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Tarpey TCCC AMEDDJ 2005-2 April-June 2005 Perspective 1 MG George W. Weightman Managing the MC Through a Team Approach and the Balanced Scorecard 3 BG Eric B. Schoomaker The AMEDD Personnel Proponency Directorate/The Structure Models 9 R. Clare Layton AMEDD Continuum of Medical Education 12 COL John M. Powers, MC, USA The Medical Corps Assignment Process 16 COL Jonathan H. Jaffin, MC, USA, et al The Reduction of Unwarranted Clinical Practice Variation in the AMEDD 18 LTC William A. Rice, MC, USA Medical Management of Medical Holdover Patients 24 COL Michael A. Deaton, MC, USA Medical Ethics in Detainee/Enemy Prisoners of War Care 27 COL Gregg Anders, MC, USA The “Intentional” Officer 29 COL Chuck Callahan, MC, USA The Tactical Combat Casualty Care Transition Initiative 33 CAPT Frank K. Butler, Jr, MC, USN/COL John B. Holcomb, MC, USA Tactical Combat Casualty Care in Operation Iraqi Freedom 38 CPT Michael J. Tarpey, MC, USA Battlefield Tourniquets: Modern Combat Lifesavers 42 Thomas J. Walters, PhD, et al Laboratory Evaluation of the U.S. Army One-Handed Tourniquet 44 Joseph C. Wenke, PhD, et al Laboratory Evaluation of Battlefield Tourniquets in Human Volunteers 50 Thomas J. Walters, PhD, et al The Chitosan-Based Hemostatic Dressing: Experience in Current Combat Operations 58 LTC Ian Wedmore, MC, USA, et al Can We Provide Level III Damage Control Surgical Procedures at a Level II Facility? 62 LTC Lorne H. Blackbourne, MC, USA/COL John B. Holcomb, MC, USA GWOT: Assessment, Treatment, and Evacuation of Burn Trauma Casualties 66 LTC Evan M. Renz, MC, USA, et al Also in this issue……. Physical Fitness/Morbidity of Conscripts in the Estonian Defence Forces 70 Oleg Noviko/Raul-Allan Kiivet A Professional Bulletin for the AMEDD Community The current issue and some back issues of the AMEDD Journal are available (Adobe Acrobat format) at http://das.cs.amedd.army.mil/. LTG Kevin C. Kiley Editorial Review Board The Army Surgeon General Commander, U.S. Army Medical Command COL James M. Lamiell, MC, Chairman Chief, Clinical Investigation Regulatory Office MG George W. Weightman Commander, U.S. Army Medical Department COL Thomas R. Cole, DC Center and School Dental Corps Staff Officer, AMEDD Personnel Proponent Directorate COL George J. Dydek, MS Director, Department of Pharmacy, Madigan Army Medical Center, Tacoma WA MAJ Rachel K. Evans, SP Research Physical Therapist, Mil Performance Div, USA Research Institute of Environmental Medicine SGM Alan E. Graykowski Corps Specific Branch Proponent Officer, Enlisted Corps, MEDCOM LTC (P) Patricia Patrician, AN Chief, Department of Nursing Science, AHS COL Ney M. Gore, MC Medical Corps Staff Officer, Corps Specific Branch Proponency Officer COL Gary A. Vroegindewey, VC Assistant Chief, Veterinary Corps & Corps Specific Branch Proponency Officer COL David L. Maness, MC COL (Ret) Robert J.T. Joy, MC Dean, Academy of Health Sciences Professor Emeritus, Uniformed Services University Neta T. Lesjak of the Health Sciences, Bethesda, MD Chief, Department of Academic Support and Quality Assurance By Order of the Secretary of the Army: Bruce Nelson Official: Editor Don Aldridge SANDRA R. RILEY PETER J. SCHOOMAKER Associate Editor Administrative Assistant to the General, United States Army Secretary of the Army Chief of Staff Linda Nelson Editorial Assistant/Desktop Publishing DISTRIBUTION: Special 0504706 The Army Medical Department Journal (ISSN: 1524-0436) is prepared support information; & provide a peer-reviewed high quality print medium to quarterly for The Surgeon General by the U.S. Army Medical Department Center encourage dialogue concerning healthcare initiatives. & School, ATTN: MCCS-HSA, 2250 Stanley Road Ste 250, Fort Sam Houston, Views expressed are those of the author(s) & do not necessarily reflect TX 78234-6150. official U.S. Army or U.S. Army Medical Department positions, nor does the CORRESPONDENCE: Manuscripts, photographs, official unit requests to content change or supersede information in other Army Publications. The receive copies, & unit address changes or deletions should be sent to the Journal Journal reserves the right to edit all material submitted for publication. at the above address. Telephone: (210) 221-6916/7326, DSN 471-6916/7326. CONTENT: Content of this publication is not copyrighted. Material may be DISCLAIMER: The Journal presents clinical & nonclinical professional reprinted if credit is given to the author(s). information to expand knowledge of domestic & international military medical OFFICIAL DISTRIBUTION: This publication is targeted to U.S. Army issues & technological advances; promote collaborative partnerships among Medical Department units & organizations & other members of the medical Services, components, Corps, & specialties; convey clinical & health service community worldwide. Perspective Major General George W. Weightman This issue of our Journal is particularly exciting and I encourage our readers to take some time to see what our authors have to say. One of the big advantages of our Journal is that our articles are timely; it doesn’t take 18-24 months for articles to make it from submission to publication. Although we may sacrifice some scientific rigor, I believe that is more than made up in having articles in our Journal that are relevant today and which can have an immediate impact on our medics and Soldiers’ lives. This issue is divided into two major topic areas. The majority of articles concern relevant topics related to our medical operations in OIF/OEF. The AMEDD’s Institute of Surgical Research, located at Brooke Army Medical Center, has taken a lead role in the research of trauma, and many of the articles in this issue reflect their cutting edge research. This understand how they work. Finally, Ms R. Clare Layton gives research has resulted in improved trauma training for providers us an easily understandable overview of the complex process at all levels, an Improved First Aid Kit being fielded today, and used to shape the size and composition of the AMEDD. Those enhanced survivability of our wounded Soldiers on the of you who wondered how it was determined how many battlefield. Other articles in this issue range from a discussion of Soldiers in the various specialties are needed will be enlightened tourniquets, hemostatic agents, medical ethics in detainee/POW as Ms Layton lays out how the largest and most complicated care, Tactical Combat Casualty Care Courses, description of health care system in the world forecasts and manages its burn patient care from the point of injury to our Institute of personnel needs. Surgical Research (Burn Unit), and a comparison of Damage Control surgical capabilities between our Level IIa (FST) and Colonel Chuck Callahan, recently returned from Level III (CSH) facilities. We are learning a tremendous deployment, gives us some great pointers on leadership, and amount about trauma and patient care from our present day challenges us to embrace the concept of “officership” in his experiences and I think that you will quickly see that these thought provoking article on “The Intentional Officer.” He articles are relevant, thought provoking, and timely. reminds us of our dual responsibility of being not only technically competent, but great officers as well. Colonel Mike The second major area covered in this issue is the Deaton lays out the pathway that led to the care of medical management of the Medical Corps, highlighted by an article holdover patients and helps us all understand the present from the Medical Corps Chief, BG Eric Schoomaker, and his structure and expectations of care for this group of Soldiers who description of how they have utilized Balanced Scorecard are a new beneficiary population since we started the GWOT. methodology to integrate and synchronize the many aspects of Lieutenant Colonel William Rice challenges us all to reduce MC management and education. An article by COL Jon Jaffin, practice variation, save money, and enhance the level of care the MC Branch Chief, takes some of the mystery out of the MC through his business case analysis of Clinical Practice Officer assignment process, as he walks us through all of the Guidelines (CPGs) in the care of asthmatic patients, in his article processes that the Branch must consider before cutting your entitled “Reduction of Unwarranted Clinical Practice Variation orders for your next PCS. These processes are nearly universal in the AMEDD.” The CPGs are a good thing and definitely throughout the AMEDD and Army and regardless of your here to stay and the sooner we can integrate them into our Branch, I think you will learn a lot about the process. Colonel practices the quicker we can realize the financial and patient John Powers, Chief of Graduate Medical Education, then care benefits. Finally, our Journal has an article from Oleg follows with an excellent review of the entire Graduate Medical Novikov and Raul-Allan Kiivet describing a universal and continuing Medical Education processes. These programs challenge for all militaries, being the “Physical Fitness and are among the best in the world and this article will help you Morbidity of Conscripts in the Estonian Defence Forces.” PB 8-05-4/5/6 Apr/May/Jun 1 Using the U.S. Army’s own APFT as a measurement tool, they Conserve Fighting Strength”. From peacetime health care, to document the improvement of their initial entry Soldiers Combat Health Support, to education and personnel through their vigorous physical training program. Good insights management, to learning and working with other nation’s for us as we convert our “Gameboy and X Box” recruits into militaries around the world, our AMEDD is leading the way, warriors. and like all great organizations, constantly learning lessons and improving. Thank you for your part in making this a huge Certainly this issue of your Journal highlights the breadth success and I urge you to keep contributing to our Journal as and complexity of what our mission is in the AMEDD: “To we reshape and refine our future.
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