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Reports from AUSA Army Medical Symposium
06/23/2008
Sullivan: You Keep Hope Alive
“The touch of your hand on our soldiers keeps hope alive – and there is something strengthening about that,” the president of the Association of the United States Army said June 9 to the over 1,300 attendees at the AUSA Army Medical Symposium and Exposition in San Antonio, Texas.
Gen. Gordon R. Sullivan, USA, Ret., citing an article in the June 8 Parade Magazine by Tim O’Brien that reported on soldiers receiving care and rehabilitation at Brooke Amy Medical Center and the Intrepid Center at Fort Sam Houston due to amputations necessitated by severe injuries occurring in Iraq, said health care professionals—from “64 Whiskeys” (heath care specialists) in the field to surgeons, nurses and technicians, give soldiers and families hope for the future – and “hope is the anchor of my soul.”
Sullivan said at the symposium’s opening session in the Henry B. Gonzales Convention Center, “You make good things happen. You have to work at it – the science of medicine, the art of medicine. You are men and women working together to save lives and bring people back to productivity.”
One soldier in the article, reproduced and distributed to all attendees with the magazine’s permission, was Staff Sgt. Nick McCoy, 24, who, while on patrol in central Iraq, was hit by a blast from an improvised explosive device (IED).
Evacuated to the states in an induced coma, he woke up over a month later with two legs amputated below the knee.
His father, Scott, from Reading, Pa., quit his job, traveled to San Antonio where he now lives with his son in a Fisher House located on the grounds of the Intrepid Center where he is receiving “rehab.”
At the conclusion of the article, Nick talks about dating again, his new “gorgeous” girlfriend and “going out again tomorrow.”
Sullivan said, “Look what you have done and what his father says: ‘Look at the handsome face. Nick won’t have any trouble. None at all.’”
Adding, “This soldier -- a double amputee – is talking about his new girlfriend. Your contributions made that statement by a father of a great soldier possible.
“And, I want you to know, that as a life-long soldier – over 50 years in uniform or around the Army, I am enormously proud of all of you -- for your skill, for your talent, for your technical knowledge and your ability to keep hope alive.”
On behalf of the Association, Sullivan presented a $30,000 check to Russell Fritz, the assistant manager of the Fort Sam Houston Fisher Houses, to support this organization for all it does for wounded warriors and their families.
Army Surgeon General Says ‘Blast’ is the Signature Weapon
“A number of things have been introduced on the fly – which we didn’t have before -- since the start of the global war on terrorism to improve Army medical care to our soldiers in harm’s way,” the Army surgeon general said at the Association of the United States Army’s Army Medical Symposium and Exposition in San Antonio, Texas, June 12.
Lt. Gen. Eric B. Schoomaker, who also commands the U.S. Army Medical Command, told over 1,300 attendees at the four-day professional development forum, “The signature weapon of this war is ‘blast’ and this is a challenge for you: to bring back into full service the soldiers who have been injured by a blast.”
Schoomaker, in his “State of the Army Medical Department” report, pointed out that the enemy uses blast effectively and efficiently and the results are devastating for the soldier – loss of limbs, blindness, severe wounds, not to mention psychological and emotional scars that may last a long time.
He told attendees that we are engaged in “really hard work – there are a lot of moving parts in what we are doing because we are fighting a war and [the Army and the medical department are] transitioning.”
Adding, “No Army of volunteers has fought this hard for so long in its 233 year history.”
Echoing the Army chief of staff, Gen. George W. Casey Jr., Schoomaker said the nation and the Army are facing a “future of persistent conflict and the Army and the medical department must transform to a campaign-quality Army.”
Adding, “We are about results, and we must promote, sustain and enhance soldier health; train, develop, and equip the medical force that supports full-spectrum operations; and we must deliver leading-edge health services to our warriors and their families.”
Schoomaker said the medical command is about “resetting the soldier and the soldier’s family,” and to do this “we have a comprehensive transition plan that addresses healing body, mind, heart and spirit. This involves healing the total person.”
The Warrior Transition Units, activated to change the way the Army cares for wounded, ill and injured soldiers by providing health care professionals who facilitate all care, support and services the soldier needs for a successful transition back to military duty or into the VA health and benefits system, are currently exceeding the projected outtake by 925 warriors transitioning per month.
Many of these soldiers are not battle casualties and are medically discharged, returned to the active force or are returned to their reserve units.
Schoomaker again emphasized the need to heal the total soldier.
“We also need to focus on soldiers, warriors,” he said, “who have witnessed traumatic events that have intruded in their lives and have given them pain. We must give them the appropriate treatment to get back on their feet.”
Although there are many challenges, Schoomaker said we must “have electronic health records that are accessible anywhere in the world – in real time.”
The challenges include the transfer of the soldier’s medical data into the private sector, sharing the data across different agencies, the inability to always capture health data in new areas of operation, to name a few.
But, according to Schoomaker, the need offsets the challenges.
Looking to the future – 2020 to 2025 -- he said “military medical care givers will be at the ‘tip of the spear’ in military engagements around the world where joint and coalition medical assets will work together as a team in a seamless environment.”
Adding, “We [in the medical community] will support high-intensity conflicts on the ‘leading edge,’ and engage in nation building on the ‘back edge.’”
Schoomaker said, “Army medicine – America’s premier medical team – we are saving lives and fostering healthy and resilient people.”
VA Provides Medical Care for OEF/OIF Veterans
To serve the medical needs of military veterans, “the VA has 153 hospitals, 732 community-based outpatient clinics and over 230 veteran centers across the country,” the principal deputy under secretary for health at the Department of Veterans’ Affairs (VA) told the 1,300 Army Medical Department attendees at the Army Medical Symposium and Exposition in San Antonio June 11.
Dr. Gerald M. Cross said at the professional development forum hosted by the Association of the United States Army, “We see over 1,000,000 patients a week and we educate 100,000 a year, plus publishing thousands of article in journals and professional publications.”
To understand and appreciate the scope of the VA, Cross said, for example, “there are nearly 1,075,000 veterans 85 years of age or older and by 2011, that number will grow to more than 1.3 million.”
The newest veterans come for service during Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF).
From 2002 through the first quarter of 2008, 837,458 OEF/OIF veterans have separated from the service and 324,843 of those veterans have sought VA health care – 88 percent male, 12 percent female.
In a “satisfaction survey” conducted by the Army, “195 out of 172 strongly agreed or agreed with the statement: ‘VA met my needs and the need of my family members who were involved with my care at VA.’ Only two disagreed,” Cross said.
To deal with today’s veteran in need of medical assistance, VA has established liaisons at 11 military treatment facilities to facilitate a transfer from the military facility to the VA.
There is also,” Cross said, “a joint VA/DoD program to provide severely wounded, ill and injured service members, families and veterans with an integrated patient-centered approach to care management.”
Cross told the medical department audience the top five diagnoses among OIF/OEF veterans who seek VA care are: musculoskeletal system/connective disease; mental disorders; symptoms, signs and ill defined conditions, diseases of the nervous system and sense organs and diseases of the digestive system.”
To address the growing problem of traumatic brain injury (TBI), VA has established four polytrauma rehabilitation centers in Richmond, Va., Tampa, Fla., Palo Alto., Calif., and Minneapolis, Minn. A fifth will open soon in San Antonio.
The VA is addressing mental health issues, to include suicide prevention, homeless care and post-traumatic stress disorder, with clinical teams and specialists in each medical center.
“We set a new culture in place. We will no longer wait for the patient to seek us, we will seek out the patient and offer help.”
According to Cross, an important and necessary aspect of veteran health care is “the collaboration between the VA and the Defense Department.”
There are now in place 260 active sharing agreements nationwide ranging from graduate medical education, administration, clinical pathology, cardiology, dermatology to ambulatory care services, radiology, mental health, neurosurgery, fitness centers and laundry.
Cross said, “I want you [Army Medical Department] to come see us, give us a call and drop by.”
Task Force Recommends Military Health Care Changes
“We as a country are facing great challenges in funding quality heath care,” and this prompted at Defense Department proposal requesting the creation of the Task Force on Future Military Health Care to ensure that armed forces personnel, retirees and family members receive the best care possible, Gail R. Wilensky, a senior fellow with Project Hope, said.
Speaking at the Army Medical Symposium and Exposition June 10 in San Antonio, Wilensky said at the Association of the United States Army- hosted forum, the congressionally-mandated task force, of which she was a member and was made up of DoD and non-DoD members, focused on heath care and the well-being of beneficiaries, to include military heath readiness, the quality of care and the efficiency of care.
Reporting back to Congress in March, the task force also considered the “health care procurement system, accurate costing, beneficiary and government cost sharing, command/control support contracts and a universal enrollment system,” she said.
Highlighting that there is an unsustainable spending growth in health care and there is an expanded population – meaning more benefits to more people – Wilensky said, “Heath care spending is growing two to three times faster than inflation and faster than the DoD budget.”
Adding, “These are huge financial challenges for military health care … and the fundamental dynamics are beyond your control,” she told the 1,300 Army Medical Department attendees and the four-day professional development forum.
Of the 12 task force recommendations made to Congress, the task force asked for better integration of direct care with purchased care.
“The use of purchased care to supplement direct care,” Wilensky said, “would strengthen the military health care system, but would require more integration and require the development of metrics to measure the outcomes.” Adding, “We need to empower, but we need accountability.”
The task force also emphasized the need to improve “efficiencies,” such as cost effectiveness of the procurement system by evaluating existing requirements to include assessing the current delivery requirements, the effectiveness of disease management and managed-care contracts.
The improved readiness of the reserve components is of prime importance, the task force said, as a result of their changing and evolving roles as the nation fights the global was on terrorism.
“The big issue for the reserve components,” Wilensky said, “is medical and dental readiness and we must assess the effectiveness of TRICARE Reserve Select, who accesses it and what is its effect on readiness.”
The pharmacy tiering structure must be revised to meet the growing demand.
Wilensky said, “Mail order pharmacy must be increased. It is the most cost effective point of service and it is the most appropriate way to maintain the meds.”
The task force also recommended that enrollment fees and deductibles be revised – not for active duty personnel or their family members – but for under-65 retirees.
“Congress must start this moving forward,” she said.
There are “huge variations” in health care to include problems with patient safety because “we have lots of problem with quality and clinical appropriateness,” she said.
Adding, “Spending more is not the same as more quality. Spending growth partly relates to technology growth. So, we need to learn how to spend smarter ... and measure better to ensure quality, efficiency and ‘patient-centeredness.’”
Adding, “There are the same challenges facing Army medicine. And, Army medicine can help lead the way for the rest by taking advantage of being a system.
“You are moving in the right direction. You can benefit the country.”
BRAC, Transformation Present Challenges, New Opportunities
“As America’s primary reception site for returning casualties, our number one priority is casualty care,” Brig. Gen. Philip Volpe reported to the 1,300 attendees at the four-day Army Medical Symposium and Exposition, hosted by the Association of the United States Army, in San Antonio, Texas, June 11.
Volpe, the deputy commander of the Joint Task Force – National Capital Region Medical, said that this relatively new command, established in September 2007, “oversees, manages and directs all health care delivery by military medical units in the joint operational area centered” on Washington, Virginia and Maryland with facilities also located in Pennsylvania, New Jersey and West Virginia. There are 37 medical facilities and four military hospitals in the National Capital Region.
The command is also in charge of the responsibilities associated with the medical aspects of the base realignment and closure (BRAC) activities, to include the construction and business plans, in this geographical area.
“When it reaches full staffing, the joint command will have 152 people – 63 military, 46 civilians and 43 contractors” who will be responsible for delivering comprehensive health care to service members, their families and veterans with assigned and attached forces to ensure quality services, disaster preparedness and military readiness, he said.
There are over 500,000 eligible beneficiaries in this command’s area of responsibility.
Addressing BRAC, Volpe said, “We have everything under control.”
The largest challenge is phasing out Water Reed Army Medical Center and establishing the Walter Reed National Military Medical Center at the present location of the Bethesda Naval Medical Center in southern Maryland – to include the construction of the Belvior Community Hospital at Fort Belvoir, Va.
The new Walter Reed, Volpe called “The Hub,” will have over 5,900 personnel assigned, Belvoir over 3,100.
According to Col. Rick Bond, commander of the Health Facilities Planning Agency who spoke on June 12, “BRAC is not about closure, it’s about progress and rebirth.”
Noting that when completed and staffed, the Belvoir hospital will be the largest community hospital in the Army.
“Our new and our expanded facilities [to include the San Antonio Military Medical Center; and the Medical Education and Training Campus, Fort Sam Houston, Texas] will be world-class facilities” with state-of-the-art healing environments, patient-centered care and green design,” Bond said.
"We will spend,” Bond said, “61/2 billion dollars in the next four years on new medical facilities – more than in the last 30 years.”
Adding, “We want a medical environment in which our soldiers and families thrive – where we can support readiness in an era of persistent conflict. We are building a foundation for the future.”
Families are of prime importance in the planning and constructing of medical facilities.
Carey L. Klug, the director of the Army Medical Department’s transformation efforts, in a joint presentation with Bond, said, “Transformation and BRAC provide an unprecedented opportunity for Army medicine. Each of you has a role to participate and ensure our successful transformation.”
Adding, “We must continue to deliver world-class health care to our soldiers and their families. Families are our beneficiaries and our hearts.”
“We must make the investment,” Bond said. “Our military families deserve the best and we must restore trust and confidence of those we serve and the American people.”
One of the challenges in a joint medical environment, Volpe said, is bringing together Army, Air Force and Navy medicine. There are cultural differences, but he said, “There are many similarities including clinical care, education, budgets, standards and employees,” to cite a few.
“But,” he said, “the bottom line: This is a magnificent opportunity to plow new ground and plant the seeds for change in the 21st century military health services.”
‘The’ Army Must Be ‘Our’ Army
“Installations are our Army home,” Maj. Gen. John Macdonald said, “and we must provide an environment where soldiers and their families can thrive.”
Macdonald, the commanding general of the Army Family, Morale, Welfare and Recreation Command, and deputy commander of the Installation Management Command, told attendees at the Army Medical Symposium and Exposition in San Antonio June 12, “We must also provide a structure that supports unit readiness in an era of persistent conflict, and provide a foundation for building the future.”
As the Army continues fighting the global war on terrorism while transforming into a brigade-centric service, “we must provide certain essential elements of support that are needed to recruit, sustain and retain an all-volunteer force,” Macdonald said at the professional development forum hosted by the Association of the United States Army and its Institute of Land Warfare.
Soldiers and soldiers with families living on Army installations must feel a sense of acceptance, physical safety, economic security, law and order, and comfort, to name a few.
Reminding the audience that this is a much different Army than the Army of the 1970s, Macdonald said, “Before 1972 and the all-volunteer Army, 20 percent were married,” and they were basically officers and senior noncommissioned officers. Now,” he said, “62 percent are married – officers, noncommissioned officers and enlisted soldiers.”
Adding, “We have come along way and it’s expensive, but we have to anti up.”
For example, specifically those essential elements necessary on Army installations may include, but are not limited to, ADA-compliant barracks, flexible family housing policies, sport programs, more recreation activities, libraries, continuing education opportunities, good food services, law enforcement and religious services.
“We must deliver to our installations the services needed and desired,” he said.
“Most of our young soldiers were 10, 11 or 12 years old when the terrorists attacked the Twin Towers and the Pentagon on 9-11,” he said. “Now they are raising their right hands out of patriotism – and we can’t buy that.”
But, Macdonald said, “We must make ‘the’ Army, ‘our’ Army … by focusing on customer service and by making the Army future community our Army home.”
To accomplish this goal, the Army’s vision, taken from the “Soldier and Family Action Plan,” to provide Army families a quality of life commensurate with the quality of their service is essential.
“We are investing on human capital,” Macdonald said.
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