospitals, Air Force hospitals and we’ve got Army folks working with U.K. folks. If you’re an airman walking into an Army hospital, or a sailor walking into an Air Force Hospital or a Marine walking into an Army hospital, that should be transparent when it comes to the EMR. Everybody should have the same kind of treatment and all the services should

be documenting care the same way, and that’s why we propagate that policy.

Q: How does an overall CENTCOM HIS Policy assist units who will deploy in support of CENTCOM?

A: By laying the foundation for the use of systems across the service, the U.S. CENTCOM Surgeon’s office and its component surgeon’s staff can monitor, evaluate and conduct surveillance on the health of the force across the battle space now and down the road. The primary benefit to using the system is how it will enable both the continuity of care from the battlefield to CONUS medical treatment facilities and beyond to the Department of Veterans Affairs. Service members will always have the documentation stored electronically and not require paper copies for the Department of Veterans Affairs care and disability systems.

Service components establish pre-deployment training and cer-tifications programs that ensure deploying medical units and deploy-ing medical personnel are required to demonstrate competency in appropriate, role-based TMIP-J applications. For deploying units, this competency assessment is performed during the unit level certification exercise. For medical personnel deploying as individual augmentees or replacements, this competency assessment is performed by the appro-priate pre-deployment replacement activity. O

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New Aortic Tourniquet Device

Hemorrhage amenable to truncal tourniquets is the most common cause of preventable death on the battlefield. Isolated extremity hemorrhage has been effectively treated with tourniquets for the last eight years. However, junctional or truncal wounds are more difficult due to the inability to effectively use tourniquets or hemostatic agents in these areas of the body. The key to surviving hemorrhage is preventing shock. The Abdominal Aortic Tourniquet (AAT) safely stops all bleeding below the waist faster than the Combat Application Tourniquet (CAT) can be applied to one extremity.

The AAT is an FDA-approved device designed to treat difficult to control inguinal hemorrhage and pelvic junctional bleeding. The AAT is the only device with human research showing safety

and efficacy for bleeding in this region of the body. The AAT is easy to apply and lightweight. It takes up very little room. It was developed with the assistance of U.S. Army Special Operations and the Institute for Surgical Research. The AAT is currently deployed to Afghanistan.

The AAT is also the only junctional hemorrhage device with CE mark approval for use in Europe. Foreign special operations units from the EU have evaluated and are using the AAT at home and abroad. The TCCC guidelines approve junctional devices for use in hemorrhage not treatable with tourniquets or hemostatic agents. The AAT is the first to stop all bleeding below the waist.

Christopher Crossley; [email protected]

New Medical Transport Monitor

The Propaq M is the newest version of the Propaq, which has been the vital signs monitor of the U.S. military for the past 20 years. The Propaq M as well as the Propaq MD, with an optional pacer/defibrillator, were specifically designed for the rigors of military operations and are used globally.

For the first time, through collaborative development with the military and partnerships with a number of telemedicine companies, true integration of data from the point of injury through to a definitive care medical facility is available in the latest Propaq model. It is the first integrated device that combines new, clinically superior monitoring parameters for all levels of

care with therapy and data solutions designed to meet future mission needs today.

Propaq’s new, unique open architecture design supports: emerging telemedicine solutions, military EHR systems, and custom report generation. With a significant reduction in size, weight and cube, the 8.5-pound Propaq M vital signs monitor is equipped with Masimo rainbow SET technology, 12-lead ECG with interpretation, life threatening arrhythmia alarms, Microstream EtCO2 measurement technology, motion tolerant NIBP, three invasive pressures, two continuous temperatures, and provides 7.5 hours of operation on a single battery.

Brenda Butler;[email protected]

FDA Clears New Diagnostic

Ultrasound SystemPanasonic Healthcare Co. Ltd’s

Diagnostic Ultrasound System GM-72P00A is a portable ultrasound system optimized to perform a non-invasive examination of the peripheral vessels. The system provides ultrasound imaging information such as the visualization of anatomical structures, characteristics and dynamic processes within the human body using ultrasound to aid diagnosis.

This system also provides an automated measurement of the intima-media thickness [IMT] of peripheral arteries such as the common carotids and allows the user to search for arterial plaques using real-time brightness, color doppler and pulse doppler imaging modes. The touchscreen keyboard allows the user to input various parameters relating to traditional cardiovascular risk factors. A built-in calculator provides risk scores commonly used in a variety of geographical locations (Framingham Risk Score, PROCAM Health Check Score, Reynolds Risk Score, Risk score based on the SCORE Project). This information is supplemented with an IMT measurement of the artery to generate a comprehensive report of cardiovascular risk assessment.


VITAL SIGNS

FDA Approves Stent Graft for Aortic Transection Repair

Medtronic Inc. announced that the U.S. Food and Drug Administration (FDA) has approved the company’s Valiant Captivia stent graft system for the endovascular repair of isolated lesions (excluding dissections) of the descending segment of the thoracic aorta. This expanded indication includes the treatment of transections, commonly known as blunt traumatic aortic injuries.

The second leading cause of traumatic death after head injuries, transection of the thoracic aorta represents a dire medical emergency in which the upper area of the body’s main artery tears due to extreme force to the chest, usually the result of motor vehicle

accidents, elevated falls or other high-impact deceleration episodes.

The Valiant stent graft, a tubular medical device consisting of a specially woven fabric sewn onto a flexible wire-mesh frame, can now be used in U.S. clinical practice to stabilize bleeding from descending thoracic aortic transections as an alternative to invasive surgery.

Previously approved by the FDA for the endovascular repair of aneurysms and penetrating ulcers of the descending thoracic aorta, the Valiant Captivia stent graft system has been widely available in the United States since May 2012.

The device is implanted in a minimally invasive procedure that uses a catheter inserted into the femoral artery, located in the groin. This technique requires only a small incision to access the aorta as opposed to larger incisions required for open surgery.

Compressed inside the delivery system, the device passes through several arteries in the abdomen and up the aorta to the location of the damaged area. By turning a mechanism on the handle of the delivery system, the stent graft flowers open from top to bottom, creating a new path for blood flow and reducing the risk of rupture, a complication that usually results in death.

New Oral Imprinted Butterfly LabelsIncidents of patients being dispensed oral medication intravenously have

been reported by various professional standards organizations. The incorrect labeling and inadvertent use of IV syringes for oral meds has often been cited as causes for these tragic mistakes.

To minimize the potential for error when dispensing oral medication, EPS has released 6 new LiquiDose Butterfly Labels, all with a distinct oral imprint. Available in white, blue, red, green, yellow and orange, all EPS LiquiDose Butterfly labels can be printed with a regular laser printer. Their unique hourglass design provides practitioners ample area for medication identification without covering important markings on the item being labeled.

The label’s oral imprint is strategically placed so as not to limit the space for necessary labeling information. When used with the company’s inexpensive MILT 3.0 software, pharmacists and nurses can take advantage of all the formatting and reporting capabilities the program has to offer. Bar codes, graphics, special fonts, tall man lettering, shapes and logos can all be included on the labels.

“Every hospital has unique requirements,” said Bob Braverman, director of marketing. “The new oral Butterfly labels help facilities call attention to information they believe vital in promoting safety and practitioner awareness, while reducing the potential for medication error.”

These new oral imprinted Butterfly labels have been designed to withstand rough use and storage in drawers or bins. The aggressive adhesive ensures that labels won’t be detached from their applied surfaces (syringes, ampules, etc.).

Bob Braverman;[email protected]

New Rugged Tablet Computer

The MobileDemand high-performance, all-light readable xTablet T1200 bolsters productivity for mobile users who work in demanding environments. This fully rugged tablet provides long-term savings over non-rugged devices with near 100 percent uptime in mission critical line of business applications.

The xTablet T1200 is powered by the latest Intel Core i5-3427U processor (Ivy Bridge) and either the Windows 8 or Windows 7 Professional operating system. Multi-touch, full drive encryption of Windows Bitlocker, the Windows Defender anti-virus application and VPN with Windows 8 are also included.

Mobile workers stay connected with the optional 4G LTE WWAN radio and wireless networks. Two 6-cell 116 watt-hour hot swappable batteries last a full shift or longer—up to 10 hours. The tablet supports a 64 GB to 256 GB and beyond mSATA solid state drive with an option to add a second high capacity hard disk drive.

The tablet contains two USB 3.0 ports and an integrated RS-232 serial port, plus 4G LTE and Bluetooth 4.0 communications. An integrated bar code scanner and RFID reader and a built-in numeric keypad are also included. The xTablet T1200 is integrated with a high resolution front facing and 5 MP rear facing camera, a GPS, PCMCIA, SDHC and smart card reader.

Maureen Szlemp;mszlemp@

mobiledemand.com


Compiled by KMi Media Group staff

Colonel Peter Benson was born and raised in Winchester, Mass. He graduated from the College of Engineering, Northeast-ern University in Boston in 1985. He received his commission upon graduation as a second lieutenant in the infantry in the Army Reserve.

After completion of the Infantry Officer’s Basic Course, Fort Benning, Ga., and the Special Forces Qualification Course, Fort Bragg, N.C., Benson was assigned to A Company, 1st Battalion, 11th Special Forces Group (Airborne) at Fort Devens, Mass. Dur-ing four years of Reserve Service, Benson worked as a quality control engineer and engineering manager for Raytheon Corpo-ration, Waltham, Mass.

In 1989 he matriculated into the Uniformed Services Univer-sity of the Health Sciences, F. Edward Hebert School of Medicine. Benson graduated and received a Regular Army Commission in the Army Medical Corps in 1993. He completed a transitional (rotational) internship at Madigan Army Medical Center in Fort Lewis in 1994. After completion of the Walter Reed Army Institute of Research, Tropical Medicine Course and the U.S. Navy Diving Medical Officer Course, he was assigned as battalion surgeon, 2nd Battalion, 1st Special Forces Group (Airborne) at Fort Lewis, Wash., in 1994. After three years in the 1st Special Forces Group, Benson was accepted into to the Emergency Medicine Residency program at Madigan Army Medical Center, graduating in 2000.

He was assigned as staff emergency physician and later chief of the Emergency Medicine Service at William Beaumont Army Medical Center, at Fort Bliss, Texas. While at Fort Bliss, Benson was also an augmentee to the Joint Special Operation Command Surgeon’s Office from 2000 to 2004. Benson served in multiple deployments to Operation Enduring Freedom and Operation Iraqi Freedom, serving as the task force surgeon for Task Force 121 in Operation Winter Strike in 2004.

In 2004, Benson was assigned to Special Operations Com-mand Europe in Stuttgart, Germany, as the first permanently assigned theater special operations (TSOC) command surgeon. He returned to Fort Bragg in 2007 as the first U.S. Army Special Forces Command (Airborne) command and regimental surgeon. He was assumed his current assignment as deputy chief of staff, surgeon of the U.S. Army Special Operations Command in 2009.

Benson’s awards and decorations include the Bronze Star Medal, the Defense Meritorious Service Medal, the Meritorious Service Medal with oak leaf cluster, the Air Medal, the Joint Ser-vice Commendation Medal, the Joint Service Achievement Medal,

the Joint Meritorious Unit Award, the Army Superior Unit Award, and other individual and service awards.

He has earned the Special Forces Tab, the Combat Medical Badge, the Senior Flight Surgeon Badge, the Master Parachutist Badge, and the US Navy Diving Medical Officer Badge, the French Military Parachutist Badge and the French Army Commando Course Badge. He completed the U.S. Army Command & General Staff College (Correspondence) in 2005.

Benson is also a Diplomat of the American Board of Emer-gency Medicine and a Fellow of the American College of Emer-gency Physicians and the American Academy of Emergency Medicine.

Q: What are your current mission and responsibilities as the USASOC surgeon?

A: The continuing mission of the USASOC Surgeon’s Office is to ensure that the commanding general is able to field the most highly skilled and resourced special operations medical providers in the world. The Surgeon’s Office has the doctrinal and policy oversight element with regard to special operations medical organization, structure, training and equipment. The Surgeon’s Office and its staff also serve as subject matter experts to the commanding

Colonel Peter J. BensonCommand Surgeon

U.S. Army Special Operations Command


Force TrainerDelivering Medical Providers for Special Operations Forces

Q&AQ&A

general and the directorate staff for medically-related issues. The central element in medically supporting Army special operations forces [ARSOF] is the enlisted, non-licensed providers—the special forces medical sergeant of the special forces groups; the special operations combat medics of the 75th Ranger Regiment and 160th Special Operations Aviation Regiment, and the civil affairs medical sergeant of the 95th Civil Affairs Brigade.

The ability of USASOC’s John F. Kennedy Special Warfare Center and School to train the most skilled non-licensed provider in the world enables ARSOF to deploy with a medical capacity unrivaled elsewhere. This translates into an operational ability to mitigate medical risk on the battlefield, which creates a strategic advantage of being able to deploy ARSOF anywhere in the world with the best medical capability available.

Q: Is the nature of tactical combat injuries expected to change over the next five years?

A: As the military’s and its SOF’s missions changes over time, there will likely be a change in the ratios of specific wounds rather than a difference in the wound patterns themselves. Over the span of Operation Enduring Freedom, for instance, the increased enemy employment of mines and IEDs created an increase in fragmentation, blast, blunt and complex traumatic injuries ver-sus penetrating ballistic injuries from small arms. These types of wounds were always a risk, but have now increased as a larger proportion of combat injuries. With this change has come a larger proportion of complex traumatic injuries, with limb amputations and pelvic injuries combined with penetrating abdominal and thoracic injuries.

The larger ration of explosive munitions injuries are also seen as blast and blunt trauma, including traumatic brain injury. In the future, as the mission of SOF potentially evolves to a less combat intense environment, the overall number of casualties will decrease. A shift to combat advisory, foreign internal defense and stability operations may affect the number and types of wounds our soldiers experience.

Q: Is it expected that a greater strategic emphasis in the East Asian Pacific region will alter SOF’s medical access and assets?

A: The Pacific Rim and East Asia are tremendously large areas to operate in. The vast distances over water and the remote areas where operations take place create the “Tyranny of Distance” effect. This is the effect whereby operational support and spe-cifically medical support become increasingly difficult the further the operation is from firm basing or dedicated assets. This is the reason that SOF has such highly trained medic providers in each element. Units that operate in remote and austere locations, far forward of dedicated support, must rely on their internal medical capacity.

The special forces medical sergeants and USASOC’s special operations combat medics are the most expert, highly trained non-licensed providers in any military, anywhere. Their expertise has been battle-tested and proven in Afghanistan and Iraq without question. The goal for the future is to create a damage-control resuscitative surgical element that is light, modular and opera-tionally agile enough to support SOF operations. As SOF comes off the battlefield in Afghanistan and increases its engagement in

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areas without the robust medical infrastructure of OEF, there will be a requirement to deliver the same level of high quality medical support in much smaller, lighter elements.

Q: Can you give an overview of current trends in partner nation medical capacities and how that is expected to change or continue in the next decade?

A: The past decade has yielded a remarkable opportunity for the U.S. and our allied and partner nations to work together in coali-tion operations. There has been a great deal of learning from each other through the combined operations in Afghanistan and Iraq, particularly. Additionally, the establishment NATO Special Opera-tions Headquarters has done a tremendous job through their com-mand surgeon’s office to bring the NATO partner nations into a common vision of SOF medical operations and training.

Undoubtedly, one of the biggest trends is the adoption of the tactical combat casualty care paradigm as the world’s standard for combat trauma response. This has enabled the disparate nations to have a common standard for tactical medical training and field procedures. Incredible as it sounds, it’s never before been the case.

One of the other trends is the recognition that damage control resuscitative surgery is a necessary adjunct for SOF medics in the deployed environment. SOF medics of all nations are very skilled and capable, but at some point many wounded soldiers will need surgical hemorrhage control or other life-saving procedures. The SOF medic’s stabilization and resuscitation skills are paramount, but historically almost 50 percent of SOF soldiers who die, die from surgically uncontrolled hemorrhage.

Many nations are looking at the creation of special operations-capable light surgical teams, if they don’t already have them. The French Service de Santé [military medical service], long familiar with the airborne field surgical team has fielded an even more agile unit, the ultra-mobile forward surgical team [UMFST]. The UMFST consists of only four personnel and is air-transportable, air droppable and maritime capable. Sweden has also developed a highly capable, modular damage control surgical capability. The

key to deploying into very austere, poorly trafficable, remote areas is to support the special operations medic with an appropriately placed surgical asset. The ‘golden hour’ can be extended only so long without surgical care. In areas like the vast Pacific basin, if the closest surgical asset is a thousand or more miles away, the risk to the force and therefore the risk to the mission becomes excessive.

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Special Forces soldiers move a manikin onto a litter for transport to a safe medical evacuation area under assignment from the John F. Kennedy Special Warfare Center and School. [Photo courtesy of Specialist Victor Ayala U.S. Army]


Q: What are some of the new medical technologies and train-ing programs being introduced to the John F. Kennedy Special Warfare Center and School?

A: The JFK Special Warfare Center and School has always been a leader and innovator in special operations medical training. There are a number of novel changes in SOF medic training courses. One aspect that has received new emphasis is medical operational planning. Often our SOF medics are required to independently direct other medical responders in mass-casualty events. With universally TCCC-trained SOF soldiers on each team, the medics are often called upon to lead and manage the unit’s casualty response. To enhance this capability, more medi-cal operations planning training was added.

Several enhancements to the training course have been the addition of practical ultrasound training and more regional nerve block training. The ability to use ultrasound for diagnosis can make the difference between calling in a patient evacuation or not. And an enhanced ability in regional anesthesia allows a greater range of treating a casualty’s pain for comfort and evacu-ation, without the side effects of narcotics. These efforts have added a great deal to the SOF medic’s ability for diagnostics and treatment in a remote setting.

Q: What are the current status and the future of behavioral health within Army special operations?

A: The enduring engagements around the globe have under-standably had an effect on USASOC’s soldiers. It would be illogical to expect the experience of multiple combat tours would have no impact. The very fact that USASOC has forces currently committed to operations around the world today is a testament to the hardiness of its soldiers. Just like the conventional forces, USASOC has its share of soldiers who are actively dealing with PTSD and other behavioral health issues. The overall percentage of the force with active issues is low, but undoubtedly any soldier of any force who experiences combat is affected to some degree.

The key is to validate the experience, recognize its effect and channel the response in a positive, constructive or healthy way. USASOC wants its soldiers to realize that some change from combat exposure is expected and that they are supported and expected to seek help if needed. Behavioral health needs to start as a ‘self-maintenance task’ just like maintaining equipment. It’s the soldiers’ duty to care for themselves and their peers, just as they’d maintain a weapons system. Maintaining yourself means they’re ready to support the unit in operations, and to support their families in garrison. The message is to self-identify when you need some help, before the issue becomes a problem.

Q: What avenues for growth are there in providing access to SOF medical professionals in hostile environments?

A: Providing a means for rapid intervention after a traumatic event for soldiers in proximity to the events has a tremendous value in preventing future problems. Most USASOC units have organic clinical psychologists as well as the chaplaincy and the medical providers. Having organic support enhances the ability for soldiers to access care, but it decreases the stigma of going to the medical treatment facility for a potential behavioral health

Infrascanner Technology – How it worksExtra-vascular blood absorbs NIR light more than intra-vascular blood since there is a greater concentration of hemoglobin (usually 10 fold) in an acute hematoma than in the brain tissue where blood is contained within vessels. The Infrascanner measures the difference in NIR light absorption at corresponding locations on the left and right sides of the head. The detection depth is superfi cial (within 3.5 cm of the skin sur-face), where blood migrates in most cases of bleeding.

Infrascanner Detection Abilities:• Patient measurement is completed within 2-3 minutes.• Can detect hematomas greater than 3.5 cc in volume.• Detects hematomas up to 2.5 cm deep from the surface of the

brain (or 3.5 cm from the skin surface).• Accuracy: In patients with Epidural, Subdural and Intracerebral

hematomas: Sensitivity = 88% / Specifi city = 90.7%*

Infrascanner Military ApplicationThe Infrascanner has a very specifi c application in detecting TBI on the battlefi eld and in routine military settings where timely triage is critical. The United States Navy and Marines have invested signifi cantly in Infra-scanner development and have successfully fi eld tested it in Iraq. Early hematoma detection can contribute to saving lives and in planning an adequate evacuation priority of the injured.

The Infrascanner is a portable screening device that uses Near-Infrared (NIR) technology to screen patients for intracranial bleeding, identifying those who would most benefi t from immediate referral to a CT scan and neurosurgical intervention. In the triage of head trauma patients, the Infrascanner can identify patients most likely to have intracranial bleeding.

© 2012 ADS, Inc. The ADS logo is a registered trademark of ADS, Inc. A0257 5/12

855-819-4276ADSINC.COM/MEDICAL

HANDHELD BRAIN HEMATOMA SCREENINGINFRASCANNER

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The Infrascanner is a portabl(NIR) technology to screen pathose who would most benefi

i l i t ti I

“T

INFRASCANNERMODEL 2000

*C. Robertson, E. Zager, R. Narayan, N. Handly, A. Sharma, D. Hanley, H. Garza, E. Maloney-Wilensky, J. Plaum, and C. Koenig, “Clinical Evaluation of a Portable Near-Infrared Device for Detection of Traumatic Intracranial Hemato-mas,” Journal of Neurotrauma, vol. 27, pp. 1597-1604, 2010.


issue. Soldiers identify better with a unit provider with whom they are familiar and are more willing to seek assistance. This allows more rapid care and enables the provider to channel the treatment experience into a personal growth or development occasion.

Q: What are some key initiatives or programs that USASOC is working on or would like to see?

A: One of the key initiatives is to refocus and reorganize the USASOC medical force generation capacity. Changes in the strategic focus and the anticipated drawdown in Afghanistan will have an impact not only on the size of the force but the type of missions undertaken and the training required. The Special War-fare Center has met the need of growing the USASOC medical force over the last decade, but maintaining the increased force and changes in the mission require additional classroom space, instructors and equipment. Additionally, a renewed focus on the core competencies of special warfare and unconventional warfare may necessitate a rebalancing of the medical training programs with more emphasis given to unconventional warfare medicine and extended care scenarios. In the same sense, there is likely a need for a secondary level special forces medical sergeant clinical training course.

The only standardized medical training currently received is the initial SFMS [18D] course. It’s highly desirable to capitalize on a medic’s clinical experiences and provide advanced practice skills training at some point, potentially combined with the advanced NCO course. Overall, the need for additional health service support manpower in the USASOC force structure is great. The medical tasks of forming, training and equipping and maintain USASOC’s expanded force structure have outstripped the medical manpower in a number of places. Lastly, with a view toward future operations in undeveloped theaters, a smaller, more agile damage control resuscitative surgical capacity either organic or in direct support of USASOC is necessary. The Army has been working to create a leaner force structure for their conventional forward surgical teams, which may suffice, but the force-generation and readiness cycle for these conventional teams would have to synchronize with USASOC deployments, which may be difficult.

Q: What are some of the most promising research areas to USASOC?

A: The most important research initiative in USASOC has been to field a freeze-dried plasma [FDP] through an FDA-approved investigational new drug request. Severe combat trauma asso-ciated with hemorrhagic hypotension and coagulopathy in the austere environment has been a critical challenge for all SOF medical personnel. While hypotensive resuscitation and certain pro-coagulants have become standard treatment principles, there has been no established resuscitation fluid which aug-ments blood volume without worsening coagulation or acidosis.

FDP is a shelf-stable, physiologically balanced fluid with contains the normal human blood proteins in normal ratios. It not only restores blood volume but replenishes the coagulation proteins consumed in trauma in their normal ratios. FDP is eas-ily reconstituted with a simple diluent and can be administered

by IV or IO line in under three minutes. When combined with the anti-fibrinolytic medication tranexamic acid, which inhibits clot breakdown, this may be the ideal treatment protocol for a field deliverable, shelf-stable resuscitative combination for severe trauma.

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

A: I would like to thank you for the opportunity to showcase some of USASOC’s medical issues. The amazing talent and energy in our USASOC medics is one of our command’s most valued commodities. The ability of these SOF soldiers to provide the very best in advanced tactical medical care in far-flung and hostile environments is unrivaled by any other military force in the world. It’s a challenge to live up to the dedication of all the great American men and women who every day, answer the call to save the lives of comrades at the point of spear. O

Top: During first aid training a sergeant places a nasopharyngeal airway in the nasal passage of a specialist medic. Soldiers and airmen of various units receive training in preparation of their upcoming deployments.Bottom: A specialist medic places a bandage around the forearm of an assistant instructor during first aid training. [Photos courtesy of Sergeant Lizette Hart U.S. Army]


how recenT advancemenTs have saved Thousands of lives.

Surgical training has long involved the use of simulators. Practicing procedures on human cadavers is a time-honored part of medical training and represents a simula-tion of sorts. Surgeons have also trained on live animals such as goats and pigs.

The advancement in military medical training in recent years has resulted in the saving of thousands of lives on the battle-fields of Iraq and Afghanistan. The skills and success of military medics and surgeons are attributable to their training and that training has increasingly revolved around the advanced simulators that have been developed in recent years.

Today’s simulators feature a realistic look, feel and function to skin, organs and blood. Some are actually designed to be worn by live human actors who can simu-late the totality of the patient treatment process.

“The IEDs, poly-trauma, the multiple traumatic amputations that you would encounter in theater can’t be replicated for training unless you use simulation,” stated Paul Bernal, director of global government business development for CAE Healthcare.

However, the needs of military and veterans medi-cine are by no means limited to combat casualty care: They run the gamut of medical problems and surgical proce-dures. The military and vet-erans medical communities therefore make use of gen-eral training simulation as well, such as those designed to train for minimally invasive procedures.

Traditional classroom methods for medi-cal training revolve around textbooks and

PowerPoint presentations, noted Dr. Haru Okuda, national medical director for the Department of Veterans Affairs SimLEARN program. “Then the students go to the ward for hands-on training,” he said. “Simula-

tions allow a more proactive approach to training. Train-ees can then apply what learn the learned on the simula-tion.”

“Training represents a precursor to actions on the battlefield,” said Mark Owens, a military strategic account manager at Laerdal Medical, a developer of medical train-ing simulators. “Medics can be presented with realistic

training simulations and that this results in better combat care for U.S. warfighters on the battlefield.”

Dr. Haru Okuda

MedicalSimulation

TrainingBy peTer BuxBaum, m2va correspondenT


“There is a revolution in surgical educa-tion that is now underway and that this is being led by the U.S. armed forces,” said Dr. Robert Buckman, chief executive officer of Operative Experience Inc. “It’s going to have an impact on worldwide health. Simulations allow training midwives to do a C-section in four months or even four weeks instead of four years. This is going to have an impact around the world in areas underserved by health care infrastruc-tures. Simulations rapidly train civilian surgeons to be prepared for combat situa-tions that they rarely if ever encounter in civilian prac-tice.”

The use of medical train-ing simulators could reduce or eliminate the need for training on live animals. “A research team at the Univer-sity of Minnesota is evaluat-ing this situation,” said Kit Lavell, executive vice presi-dent of Strategic Operations Inc. There is also legislation pending before the U.S. Con-gress which would eliminate live tissue training by 2017.

“An animal is a simulator of sort because their tissues are great to work with,” said Buckman, “but they don’t have the same anatomical architecture as humans. Sim-ulators represent as closely as possible the anatomy, tissues and pathologies represented by combat trauma.”

But combat trauma is not the only training requirement for the military medicine. “Military and veterans military hospitals and organizations have a wide range of needs and requirements for training,” noted Dror Paz, vice president of North American sales at Simbionix USA Corp. “It is not limited to combat and disaster relief.” Simbionix spe-cializes in developing and marketing simula-tors for training practitioners for minimally invasive procedures.

The same logic applies to the VA. “The number of female veterans has doubled over the last 10 years,” said Okuda. “Some of our practitioners needed additional training on procedures involving women’s health.” To

that end, the VA has invested in simulations that train practitioners to perform proper pelvic and breast examinations.

Operative Experience Inc. (OEI) recently participated in Operation Bushmasters, an annual training exercise of the Uniform

Services University Medi-cal School. “They used our simulators for almost every aspect of training from point of injury to Level 2 care,” said Buckman. “We trained in excess of 150 students.”

OEI developed its simula-tors with a Small Business Innovation Research grant from the U.S. Army. “What the Army wanted was a sim-ulator that could provide rapid combat trauma skills training,” said Buckman. “In response, OEI created train-ing courses using high fidel-ity and anatomically correct simulators with pathology and wound patterns represen-tative of combat injuries. The simulators consist of artificial tissues, including skin, bone, muscle, fascia, blood vessels and nerves that can be oper-ated on with standard combat surgical instruments.”

OEI point-of-injury simu-lators emphasize training in damage-control and opera-tive management of high velocity gunshot wounds. They enable instruction in, among other things, the vas-cular control of blood vessels, damage-control shunting of arteries and veins, and amputations. OEI’s head and neck simulator series enables

instruction in procedures associated with high-occurrence traumatic brain injuries such as evacuation of subdural hematoma, evacuation of epidural hematoma, and man-agement of fragment penetration of brain.

CAE’s Caesar patient simulator also provides point-of-injury trauma care expe-rience. According to Bernal, “Caesar can withstand harsh environmental conditions, extreme temperatures and body impact.” Moreover, “he is also a dramatic bleeder.” Caesar is also appropriate for placement in areas where a human actor would be at risk. Bernal gives several situational examples:

“high-angle rescue, a confined space inside a tank or truck or under a collapsed building.”

Currently, the Department of Homeland Security’s Center for Domestic Preparedness uses Caesar for decontamination training exercises. “We are always working on improv-ing our products,” stated Bernal. “With Cae-sar, we are adding injuries and writing new scenarios based on the latest health care threats, injuries and mechanisms of injury.”

Laerdal Medical develops simulators that run the gamut of combat procedures applica-ble both to first responders and to clinicians delivering services at higher levels of care. “Military medical organizations are empha-sizing training for the platinum 10 min-utes,” said Owens. “Immediate treatment on the battlefield increases survivability. That is where much of our efforts are concentrated.”

Laerdal’s manikins exhibit realistic reac-tions, such as variations in pulse and eye dila-tion, to the procedures performed on them. The chest rises and falls appropriately and the manikin emits a hissing sound which shows that a chest needle has been applied correctly in the case of a tension pneumothorax (a sucking chest wound) procedure.

“If the procedure is not performed well the manikin will expire,” said Owens. “The negative result is important because data is captured throughout the procedure. After the session, the instructor can debrief the learner individually or in a classroom environment. If the procedure is performed correctly the mannequin will respond accordingly.”

Embedded in the manikin is a wire-less connection that transmits the training session to the instructor’s tablet computer. “Instructors can increase the complexity of the situation remotely from the tablet,” Owens explained. “The training scenarios can be modified and customized based on the needs of the customer.”

Strategic Operations’ Cut Suit is a simu-lator that is worn by a live human actor. “The product is designed to enable training for care under fire as well as the transition up the echelon of care with battlefield effects,” said Lavell. “The actors and trainees can be put into realistic situations where trainees can learn procedures for combat casualty care for the three most preventable causes of death on the battlefield: hemorrhage, tension pneumothorax and airway blockage.”

The Cut Suit simulates realistic bleeding of the arms and legs and can be supplied with Strategic Operations’ blood pumping system, which can be used to train on the applica-tion of tourniquets. “The simulator allows

Dr. Robert Buckman

Dror Paz

Kit Lavell

[email protected]

[email protected]

[email protected]


the trainee to stop bleeding without injuring the actor because there is a protective shield between the person and the tourniquet,” said Lavell. “If the tourniquet is not applied prop-erly, the bleeding won’t stop and the patient will bleed out.”

The point of working on a human patient rather than a manikin is to simulate realistic interactions between patient and provider. “You can look into the patient’s eyes, they can cry, scream, act hysterically and even give misleading information, all the things that casualties do on the battlefield,” said Lavell.

Strategic Operations recently introduced a new device called blast pants, which can be used with a live human patent to train on treating groin injuries. The company’s IV and suture sleeve is also used with a live patient. The blood pumping system simulates blood flow with a reservoir and electrical pump and can be used with other Strategic Operations products. The company recently introduced a six-in-one trainer that provides learning expe-riences for all of the tactical combat casualty care procedures for a variety of head, neck and nasal injuries on a single device.

Simbionix specializes in simulators that train on minimally invasive procedures such as laparoscopies, endoscopies, bronchosco-pies, gynecological and endovascular sur-geries that are not used on the battlefield. These minimally invasive procedures involve inserting cameras and small tools inside a patient through as small incision rather than performing an operation by cutting the patient open.

“Our simulators are for the operating room environment,” said Paz. “These are used by institutions training physicians and surgeons and by doctors seeking to increase their skill levels increase comfort level, and all together contribute to better procedures outcomes and patients’ safety. The simula-tors we sell to military medical organizations and VA hospitals are the same we sell to our commercial customers, such as teaching and university hospitals, and are typically incor-porated into residency/fellowship and other training programs.”

In this case, computers are integrated into the simulator to offer virtual reality simulation to improve students’ hand-eye coordination, in-depth perception and overall procedural performance. “The trainee will have an experience as close as it gets to real life,” said Paz. “We incorporate haptic feedback technology, which uses the sense of touch to apply vibrations and motions to the training experience.” Simbionix recently

added ultrasound and arthroscopy simulators to its repertoire of products.

In 2009, the VA inaugurated its Sim-LEARN program, an effort to standardize simulation across the VA system. “We are looking at the use of simulators in the VA,” said Okuda. “Some of our facilities are being brought up to speed. We are in the process of developing a national skills program and national curricula based on the clinical gaps we have identified within the VA.” One area of emphasis, in addition to women’s health issues, involves airway management.

Some of the simulations are being devel-oped in the VA’s own innovation centers. One recent development has been an avatar that is used to train clinicians in interviewing techniques with geriatric patients.

Dror expects medical simulators to become even more realistic and comprehen-sive in the future, with more incorporation of haptic feedback as well as three-dimensional depictions and advanced software develop-ment. “Computer power is constantly advanc-ing, and that improves the realism of the simulators,” he said. “We also enable doctors to practice on specific patient data through our PROcedure Rehearsal Studio simulator, where doctors can load their specific patient CTA scans and practice on the simulator before performing the actual endovascular procedure in the operating room.”

Owens also expects greater realism from future medical training simulators with improvements in the developments of syn-thetic tissues, which will further reduce the dependence on live animals. He also expects that the future will see more requirements for simulators from the military medical community, despite the promise of federal budget cutbacks.

“The Army currently has 28 medical sim-ulation training centers around the world,” he said. “They expect to expand to 40 by 2017. The military recognizes that simula-tion training reduces performance risk. It enables organizations to better control the pace of training. Instead of having students sitting around in an emergency room waiting for situations to present themselves, they can schedule training for procedures on realistic simulators.

“Simulators are expensive,” Owens acknowledged, “but the costs are offset by reducing risk and saving lives.” O

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The Army is one step closer to issuing an updated version of its ballistic underwear after a recent review and approval by the U.S. Army Public Health Command.

Experts in the command’s Health Hazard Assessment Pro-gram completed an occupational health assessment of the new protective outer garments and undergarments, and provided recommendations on how to minimize any risks.

“We evaluated these items to identify any occupational haz-ards that could arise from wearing them,” said Robert Booze, an industrial hygienist project officer at the USAPHC. “Our goal was to mitigate any risks to soldiers before the protective outer garments and undergarments were distributed to the user.”

After a thorough review, the HHA Program approved the protective outer garments and undergarments for military use.

Military work is inherently dangerous, but officials at the USAPHC believe that soldiers in combat should not be placed at a disadvantage or at unusual risk because their protective clothing is deficient.

Although these undergarments look similar to a set of men’s bicycle pants, they are no ordinary underwear.

“They are designed to use protective fabric and withstand injuries to the pelvic region that may result from the blast of an improvised explosive device,” said Booze.

From 2003 to 2011, more than 600 soldiers suffered inju-ries to the genital region during the wars in Iraq and Afghani-stan. Although soldiers are well protected by body armor on their torso, some injuries to the lower body are so severe that they can cause soldiers to lose all or part of their genitals. This loss of the reproductive organs can have devastating psycho-logical effects.

The Health Hazard Assessment Program was not the only program within the USAPHC that helped complete the assess-ment of the pelvic protection system.

Wilfred McCain, senior toxi-cologist, said the USAPHC Toxicology Port-folio conducted an evaluation of the materials that were used in the underwear to see if they posed any potential risk to the wearer’s skin.

“We evaluated the fabric, and did not see any threats to the user,” said McCain. “The safety of our soldiers is a top priority.”

The garments must also be comfortable, using breathable fabrics like cotton, according to specifications requested by the Army.

Booze, who once served as an infantry officer in the mili-tary, said he feels blessed to perform a job that helps ensure protection of the troops. The HHA Program reviews not just personal protective clothing, but weapons systems, equipment and training devices as well.

“I am grateful that I still have a job that allows me to sup-port our Army in a meaningful way,” he said.

Now that the USAPHC health hazard assessment is com-plete, the Army will conduct several more reviews before the outer garments and undergarments are adopted in the field. The Army is expected to have 75,000 pairs ready this fall. O

Chanel S. Weaver is with the Public Affairs Office, U.S. Army Public Health Command.

usaphc compleTes healTh hazard assessmenT of BallisTic underwear.By chanel s. weaver

Updating Ballistic Underwear




J. David Schairbaum is currently the chief of the rotary wing branch, Air Force Life Cycle Management Center, Air Force Materiel Command, at Wright-Patterson Air Force Base, Ohio, since 2010.

During his tenure starting in 1985, he has served as program manager, deputy chief, deputy program director for various programs within the acquisition arena, from the F-22, C-5, C-17 and T-6 (Joint Primary Aircraft Training System), all at Wright-Patterson Air Force Base, making him an expert on numerous platforms. He has also held staff positions within the then-aeronautical systems center pro-gram executive group.

Schairbaum received a Bachelor of Science in electrical engineering in 1985 and a master’s degree in business admin-istration in 1995, both from the University of Dayton. Additionally, he completed the advanced and executive program man-agement courses, Air War College, and is acquisition professional development plan management level three certified.

Schairbaum’s awards include the Wil-liam A: Jump Award (1990), the Johnston Award, (1992), the Civilian Achievement Award (2007), and the Meritorious Civil-ian Service Award (1999 and 2010).

Q: What are the requirements for the combat rescue helicopter [CRH] con-tract?

A: The combat rescue helicopter program will replace the USAF aging HH-60G Pave Hawk helicopter fleet with new air vehi-cles, training systems and product support as required for the personnel recovery [PR] mission. The contract will allow for the purchase of up to 112 aircraft, associ-ated training systems and provide for ini-tial sustainment of the CRH system.

Q: Please describe industry’s role in your development of your acquisition strategy.

A: Market research played a significant role in developing the acquisition and contracting strategy for the CRH. Responses through sources sought synopsis, several requests for infor-mation and Industry Day meetings revealed a strong competitive environment for both the air vehicles and the training systems. Mar-ket research also revealed that the USAF requirement could be met by modifying existing, in-production and flight-proven air vehicles and training systems. These modifications will require some level of integration and software development to meet the warfighter’s requirements.

Q: What is the status of the program?

A: The request for proposal should be released to industry imminently. Proposals will be due to the CRH Program Office 60 days after RFP release.

Q: When does the Air Force expect it to be awarded?

A: We expect to award the contract in the fourth quarter of fiscal year 2013.

Q: Why does the Air Force want a new combat rescue helicopter?

A: Aging HH-60G Pave Hawk helicopters are experiencing decreasing operational readiness due to structural integrity issues and battle damage, increasing operating costs, scarcity of spare parts, and difficulty

in conducting the demanding mission of PR in today’s operational environment. First fielded in the early 1980s, these older, analog-based helicopters were simply not

designed for today’s evolving battlefield.

Q: How will it change Air Force operations?

A: Even though the HH-60G availability rate is declining due to combat damage and structural integrity issues, our fleet has continued on an unprecedented pace with over 27,475 combat

sorties and 12,997 personnel recovered since 2008. We do not expect significant changes to operations with the fielding of the CRH; however, there will be enhance-ments in tactics, techniques and proce-dures along with the inherently greater capabilities that are expected with a new platform. Additionally, availability to the combatant commanders will experience a tremendous improvement with CRH, fur-ther enabling mission accomplishment.

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

A: Thank you for taking the time to inform your readers about this new Air Force program. We look forward to deliv-ering these much needed aircraft to the warfighter in time to prevent a significant gap in United States combat search and rescue capability. O

J. david schairBaum discusses The air force’s requesT for a new comBaT rescue helicopTer.

J. David Schairbaum


There is some truth to the maxim that if medicine is to advance, medical professionals must serve in war zones.

During the decade that Canada has participated in the NATO-led, UN-supported mission of Afghanistan, the Canadian Forces Health Services (CFHS) had ample opportunity to test its mettle and push the limits of combat medicine while working with CF combat forces and alongside allied counterparts in the Role 3 Multi-National Medical Unit at Kandahar Airfield.

“If you want to learn surgery, it is well-known that you should follow the army,” said Colonel Homer Tien, a Canadian Forces (CF) trauma surgeon who completed five tours of duty at the Role 3. “In Afghanistan, this has certainly been the case. We have made important advances in surgical procedures. For example, the way we transfuse blood into casualties is different now—we transfuse large amounts of blood into severely injured casualties early in their care and treatment because there is evi-dence that this is beneficial to our soldiers.”

But now that combat operations have ended for the CF in Afghanistan, post-combat reconstitution is ongoing while at the same time it is well understood that the next several years will require specialized care for our soldiers on the home front.

“Canadians should be very proud of the way our soldiers fulfilled their duties while in the Afghanistan theater of opera-tions,” said Colonel Scott McLeod, the CF director of mental health. “Canadians should also be aware that many CF members were exposed to aspects of operations that will potentially have long-term mental health effects and that will require extensive treatment.”

“Mental health will continue to be a predominant focus of the military health services for many years to come, and we’re very well resourced for this purpose,” said the surgeon general, Brigadier General Jean-Robert Bernier. “An aggressive plan is underway to further enhance our already robust preventive edu-cational and treatment programs, and to attract and retain even more high quality mental health professionals.”

The CF Directorates of Mental Health and of Force Health Protection provide several evidence-based mental health edu-cational programs to prevent or mitigate the impact of factors that contribute to mental health problems. They are delivered throughout the career cycle to CF personnel, family members and leaders, covering conventional mental health issues as well as deployment-specific issues. To date, well over 50,000 CF members have received some form of mental health training and education.

Over the coming years, Canadian Forces Health Services (CFHS) will also focus on successful completion of its mentoring mission in Afghanistan, domestic defense and humanitarian oper-ational capabilities, further modularization and mobility enhance-ments to permit more rapidly deployable health capabilities, and greater allied interoperability and coordination.

Operational readiness is a multi-faceted and complex aspect of the CF and an ongoing CFHS priority. It is achieved by mov-ing CF members through a complex force generation system that includes health readiness. “CF must maintain a level of readiness that prepares its members to rapidly deploy on both expeditionary and domestic operations as directed by the government of Can-ada,” said Bernier. “Canadian Forces Health Services is responsible for leading and supporting the health readiness of our members, thus playing a critical role in overall CF operational readiness.”

To this end, health system clinical and management efficien-cies are expected to improve through the clinical support and analytical applications of the CFHS, the first pan-Canadian elec-tronic health record system. It supports better individual care and population-level analyses, and permits clinicians to access the electronic health records of their highly mobile CF patients anywhere the CF operates on land or at sea.

The retention and expansion of the military health research program will be critical over the coming years to maintain leading-edge capabilities, to address evolving operational, occupa-tional and environmental health threats in expeditionary opera-tions, to optimize cold climate health service support during sovereignty operations in Canada’s vast Arctic, to optimally target health resource allocations and program modifications, and to find better and less resource-intensive technological approaches to training. Medical simulation in particular is being studied closely to enhance operational clinical readiness, and maximum use of distance learning technologies is being aggressively pursued to mitigate some of the challenges related to our physical dispersion across multiple time zones.

CF health professionals are well trained, disciplined, experi-enced, mission-focused, highly effective and incredibly dedicated. With such a foundation, there is no doubt that the CF will over-come challenges to maintain and enhance its clinical programs, capabilities and operational readiness to the highest standard. O

healTh care afTer The war is over.By maJor nicole meszaros, canadian forces healTh services (puBlic affairs)

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

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

Canadian Forces Health Services

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Graham MurphyChief Executive Officer

RDT

Q: What makes RDT’s Tempus Pro different from other transport monitors?

A: Uniquely, Tempus Pro is more than just a vital signs monitor; it is a small, market-lead-ing, easy to use, very robust, fully featured monitoring platform with increased func-tionality beyond any other transport moni-tor. Additional functionality includes secure patient record data collection and sharing; a flexible monitoring platform for the addition of advanced clinical capabilities like ultra-sound or tissue oximetry so customers get more from the display, processor and battery already carried for monitoring; sophisticated telemedicine ReachBak; and powerful hard-ware and field upgradable software, enabling integration with other products and software over the life of the product.

Q: Military medical equipment size, weight, battery life and durability have always been of critical importance. What advantages does Tempus offer?

A: Tempus Pro is almost half the size and weight of traditional transport monitors, weighing just 6.2 pounds including the bat-tery and RapidPak clip for housing the adult cuff, 5 Lead ECG cable, and SpO2 probe. It has unmatched durability with the highest ingress protection rating of other transport monitor, IP66. Battery life is unparalleled with a run time of 8.5-11 hours and is hot swappable without loss of patient data.

Q: Patient data capture throughout the care continuum is an historical capability gap. How does RDT address this?

A: All Tempus monitors have the ability to securely collect and share rich patient record information from first encounter. Vital signs data are automatically stored in the monitor, and the care provider can easily enter additional information and interventions. Because the data is on the monitor and can easily be exported from Tempus to Tempus or sent in advance of the casualty, it is available whether the monitor stays with the patient or the previous care provider. Data moves with the patient in both cases and is always

available at the point of care and for download into the EMR and JTTR.

Q: Completing the patient record during and after an encounter has always been a chal-lenge. How does Tempus make this process easier and more accurate?

A: The TCCC record is built into the Tempus complete with body map, interventions such as drugs given and tourniquets applied, and patient record notes. During monitoring all vitals are entered into the patient record auto-matically, thus ensuring patient data accu-racy. Additional data can easily be entered using the color touchscreen.

Q: How does RDT address telemedicine, identified as a potential requirement on the battlefield and beyond?

A: Tempus has a fully integrated optional real-time ReachBak capability that can securely stream all the data from the monitor to another location. This includes all vital signs data and waveforms, the full patient record, photographs and video taken with the inter-nal camera, and full duplex voice communi-cation. This can be done wired or wirelessly over the Tempus’ various communications connections as well as military radios, mili-tary and civilian satellite communications, and over systems such as Sierra Nevada’s T2.

Q: Does Tempus Pro have the ability to download patient data into an EMR and EIC?

A: All Tempus monitors have the ability to collect and share the complete patient record information and transmit that data wired, wirelessly, or via USB to an EMR or any computer. This is done without the need for additional devices or computers.

Downloading patient data into AHLTA-T was demonstrated earlier this year, as well as on to the soldier EIC.

Q: How is the patient data transmitted?

A: Flexibility and ease of use are integral in Tempus’ design, making patient data capture and transmission easy to achieve. As a patient is handed off at each level of care, their data can be downloaded into the next Tempus monitor, and the next, so their patient record is built upon throughout each echelon of care. The patient data can also be exported to a computer for incorporation into the patient record, printing, or sending electronically to another location or care provider.

Q: Technology is rapidly developing. How does RDT address the issue of obsolescence?

A: From its inception, Tempus was designed to be a flexible platform that can evolve as technology, missions, and budgets change. As the military’s requirements change, so can Tempus Pro. It has a powerful processor and can be upgraded to include entirely new capabilities such as ultrasound and video laryngoscopy. As other technologies become available and clinically accepted, such as deci-sion support algorithms, these can be added in the field via software with no hardware changes necessary.

Q: Describe RDT’s background and vision for the next five to 10 years.

A: Founded in 1997, RDT is recognized as a leader in the design and manufacture of pre-hospital care vital sign monitors. RDT has established a reputation for responsiveness, reliability and excellent customer service.

Tempus IC Professional was selected by SOCOM as the standard monitor of choice for the USSOCOM TCCC Kit in 2011.

RDT will continue to work with differ-ent types of military users in far-forward and mobile mounted environments to inform product development and looks forward to continuing to provide the military with the most flexible and capable monitoring plat-forms for many years to come. O

INDUSTRY INTERVIEW Military Medical & Veterans Affairs Forum


February 2013Vol. 17, Issue 1NEXTISSUE


ChiefPharmaceutical Operations DirectorateTRICARE Management Activity

Cover and In-depth IntervIew wIth:

Rear Admiral Thomas J. McGinnis

SpeCIal SeCtIonWho’s Who

TRICARE Management Activity

FeatureS

• Pharmacy Workflow Efficient pharmacy workflow operations systems are increasingly necessary within the medical community.

• Pre-Deployment Vaccines and Hepatitis C Vaccinating the warfighter against widespread diseases found overseas with additional emphasis on Hepatitis C prevention.

• Diabetes Diabetes rates have risen in the United States for the past 20 years. This public health issue threatens both the health of the populace and the military.

• Mobile Health Technology A broad array of technologies now exists that takes health care services from the American hospital to the frontlines.

BonuS dIStrIButIonMHS Conference

AUSA Winter

Insertion Order Deadline: January 18, 2013 • Ad Material Deadline: January 25, 2013

To Advertise, Contact: Charles Weimer, M2VA Associate Publisher 301.670.5700 x 134 • [email protected]

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m2va 16-8 (dec. 2012)

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