ARMY MEDICINE

MERCURYVolume 40, No. 12 SEPTEMBER 2013

A worldwide publication telling the Army Medicine Story ARMY MEDICINE

MERCURYVolume 40, No. 12 CONTENTS

DEPARTMENTS FEATURE ARMY MEDICINE

MERCURYUS ARMY MEDICAL COMMAND TSG INITIATIVES READY & RESILIENT Commander The Ready and Resilient Campaign integrates and synchronizes multiple efforts and Lt. Gen. Patricia D. Horoho programs to improve the readiness and resilience of the Army Family.

Director of Communications Col. Stephen Wooldridge PERFORMANCE TRIAD AND LIFESPACE Army Medicine’s operational approach to improve Soldier and Family health and stamina Chief, MEDCOM Public focusing upon Activity, Nutrition and Sleep Management (ANS). Visit the Performance Affairs Officer armymedicine.army.mil/PerformanceTriad/index.cfm Jaime Cavazos Triad webpage at:

Editor OPERATING COMPANY MODEL Valecia L. Dunbar, D.M. The Operating Company Model (OCM) seeks consistency of experience across the enterprise by both patients and medical staff. It is the abstract representation of how an Graphic Designers Jennifer Donnelly organization operates across process, organization, and technology domains in order to Rebecca Westfall accomplish its function. The OCM reduces operational complexity and describes the way a 21st century organization does business today.

The MERCURY is an ARMY MEDICINE 2020 CAMPAIGN PLAN authorized publication The Army Medicine 2020 Campaign Plan (AM 2020 CP) operationalizes the vision of for members of the U.S. the United States Army Medical Command (MEDCOM) for 2020. It also establishes Army Medical Department, published under the authority the framework through which the Army Medical Department (AMEDD) will achieve its of AR 360-1. Contents are 2020 end state. Download the Army Medicine Campaign Plan not necessarily official views of, or endorsed by, the U.S. Government, Department of Defense, Department of the SOCIAL MEDIA CENTER Army, or this command. The MERCURY is published FOLLOW US ON monthly by the Directorate of Army Medicine Communications, U.S. Army Medical Command, 2748 LTG Patricia D. Horoho Worth Road Ste 11, Fort Sam CSM Donna A. Brock Houston, TX 78234-6011. Questions, comments BE CONNECTED ON or submissions for the MERCURY should be Army Medicine directed to the editor at 210-221-6722 (DSN 471-7), or by email; SEE WHAT’S PLAYING ON Army Medicine

The deadline is 25 days before EXPLORE OUR PHOTOS ON the month of publication. Army Medicine Unless otherwise indicated, all photos are U.S. Army photos. The MERCURY submission and style guide can be accessed START PINNING TODAY ON Army Medicine JOIN THE CONVERSATION ON Army Medicine

3 | ARMYMEDICINE.MIL TSG SPEAKS! The Performance Triad An Army-Wide Movement toward a System for Health TSG Remarks from the Stand-up for Health Training Day held August 8, 2013

Good Morning, I have the privilege has been here for 238 years. We have to be able to be speaking from Munson had tremendous challenges that we have Army Health Clinic. I usually talk faced over the past 238 years. What we off the cuff but what I decided to do have done well is that we have seized with this, because I really believe this the opportunities that those challenges is a monumental kind of launching present and today is no different. for Army Medicine, I wrote down my So my intent today is to sharpen our thoughts and I want to make sure that common understanding of the challenges there are comments and thoughts that I and potential solutions before Army don’t forget to share with you so it will Medicine and Military Medicine more be a little different than usually how I broadly. This is a call to action and talk to everyone across the Command. when I took command in 2011, we What I want us to walk away from talked about a call to action. We have this is a common operating picture; an been working for the last 20 months to understanding of where we have the develop the plan of where we are today, opportunity to influence and shape how and what I need is everyone across the Lt. Gen. Patricia D. Horoho healthcare will be delivered in the future; Command to feel that this is a call to what the tools are, and where you fit into and peoples’ feeling of self-worth. But I action and that there is no option for this strategic plan so that you can start submit to you, that while these symptoms us but to dig in, no option to wait for driving the change that we need to have require recognition and obvious response, the storm to pass. Everyone in Army across Army Medicine. if we focus only on the symptoms, we Medicine has an active role in changing, I would be remiss if I started this and will never be able to get through this. We not only the way Army Medicine is didn’t thank everybody for the hard work have got to be able to focus on more than organized and operates, but also in that is being done across our Command. the things that I just talked about. We how we interact with our patients and It is incredible, when I travel abroad, to have got to address the underlying illness, our beneficiaries and how we influence see the dedication and the challenges because the ultimate threat is to our health. Whether in leadership positions that we have had and to see folks so National Security. Some people may be at OTSG, MEDCOM, the Regional committed to really making a difference. sitting there listening and thinking that Medical Commands, the Major Support That’s what I have seen over this last I am being grandiose or overly dramatic, Commands, or closer to the point of two years and, more especially, that is but I really believe that this is a threat to healthcare delivery both in our Medical what I have seen over this last, probably, our National Security. Treatment Facilities and in our line units, 8-10 months with the challenges that The most visible challenges are financial each of us have a critical part in shaping we have had. As I travel throughout in nature. It’s the unsustainable cost of Army Medicine’s future. That future the Command, one of the things that I defense spending relative to our federal begins today. This will be our legacy also had the opportunity to do is hear budget, it’s the cost of Military Health and you all will be here in making this a lot and also feel the concerns that are System relative to our DOD budget and historical moment. That is something I there. There are also common concerns the major challenge often concealed or believe you are going to remember and that we have had across Army Medicine. overshadowed by the financial challenges, you will look back and realize you were There is a natural tendency to focus on is the declining health status of our a part of the launching of the change in, what are visible symptoms of our current Soldiers, our Families, and the nation not just healthcare across Army Medicine, challenges. We have challenges with the at large. These two challenges; financial but healthcare across our nation. drawdown, sequestration, budget cuts constraints and declining health status, To access TSG’s full remarks click here: and furloughs. It is obvious that these merge before us today and together http://www.armymedicine.army.mil/ challenges fill our inboxes, consume our present a significant threat to our news/Health/TSG_SUFHTD_Remarks. days and they negatively affect morale Security. We are an organization that pdf

4 | ARMYMEDICINE.MIL CSM CORNER A Wise Woman Said The Longest Serving Enlisted Female Soldier in the U.S. Army

I joined the Army in a roundabout teaching, and coaching are what good way. At 17 years old, I was ripping leaders do. If you are micromanaging and ready to go to college, but you are not a leader. Your team will then something tragic happened. never grow if you are micromanaging. My mother passed away at 40 years The most important thing I have old from a heart attack. I made the learned in my career is that if decision to stay at home with my you want to be heard, speak up, father to help with the other children. especially as a female in a male- I went to school and worked full time. dominant environment. But do your In 1979, I visited a recruiter and homework before you open your joined the Army. My intent was not mouth. Make sure you know what to stay in the Army. I was going to do you are trying to say and with factual four years and get out and work for proof. You will make mistakes, but the Postal Service. when you do, make sure you My leadership is a credit to the acknowledge them, to acknowledge many mentors who trained me, Command Sgt. Maj. Donna A. Brock that there is no such thing as coming starting with my father. Every five out of traumatic events unaffected. or so years I would mention that I You can control those stereotypes by was going to get out of the Army, and establishing your own work ethic. Donna Brock is Command Sergeant it was my father who believed in me Fair treatment for everyone is Major and senior enlisted advisor to the and pushed me to stay in. At the other important as a leader. As a female Army Surgeon General. As the longest end of the spectrum, a squad leader in command sergeant major, I am serving enlisted female soldier in the Germany told me I wasn’t going to be expected to mentor females. I work for U.S. Army, she will retire in the next in the Army forever. He told me to go everyone, males and females, so I try year and a half after completing 35 to school and to do what I can while I to be neutral. years on active duty and completing was still in. That was hard to hear, but Effective leadership entails nearly every assignment a female enlisted now I realize he was setting me up for expressing confidence in your people. soldier in the medical field can hold. life after the Army. I strongly believe that mentoring, You have to take care of people directly and indirectly and always treat them with dignity and respect. “I strongly believe that mentoring, You must trust that people will do the right thing and not assume that teaching, and coaching are you should complete a task because others will not do it right. If you do what good leaders do. If you are that, you are carrying too much of the workload. The team will have nothing micromanaging you are not a to do and will feel that you are not leader. Your team will never grow confident in them. Stereotyping is another major if you are micromanaging.” challenge leaders face. People will have preconceived notions of how -Command Sergeant Major Donna A. Brock things are or why they are that way.

5 | ARMYMEDICINE.MIL AMEDD GLOBAL Be Ready! September is National Preparedness Month Would you be ready if there were an emergency? Be prepared: assemble an emergency supply kit, make your emergency plans, stay informed, and get involved in helping your family, your business, and your community be ready for emergencies July 2, 2013. Throughout September there will Response” and follow these four steps: One goal of Homeland Security is be activities across the country to • Get a Kit. to educate the public about how to promote emergency preparedness. • Make a Plan. prepare for emergencies, including More than 3,000 organizations – • Be Informed. natural disasters, mass casualties, national, regional, and local public and • Get Involved. biological and chemical threats, private organizations – are supporting radiation emergencies, and terrorist emergency preparedness efforts and September 2013 marks the ninth attacks. encouraging all Americans to take annual National Preparedness Month, action. sponsored by the Federal Emergency http://www.cdc.gov/Features/BeReady/ Join the effort! Visit our Web site Management Agency in the US for “Emergency Preparedness and Department of Homeland Security.

Patriot Day and National Day of Service and Remembrance On September 10, 2009, the than 1,000,000 military members rescue those trapped inside. President of the United States of have served in our all-volunteer armed At a triage point outside the America issued a Proclamation forces here in the U.S. and abroad and Pentagon, Warriors and Civilians used declaring September 11 as “Patriot in direct support of Operations Iraqi whatever means available to render Day and National Day of Service and and Enduring Freedom. As we observe comfort and to move the wounded to Remembrance” to honor the victims of Patriot Day 2013, we ask that you pay local area hospitals after first aid was September 11, 2001, and to call upon tribute to those who serve this great administered. all Americans to join in service in the nation, honor those lost since 2001, This day means so much to us and to spirit of patriotism…To access the full honor and continue to support those those whose lives were directly affected Proclamation visit: injured, and always remember those by this horrible event. who continue to serve and protect our On this day, of September 11 simply http://www.whitehouse.gov/the_ great nation. This day has special remember. press_office/Presidential-Proclamation- meaning for all Americans, but most Patriot-Day-and-National-Day-of- especially for those who serve, have lost That’s all. Remembrance-and-Service/ loved ones or assisted in the rescue and ------recovery efforts at the Pentagon, New Remember. The Army Surgeon General Patriot York City, and in Pennsylvania. Day Remarks This is most meaningful to me because I was there -- inside the A dozen years have passed since the Pentagon on September 11, 2001when tragic events of September 11, 2001 the plane hit the building. My that took the lives of nearly 3,000 colleagues and I remember the shudder innocent people. We fly the American of the building and the smoke. We flag at half-staff in their honor and in remember the wounded that walked honor of those who serve. This day out. We remember the chaos amid the has been officially named Patriot Day smoke, but most of all we remember and the National Day of Service and those who risked their lives to enter Remembrance. Since 9/11/2001 more and re-enter the blackened corridors to

6 | ARMYMEDICINE.MIL AMEDD GLOBAL Defense Health Agency leans forward to change By Rob Cain, OTSG Public Affairs

“We all have big changes in our lives Research and Development (two of ten Technology, the Tricare Health Plan, that are more or less a second chance.” funtions) that quite logically should and Pharmacy Programs move over --Harrison Ford be the same no matter if you are in the on October 1, 2013. The remaining Army, Navy or Air Force. shared services of Public Health, In the military, pomp and ceremony Money can be saved in sharing Acquisition, Budget and Resource usually denotes an end to a new services such as Healthcare Operations, Management, Medical Education and beginning . On October 1, 2013, Business Support, Research and Training, and Medical Research and 10:00 a.m., at the Defense Health Development, IT, and Education and Development will be part of DHA by Headquarters in Falls Church, there Training. 2015. will be the casing of the colors of the A baby is delivered the same for an What is the goal of so many Tricare Management Activity (TMA) Air Force dependent as it is delivered changes? The goal is to reduce costs, and the raising of a flag to celebrate for an Army dependent. The doctor to implement system improvements, to the creation of a new activity called the may wear a different uniform that have data available across the Medical Defense Health Agency (DHA). assists the expectant mother, but why Services, to standardize processes in This is a special event. It shall have should the health record that records performing analytic functions. It is what other ceremonies of this kind her medications and symptoms be not taking away any unique qualities have had in the past: people watching different from the health record or requirements for each of the Armed seriously from the sidelines, service of a mother delivering in an Army Services, but is aimed directly in members standing at attention, and will Hospital? Why should the research improving care to the patient. The goal have a unique mission and intent for and development of new medications is to be efficient. The goal is to be the the future to make medical care better and surgical procedures be under Soldier-first. for our nation’s service members. The different commands when such What does this mean for civilians day of the ceremony is not the end of discoveries benefit all no matter what and Soldiers in the new organization? a journey, but marks a beginning from uniform the service member wears? Most will continue in their present the first step in 2013 to being fully In addition, this means that drugs jobs, and will experience no change in operational in the fall of 2015. that are prescribed and kept track by their current team or supervisor. Large Led by Air Force Maj. Gen. Douglas computer can be easily standardized scale relocations are not expected, and J. Robb this October 1, 2013, the across the services. Thinking in these entitlements such as pay, leave, and Defense Health Agency will stand terms, understanding how these types benefits remain the same. Employees up with the mission to change how of processes overlap, is an opportunity will not be expected to compete for military medicine does business. This to increase efficiencies and save money. positions. Only those in key leadership means streamlining processes, reducing Having the Armed Services work positions within the DHA will have complex operations, and achieving separately to achieve the same objective this issue. As for job security, the actual cost reductions with an end state is redundant and wastes taxpayer Secretary of Defense has made it clear of improving care to beneficiaries. This dollars. we are in for some tough financial means Army beneficiaries. The establishment of the DHA is decisions in FY14 that will impact the This change does not alter slated as “…the biggest structural work force. This is a concern of many MEDCOM’s mission to provide organizational change” in military government organizations and should responsive and reliable heath services. health system history, acting Tricare not be a surprise. It does not alter the mission to improve Deputy Director Allen Middleton sees Additional information can be readiness and advance the wellness of these changes as “relevant” and will obtained by going to the website: Soldiers and their Families. Everything eventually make the Defense Medical https://mhs.health.mil. At this website is in place and remains the same. System “stronger.” questions will be accepted by email, However, the implementation of DHA There are ten shared services that will Frequently Asked Questions (FAQs) are is an attempt to reduce operating costs be placed under the DHA umbrella. available for review, and the new DHA by consolidating services. It is to bring The movement will be transitional. organizational structure is online to under one command those services The first five: Facility Planning, review. such as Information Technology, and Medical Logistics, Health Information

7 | ARMYMEDICINE.MIL Global HEALTH DEFENSE At the Forefront of Vaccine Research to Safeguard the Military By The Washington Post Since she was a young girl, Connie in the Four Corners as Hantavirus,” said Schmaljohn knew she wanted a career that Jean Patterson, chairman of Virology and involved saving lives. More than 30 years Immunology at the Texas Biomedical ago, she started down the professional path Research Institute in San Antonio, toward achieving that dream by becoming referring to a region comprising parts an Army research scientist and working on of Arizona, Colorado, New Mexico Connie Schmaljohn vaccines to prevent diseases not typically and Utah. “It was the first time it was found in this country, but which afflict identified in America.” Schmaljohn decided early on she wanted members of the military overseas. Historically, USAMRIID has blazed to help save lives. She calls the story silly Schmaljohn, now an internationally medical trails, since the military serves all now, but she was watching a TV show, recognized expert on Hantaviruses and over the world and comes into contact in which a little girl’s mother died from a hemorrhagic fever with renal syndrome, with viruses not found in the United disease. “I said, ‘That’s not right.’ ” uses molecular biology tools to develop States and therefore aren’t widely studied At first she thought she was going to and test vaccines for a range of viruses. here, said Colleen Jonsson, director of be a doctor, but realized she preferred She and the scientists in her lab use the Center for Predictive Medicine for the broader reach of medical research. “I recombinant DNA, a form of artificial Biodefense and Emerging Infectious wanted people to not die of disease,” she DNA, to take the genes out of potentially Diseases at the University of Louisville. said. deadly viruses so they are no longer “They were the frontline for exotic Schmaljohn describes the experiments infectious. pathogens predominantly because soldiers she performed—and planned, designed “We like to call them next-gen vaccines,” serve in many, many countries,” she said. and tested—as the highlight of her career. said Schmaljohn, a senior research After 9/11, the National Institutes of “Every top moment has to do with an scientist for the U.S. Army Medical Health also started sponsoring research to experiment,” she said. “I don’t know Research Institute of Infectious Diseases study these agents, she added. how many years I’ve gone to parties or (USAMRIID) in Frederick, Md. Schmaljohn’s work on dangerous dinners and said, ‘I have to go check my Research scientists at USAMRIID pathogens may be aimed at protecting experiment.’ It was a roller coaster of were among the first to use these DNA military personnel, but the benefits spill emotion. Did it work? Did it not work?” vaccines. “We’re always in the forefront of over into the civilian population, as the Schmaljohn now mostly manages what the technological state of the art is Hantavirus outbreak demonstrated. other scientists, but experiences “vicarious and then we push it further,” Schmaljohn Her lab works on two types of vaccines: happiness,” through the people who work said. those that protect against medical for her, she said. She continues to focus on Schmaljohn’s expertise enabled her infectious diseases and those that defend keeping Soldiers healthy and safe. and her colleagues to identify what was against agents that could be used as “My job is to bring the newest going on when the number of cases of weapons in biological warfare. technology to the Army and improve our Hantavirus Pulmonary Syndrome (HPS) Researchers at USAMRIID were the science, and make us be at the very front exploded in the southwestern part of first to start testing DNA vaccines for of what we can do to protect the military United States in the 1990s. Previously, biodefense, using a method of delivering from disease.” the severe, sometimes fatal, respiratory DNA vaccines with a short electrical burst. This article was jointly prepared by the illness due to Hantavirus infections was The first study of this electroporation Partnership for Public Service, a group not known to cause disease in the Western method dispensed a vaccine to muscle seeking to enhance the performance of the hemisphere, and Hantaviruses had only in a clinical study at Walter Reed Army federal government, and washingtonpost. been associated with kidney failure diseases Medical Center with two vaccines for com. Go to http://washingtonpost.com/wp- in Asia and Europe. Hantaviruses. srv/politics/fedpage/players/ to read about But then HPS started felling people The next study will deliver the vaccine to other federal workers who are making a here. the skin instead of muscle, a less invasive, difference. “Because of the groundwork she had less painful method. Schmaljohn hopes done, she was able to identify the outbreak the immune response will be even better. 8 | ARMYMEDICINE.MIL Global HEALTH DEFENSE Dog Center Europe: Taking care of four-legged warriors saves Soldiers lives too By Sgt. 1st Class Randall Jackson, 30th Medical Command Public Affairs Veterinary care for military working Since ancient times, military working “Every chance I get to work in a clinic is dogs is essential to keeping four-legged dogs were used as front line attackers, amazing,” Lamanna said. “It just shows I warriors “mission ready” both in garrison guard dogs, scouts and messengers. More can use what I’ve learned under stress.” and downrange. recently they’ve been used to detect Veterinarians also offer first aid training That’s why the Baumholder, Germany- explosives. They’ve even been attributed as for dog handlers - information that once based 64th Medical Detachment saving thousands of lives during conflicts helped Air Force Staff Sgt. Jonathan (Veterinary Services) took time recently in Vietnam, Iraq and Afghanistan. Forgham, from the 86th Security Forces to brush up on their skills prior to their The Army values its canine corps and Squadron, whose canine partner severely deployment to Afghanistan. On July 24, specifically trains a dedicated cadre of injured his head when jumping through a Dog Center Europe personnel tested veterinarians and technicians to take care window. the detachment’s skills and assessed their of the health of these often courageous “We had to rush him across the base readiness, during training at U.S. Army animals. Members of the 64th said they to get him to the veterinarian. The whole Garrison Kaiserslautern’s Pulaski Barracks. take every chance they get to work on time I was in the cage with him stopping Their goal was to hone their abilities in bettering themselves, said Army Capt. the bleeding,” Forgham said. “We got garrison to prepare for the challenges of Lindsey Day, a veterinary corps officer. to use the training they gave us and it a deployed environment, said Maj. Kent “This was another opportunity to helped.” Vince, an Army veterinarian who is the practice our skills, and a chance to work The care veterinary teams offer to center’s director. together.” Day said. working dogs in turn pays off for humans. “It’s imperative that these teams get Three teams of veterinarians and “Not only are dogs’ lives dependent on training in clinical medicine before going technicians performed surgeries while you, but also humans’ lives,” Lamanna downrange,” Vince said. “You never know being observed and evaluated. Spc. Nicole said. “The dogs save lives. So, by saving the what they might face when they’re down Lamanna, an Army animal care specialist, dog, we’re saving other Soldiers.” there.” said, she loves the atmosphere. Watch what’s playing now on

Senior Army leaders talk about Army Medicine’s transformation from a healthcare system to a system for health. This is a call to action. Are you ready?

Lt. Gen. Patricia Horoho, Army Surgeon General and Commanding General U.S. Army Medical Command discusses moving towards a System for Health and the Performance Triad.

The Functional Capacity Evaluation assesses the capacity of service members for specific work-related tasks.

9 ARMYMEDICINE.MIL PERFORMANCE TRIAD Keeping Soldiers active first prong on Performance Triad By David Vergun, ARNEWS

“As an Army we must be ready and pedometer or by a smart phone app,” resilient,” said the Army’s surgeon general. Gregg said. To achieve these goals, “we need to Some Soldiers can benefit by keeping fully appreciate the impact that the a diary of how much time they spend Performance Triad has on our daily lives,” sitting in the office or reclining in the should also be time set aside to warm said Lt. Gen. Patricia Horoho, who is easy chair watching TV. He said they’d be up prior to each workout to reduce the also the commander of Army Medical surprised at how much of the time they’re likelihood of injury. Command. The Performance Triad sedentary. Another exercise principle, he said, is includes Activity, Nutrition and Sleep. Workouts combined with activity to gradually increase the intensity and Lt. Col. Scott Gregg, an Army physical breaks throughout the day can contribute duration of a new workout. therapist and expert on how physical greatly to such things as weight loss and “The Army has a good exercise activity affects the body, said Soldiers reducing the odds for a host of chronic plan in its physical readiness training already understand the importance disease such as depression, diabetes, heart manual,” he said, “but I also realize many of working out to build strength and disease, high blood pressure, stroke, and Soldiers are into other programs as well, stamina. But citing work done by obesity some forms of cancer. such as CrossFit, P90X, Insanity and expert Dr. James Levine, he said new The reverse is true for those leading a [Performance Triad] Pyramid.” studies suggest that workouts alone are sedentary lifestyle, especially those with He cautioned Soldiers not to dive right not a guarantee of good health. bad habits in the sleep and nutrition into a new exercise without a break-in aspects of the Performance Triad, Gregg period. KEEP MOVING said. Also, workouts should ideally include For Soldiers andFamily members who People who lead a sedentary lifestyle are movements for strength, endurance, are sitting all day in an office or driving more apt to consume junk food and have balance, agility and coordination for a a vehicle, a 30-minute workout, while poor sleeping habits, compounding the holistic effect. The Performance Triad has beneficial, is not enough to keep the negative effect. those. pounds off and stimulate the body’s “It’s a synergistic effect,” Gregg Another way to decrease the odds metabolic engine, Gregg said, citing explained. of injury is to wear the right gear, he Levine’s work. said, including mouth guards and other “The human body was just not built DON’T OVERDO IT devices for used in Combatives training, to sit all day,” he said, adding that there Gregg cautioned that too much as well as good running shoes. are some surprisingly simple and effective exercise can lead to overuse injuries and Finally, Soldiers experiencing pain things Soldiers and their Families can do is something Soldiers particularly should or acute muscle soreness should seek to stay fit. watch for, as many are highly motivated treatment, said Gregg. Small problems In addition to a daily workout, Gregg to be in top physical shape for personal can lead to bigger ones requiring a profile advises using the stairs whenever possible, and mission goals. or hospitalization. taking a short walking break every Warning signs for overuse injuries Soldiers who do end up on profile hour, perhaps to the water fountain to include joint pain and muscle soreness. should, nonetheless, remain active, he rehydrate or just a quick trip around the “Some Soldiers think it’s cool to said. building. exercise until you puke,” he said. “I’ve “Commanders tell me they want their Ideally, moving around would be 10 even seen it on T-shirts. That’s definitely Soldiers on profile to get back in shape as minutes each hour, but unfortunately, not cool, and it’s not healthy either.” this is a unit readiness issue,” he said. that is not always possible, he said. An ideal workout would be 150-plus Army physical and occupational “The important thing is to just keep minutes per week, including at least two therapists and others routinely work moving, ideally 10,000 steps a day, which muscle strengthening sessions involving with Soldiers, designing workouts can be measured by an inexpensive all major muscle groups, he said. There

10 | ARMYMEDICINE.MIL PERFORMANCE TRIAD

that rehabilitate injuries and maintain Editor’s Note: This is the first part of three- • Performance Triad: Nutrition conditioning so that their profile period part series about the Army’s “Performance • Ready and Resilient Campaign: is shortened and so that they don’t need Triad,” which includes Activity, Nutrition Comprehensive Soldier and Family as much time to get to full recovery once and Sleep. Fitness they’re off profile, he said. While it is the responsibility of every Resources: Related articles: Soldier to ensure he or she is physically • armymedicine.mil • Leveraging technology to increase fit, it is the responsibility of leadership to • army.mil/readyandresilient Soldier health and awareness ensure Soldiers are working out correctly, • The Performance Triad: Nutrition- he said. Related STAND-TO!: The connective link in your The activity portion of the Performance • Ready and Resilient Campaign Lifespace Triad empowers leaders to engage their Update • Surgeon General defines end state of Soldiers in effective physical training that • Performance Triad: Activity Performance Triad roll out minimizes injury risk. • Performance Triad: Sleep

Army Surgeon General Calls a Stand-Up for Health Last month, the Army Surgeon General and commander “As we wind down from nearly 12 years of combat U.S. Army Medical Command (MEDCOM) Lt. Gen. operations, we – as an Army and as a nation – have a Patricia Horoho officially announced Army Medicine’s golden opportunity to reset, refit and refocus. That focus System for Health and the Performance Triad during a should be on maintaining, restoring and improving health MEDCOM-wide Stand Up For Health Training Day. – using improved physical activity, nutrition and sleep In a call to action, Horoho challenged Army Medicine habits to foster increased readiness and resilience,” said leaders to change the way they think about healthcare Horoho who spoke to her leaders worldwide via video delivery. The System for Health represents a paradigm teleconference from Ft. Leavenworth, Kan. shift from a health care system focused on disease, to a system focused on prevention; to sustain health, readiness The Stand Up For Health Training Day (SUFHTD) and resiliency. The key tenants of the Performance Triad documents/videos are available via the Army Medicine – activity, nutrition and sleep – provide the foundational homepage and clicking at http://www.armymedicine.army. road map upon which Soldiers and their families can mil/news/Health/SUFHTD.cfm make healthy life choices. The following items are available: • TSG Video ‘A Fireside Chat on Moving Towards a System for Health’ • TSG’s Talk from SUFHTD • Activity Video • Nutrition Video • Sleep Video • Technology Video • Stand Up for Health Training Day Slide Deck

Mandatory Training Day Introduces the Performance Triad to All of Army Medicine

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COVER STORY SUICIDE PREVENTION: Sustaining the Drumbeat of a Ready & Resilient Force Through Awareness and Action By Valecia Dunbar, D.M., Army Medicine Public Affairs

September is Suicide Prevention Since that time, the Army has invested stand down began and continues today. Month and the Department of the tremendous effort in investigating the Phase two (Training and Sustainment) Army joins our nation and the world in causes of suicide within its ranks and will continue indefinitely. observing National Suicide Prevention in implementing policies and programs Suicide prevention continues to Week from September 8-14, in the U.S. whose sole purpose is to promote be one of the most pressing ‘Health and the World Health Organization’s resilience, prevent suicides, and enhance of the Force’ issues. Army leaders are World Suicide Prevention Day on the readiness of the Force. One such committed to maintaining a supportive September 10, as part of efforts to program is the Performance Triad environment that improves the physical, promote awareness about suicide and which focuses on monitoring one’s emotional, and psychological resiliency empower individuals and communities to Activity, Nutrition and Sleep as a means of our Soldiers, Families, Civilians and intervene and save lives by understanding of fortifying Soldiers’ readiness and individual/unit readiness. With the the risk factors, warning signs, protective resilience. implementation of the 2020 Army measures, and to take appropriate In 2012, the Army doubled its efforts Strategy for Suicide Prevention, the intervention actions when needed. towards reducing the stigma associated Army will attempt to shift its culture The Army’s leadership role in the fight with seeking behavioral healthcare. To by increasing the emphasis on leader to prevent suicide is to increase awareness address this tragic problem, the Army involvement to protect and promote life. of the Army’s suicide prevention has instituted a multi-disciplinary, Army regulations governing health resources, and continued efforts to holistic approach to health promotion, promotion, risk reduction, and suicide educate, empower, and equip Soldiers, risk reduction, and suicide prevention prevention describe suicide prevention as Families and Department of the Army that addresses the many challenges our a continuum of awareness, intervention, Civilians to seek help for life stressors Soldiers, Families, and Army Civilians and “postvention” [sic] to help save lives. and intervene to aid others who display face. Ultimately, the goal of prevention is to at-risk behaviors. The end state is a more “From our individual Soldiers and develop healthy, resilient Soldiers to the informed and resilient Army Family and Civilians to our units and Families, point where suicide is not an option. a climate where Soldiers, Families, and we must be committed to investing in The Ready and Resilient Campaign Civilians seek help when needed and are building enduring strength in a holistic (R2C) exemplifies the Army’s empowered to intervene and act to save way,” said John M. McHugh, secretary of collaborative, holistic approach which lives. the Army. tailors suicide intervention, prevention, “We call on each of you to act, know On September 27, 2012, the U.S. and response measures to ensure Soldier your Soldier, and know the existing Army conducted phase one (Awareness resilience. As a comprehensive plan prevention resources, said Lt. Gen. and Education) of an Army-wide suicide addressing the immediate and enduring Patricia D. Horoho, Army surgeon prevention stand down to empower needs of the total Army -- Active, general and commander of the U.S. leaders, Soldiers, Families and Civilians. Reserve, and National Guard Soldiers, Army Medical Command. “These tools During phase one, leaders conducted their Families, and Department of Army are key to self care and sustainment of discussions with Soldiers and used the Civilians, this campaign synchronizes our Army Family.” Leader Risk Reduction Tool (specifically and integrates key Army programs that In March 2009, in response to a developed for this purpose), conducted focus on building resilience, reinforcing growing number of Army suicides, the community and family-oriented prevention, and supporting the reduction vice chief of staff of the Army released events, and identified local programs, of suicide and suicidal ideation, sexual the Army Campaign Plan for Health and resiliency training. The resources harassment and sexual assault, bullying Promotion, Risk Reduction and Suicide developed and utilized during the stand and hazing, substance abuse, domestic Prevention, and chartered the Army down are housed on the website of the violence; and stigma associated with Suicide Prevention Task Force and the Army Human Resources Group (Army seeking help. Army Suicide Prevention Council. G-1). The following day, phase two of the

13 | ARMYMEDICINE.MIL COVER STORY cont’d.

Suicide is a multi-faceted problem that For more than a decade, Army and challenges. requires an equally sophisticated response. leadership has been up front in the For more information on the Army Life stressors including behavioral health creation and establishment of suicide Suicide Prevention Program and a list of issues, relationship difficulties, physical prevention policy and innovative resources: http://www.armyg1.army.mil/ illness, and financial and legal problems initiatives to bridge available resources hr/suicide/default.asp can all weigh heavily on an individual, with current needs. Over the past several For current and historical information engendering feelings of burdensomeness years there has been a decrease in the on Army partnerships and program and hopelessness. As these difficulties percentage of Soldiers that hold views initiatives to prevent suicide, access and feelings, real and/or perceived that bar them from seeking help. At the the 2020 Army Strategy for Suicide multiply within an individual, suicide can same time, the number of Soldiers who Prevention: http://www.armyg1.army. become an increasingly viable solution are using treatment programs such as mil/hr/suicide/docs/2020%20Army%20 – a permanent solution for a temporary behavioral health and substance abuse has Strategy%20for%20Suicide%20 problem. steadily increased which indicates Soldiers Prevention_1%20Oct%202012.pdf “Each suicide is a tragic loss for the are overcoming those stigma barriers. For assistance, Soldiers and Family Army Family and America,” said Horoho. It will take time to change this culture, members can contact The National “As leaders it is our responsibility to end but through actions and example, Army Suicide Prevention Lifeline, 1-800-273- hazing, harassment, discrimination, and leaders are beginning that transformation. TALK (8255) and Military Crisis Line, any behavior that runs counter to Army Defeating suicide will take active 1-800-273-8255. values. Empower those you lead to always involvement from everyone. Get involved intervene and act to save lives.” and engage those struggling with setbacks

SEPTEMBER IS SUICIDE PREVENTION MONTH

14 | ARMYMEDICINE.MIL AROUND ARMY MEDICINE (Courtesy Photo) Back to School Health Fair Fort Sam Houston By Walter Ham, Eighth Army Public Affairs Brooke Army Medical Center pediatric staff members conduct immunization screenings for beneficiaries during the Back to School Health Fair July 26, at San Antonio Military Medical Center. The staff administered more than 100 immunizations at the event. (U.S. Army photo by Maria Gallegos)

(Courtesy Photo) LRMC Team Earns Marching Award in Grueling Four-Day, 111- Mile March Landstuhl Regional Medical Center Germany – Since November 2012, a small team of dedicated Soldiers have been crawling out of bed in the early hours, two to three times a week, to march with each other at times over 25 miles. This sacrifice was in preparation for one of the most arduous and intensely celebrated annual events of modern times, the International Four Days Marches Nijmegen. The first “Vierdaagse,” or four-day march, was held in 1909 as a way of keeping the Dutch army fit after the introduction of motor vehicles. Depending on the age group and category, participants must walk 30, 40 or 50 kilometers each day for four days. Originally a military event with a few civilians, it now is a mainly civilian event. Numbers have risen in recent years, with over 40,000 taking part - including about 5,000 Military. It is now the world’s largest walking event. On July 16, a small contingent of 17 Soldiers from a combined group from Landstuhl Regional Medical Center and U.S. Army Public Health Command Region-Europe joined 31 other countries and 48,000 participants for the first day of this march. Lowland dikes and small villages along the route were crammed with thousands of supporters who cheered everyone along the roadsides. Friendly, smiling faces filled almost every yard and sidewalk along the route. With 48,000 participants filling the street, this caused the team to use cadence calling skills and discipline while marching to drive through the slower crowds. (U.S. Army photo by 1st Sgt. Michael Eldred)

Completing the Savage Race Aberdeen Proving Ground, MD Is there a better way to spend a day than to race through an extreme obstacle course and finish exhausted and covered in mud? You may be thinking that there is, but for Lt. Col. Greg Saturday and seven other volunteers on the team from the U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), at Aberdeen Proving Ground, Md., Savage Race was a challenge worth undertaking. MRICD’s team was muddied but triumphant after completing the Savage Race. In the back row, left to right, are Maj. Matthew Wegner, Col. Bruce Schoneboom, Sgt. Marco Acevedo, Lt. Col. Greg Saturday and James Swails; in the front from the left, Ken Barton, Sofia Elgarresta, and Sgt. Alicia Swails. (Photo courtesy of Mac Stone, provided by Savage Race) 15 | ARMYMEDICINE.MIL AMEDDC&S U.S. ARMY MEDICAL DEPARTMENT CENTER & SCHOOL Book Discusses Accomplishments of the Armed Forces Research Institute of Medical Sciences Borden Institute Releases The Armed Forces Research Institute of Medical Sciences, 1960-2010 This publication captures the immunodeficiency virus infection to Medical Aspects of Biological Warfare; significant activities and dramatic date.” This textbook is now available The Walter Reed Army Medical Center achievements in tropical infectious for online order or PDF download Centennial, A Pictorial History, 1909- diseases of the Armed Forces Research from the Borden Institute Website: 2009; Answering The Call: The U.S. Institute of Medical Sciences during www.cs.amedd.army.mil/borden. Army Nurse Corps, 1917-1919: A the last fifty years. Begun in 1959 as The Borden Institute, Army commemorative Tribute to Military a result of the Southeast Asia Treaty Medical Department Center and Nursing in World War I; Anesthesia Organization, the Thailand SEATO School (AMEDDC&S), publishes the and Perioperative Care of the Combat Cholera Research Project in Bangkok, Textbooks of Military Medicine. The Casualty; and Legacy of Excellence, The later the Medical Research Laboratory, volumes in the series (now numbering Armed Forces Institute of Pathology, and finally, AFRIMS (in 1977), was a 24) constitute a comprehensive treatise 1862-2011; Military Quantitative collaborative research effort between on the art and science of military Physiology: Problems and Concepts in the U.S. Army Medical Department medicine, covering such diverse Military Operational Medicine; and and the Royal Thai Army. Throughout topics as biological and chemical Combat Casualty Care: Lessons Learned the institute’s history, U.S. Army warfare, military preventive medicine, from OEF and OIF. In addition and Thai doctors jointly pursued military medical ethics, combat and to the print version, publications research and therapy for illnesses operational behavioral health, harsh are available in PDF format at the that threatened both U.S. troops environments, and care of combat Borden Web site, as well as on CD- and Thai citizens, such as cholera, injuries. Other Borden Institute ROM. Copies of Borden Institute malaria, opisthorchiasis, dengue, products include volumes on military publications may be ordered free of Japanese B encephalitis, hepatitis, medical history, monographs, and charge by eligible personnel. Anyone enteric infections, and HIV/AIDS. specialty titles such as Emergency War may download PDF versions free Maj. Gen. James K. Gilman, former Surgery. Borden Institute has published of charge. www.cs.amedd.army.mil/ Commander, USAMRMC, highlights nine books that have won a combined borden recent achievements, by stating that thirteen publishing awards: War Surgery “AFRIMS provided the clinical trials in Afghanistan and Iraq: A Series of BORDEN network for conducting the only Cases, 2003-2007; Pediatric Surgery INSTITUTE successful vaccine trial for human and Medicine for Hostile Environments; www.cs.amedd.army.mil/borden

Congratulations Borden Institute engineering, the work of military solve problems in the life sciences.” The Quantitative Physiology: Problems scientists in various disciplines is leading Army’s efforts to protect Soldier health and Concepts in Military Operational to an “integrated Soldier health and and increase warfighting effectiveness Medicine received Honorable Mention performance model,” a model with have multiple applications in everyday in this years’ American Medical broader implications in civilian medicine life: in Sleep, Nutrition and hydration, Writers Association competition in the as 10 years of combat draws to a close. sports and endurance, and protection Physician Category. The book, which Military medicine has pioneered in from injury. This text presents the work also won a first place in its category “convergence science,” according to Karl of dedicated Army scientists in these in the Washington Book Publishers Friedl and William Santee of the U.S. fields, in collaboration with academic competition this year, has been deemed Army Research and industry colleagues, “all committed one of the best medical books published Institute of Environmental Medicine to the protection of the nation’s in 2013 in the nation. (USARIEM), “characterized by the defenders and the global human family,” Drawing on decades of research as well increased reliance on mathematics, said former Surgeon General Lt. Gen as the recent revolution in computer physics, and computer engineering to Eric B. Schoomaker.

16 | ARMYMEDICINE.MIL DENCOM DENTAL COMMAND DENCOM ‘Go First Class’ Program Improves Army Readiness, Wellness By Lt. Col. Jeff Marks, U.S. Army Dental Command Scheduling multiple dental visits will Bliss, Texas and Fort Gordon, Georgia. They are away from their units much soon be unnecessary for most Soldiers Results showed significant reductions in less.” thanks to the Go First Class (GFC) the number of Soldiers that are dentally As oral health improves, sick days program led by the U.S. Army Dental non-deployable (class three or four). At decrease. Workload models predict up Command (DENCOM). Under the the same time, the number of Soldiers to 1.25 million hours of time will be new initiative, Soldiers will receive with no dental treatment needs (class returned to unit commanders Army-wide routine oral care procedures including one) is on the rise. Through October 1, as a result of the initiative. exams, cleanings, tooth varnishing, and all dental clinics will be implementing the Distribution of marketing material simple fillings in a single appointment. program. is underway and dental officials are “Go First Class addresses several pillars Bundled services, combined with a briefing unit leaders to increase program of the Army Medicine 2020 campaign shift to scheduled appointments, enables awareness. Additional information on plan including prevention, wellness, dental teams to treat more patients Go First Class is available at ArmyGFC. and readiness,” said Col. Bryan Kalish, and increase overall satisfaction. “The info. director of Health Care Delivery, at feedback I’m getting from commanders DENCOM. “It helps us transform and Soldiers is very positive,” said Col. from a healthcare system, to a System for Ken Dunn, director of Health Care Health.” Support. “With GFC most Soldiers GFC pilot programs were tested at Fort only need to visit the dentist once a year.

17 | ARMYMEDICINE.MIL ERMC EUROPE REGIONAL MEDICAL COMMAND Army Spouse Gets a Chance at Life Thanks to Medical Breakthrough at LRMC By Sgt. 1st Class Randall Jackson, 30th Medical Command Public Affairs

When a patients’ life depends on a 13- Germany, which is a regional center that hour flight and a complicated lung bypass does ECMO care and one of the world’s machine for survival, there’s a lot of fear leading experts, and a great resource that something could go wrong. But for available to us,” added Zonies. the wife of an Army Soldier stationed in Even though Regensburg University Germany, it was not only a smooth medical Hospital has supported U.S. and NATO evacuation flight across the Atlantic, but patients in the past, the DOD is now able also a first in military medicine. to provide that care. On July 10, a team from Landstuhl “The advantage of this change is to Regional Medical Center flew an Air Force Lt. Col. (Dr.) David Zonies, the LRMC Acute maximize the trauma care that they Lung Rescue Team leader, checks on his patient Army spouse from Ramstein Air Base, before she is medically evacuated to the San Anto- receive,” said Air Force Maj. Michelle Germany, to the San Antonio Military nio Military Medical Center in Texas. The Army wife Langdon, a registered nurse and the Medical Center in Texas (SAMMC) is the first patient to be flown across the Atlantic ECMO program coordinator at LRMC. while on the Extracorporeal Membrane Oxygen- while connected to a portable lung bypass ation machine. (U.S. Army photo by Sgt. 1st Class “Regensburg is not a trauma center, and machine called ECMO, which stands for Randall Jackson) the wounds that our warriors receive Extracorporeal Membrane Oxygenation. in battle are very difficult for them to The machine oxygenates the patient’s blood to team development, to systems maintain and manage with their other outside their body, allowing the organs to development, to standing up ECMO patient load. So the advantage to this is that rest and recover on their own. capabilities here in Germany and in San our patients will be repatriated into our So far the specialized 6-person Acute Antonio, it’s a major breakthrough.” trauma system and receive that same level Lung Rescue Team from LRMC has flown And it happened fast. of care.” American, British and Italian military “I talked to the American doctors about The LRMC team plans to continue their patients from downrange to LRMC since six days ago about moving her to the states. ECMO training quarterly, including in- 2010, but this was the first transatlantic Once they decided to move her to the flight practice, hoping to use their skills to flight in the history of ECMO. Until states, it happened really quickly,” said the save more lives in the future. now, the patients have been mostly service husband. “It makes me excited and happy that members injured in Afghanistan, but In addition to helping the patient, the the capability is there and that they’re able this patient, who has spent the past four transfer is also a chance for the LRMC to do it in such a quick fashion,” said the months in a German hospital, shows how Acute Lung Rescue Team to validate the patient’s husband. ECMO is increasingly being used to save skills of the San Antonio Military Medical lives under different scenarios. Center’s ECMO team who have plans to “We’re nervous, but excited that the make this a regular mission. technology is available for Soldiers and “The ultimate goal is that we have a spouses alike, and that they care as much global reach capability so that there can be for the Family members as they do for the a team based here in Europe, the U.S., and Soldiers,” said the husband. “She’s getting a team based in the Pacific so that we have the exact same support as a Soldier.” The the ability to move patients anywhere on husband and patient both wish to remain the globe to this central ECMO center in anonymous; however, the medical care they San Antonio,” said Air Force Lt. Col. (Dr.) received made military medical history. David Zonies, the LRMC Acute Lung A nurse from Landstuhl Regional Medical Center Rescue Team leader. holds the hand of a patient before her historical “It’s a huge milestone, a breakthrough on medical evacuation flight to the states in July. The many levels,” said Air Force Lt. Col. (Dr.) “In addition to the training platform in patient, an Army wife, is the first ever to be flown San Antonio, our relationship started with across the Atlantic while on ECMO, a specialized Jeremy Cannon, the SAMMC’s ECMO lung bypass machine. (U.S. Army photo by Sgt. 1st team leader. “From technology application the University Hospital in Regensburg, Class Randall Jackson)

18 | ARMYMEDICINE.MIL MRMC U.S. ARMY MEDICAL RESEARCH AND MATERIEL COMMAND

Saving Lives by Saving Blood By Jeffrey Soares, USAMRMC Public Affairs

In an age of ultra high-tech devices buddy aid [first aid administered by would not take much modification to that are worthy of screen time in a big battlefield ‘battle buddies’].” create a smaller device to place into budget Hollywood action movie, one As the portfolio manager, Pusateri the wound. Pusateri said that the might be surprised to discover that must orchestrate matters among applicator will be narrower, although a very “unglamorous” and simplistic the various armed services and the the sponge-like product inside will be medical device is being developed by company in charge of production who the same size. the Combat Casualty Care Research are collaborating for the successful When asked about the timeframe for Program (CCCRP) of the U.S. Army development and release of this new U.S. Food and Drug Administration Medical Research and Materiel medical device. However, as he states, approval, Pusateri said it should most Command, Fort Detrick, Md., that Pusateri came into the project during likely receive approval during this may soon save lives on the battlefield its later development, at the time the summer. and beyond. Army took over management of the “We have not identified any “Hemorrhage is the leading cause program. significant problems, and we expect it of death on the battlefield, and one “This project started with the United will fill a capability gap that we’ve had of our most challenging forms of for quite some time,” he said. “Upon hemorrhage has been junctional FDA approval, the device will be hemorrhage [the junction of the legs commercially available off the shelf. I or arms with the torso], or hemorrhage expect that a private sector partner will from deep wounds on which it do an initial production run.” is impossible to put a tourniquet While the XSTAT device is certainly or apply manual compression small and light enough to be carried in externally,” said Dr. Anthony military aid bags or combat lifesaver Pusateri, portfolio manager of the bags, Pusateri said this does not Department of Defense Hemorrhage guarantee its use as standard military The XSTAT device injects pellet-shaped sponges and Resuscitation Research and that enlarge to fill up a wound area quickly to pre- medical equipment. Development Program, managed by vent blood loss. (Courtesy photo) So why wouldn’t the military want the CCCRP. to have this in every warfighter’s bag? Cue XSTAT is the new device so States Special Operations Command “Well, for one, this doesn’t solve practical, one will wonder how the (USSOC), who was working with all of our bleeding problems,” said medical field has not thought of it medical technologies to conduct the Pusateri, “but it does fill a capability until now. Simply put, the device initial work,” he said. “The research gap for use on a wound area where looks like a large plastic syringe looked promising enough that the you could not place a bandage or filled with many small, pellet-shaped Army chose to fund it through its tourniquet.” sponges that enlarge to fill up a wound completion.” “It’s primarily intended for deep area quickly to prevent blood loss. While the current version of the wounds with heavy bleeding inside, “This XSTAT device allows the device is useful for large wounds, with no way of putting direct pressure haemostatic material to be put Pusateri said that the next iteration on the wound, and no way to wrap a [injected] into the wound tract, and will be one suited for narrower wound tourniquet around it. Basically, it’s then it expands from the inside out, tracts. Due to the location of the designed for use in the axillary and putting pressure on the bleeding target wounds, the original concept inguinal regions, or the junction of to stop it,” said Pusateri. “It is a was for a common-size wound tract. the legs and arms with the torso – too capability that has never existed As development progressed, the high for a tourniquet and too deep for before, and can be used in the field researchers found that in some cases, setting by medics, possibly even with the wound tract is smaller, and it

19 | ARMYMEDICINE.MIL MRMC U.S. ARMY MEDICAL RESEARCH AND MATERIEL COMMAND

a dressing.” medicine, and it is a perfect illustration While the XSTAT device is currently Pusateri added, “Any new item must of creating a medical item to satisfy a on the forefront of the CCCRP’s work, be considered along with all of the critical need in the field. Pusateri said that his group continues others items that medics, or others, “This is a good example of very to work on developing blood-related must carry. Many factors come into innovative and thorough work done items to help save lives. On the play for the final fielding decision. In by USSOCOM to get this started, horizon, the CCCRP is researching the Army, the Directorate of Combat working with the initial lead company,” dry plasma products to help restore/ and Doctrine Development at the U.S. said Pusateri, “but it is also an replenish blood loss quickly and help Army Medical Department Center and example of excellent cooperation and make the body more resistant to the School and the U.S. Army Medical communication in a joint environment, detrimental effects of severe bleeding. Materiel Agency will play major roles between USSOCOM and the U.S. in fielding decisions.” Army.” Despite its specificity – or perhaps “This could certainly be a significant because of it – the XSTAT device advance in our ability to control seems to be a necessary part of the hemorrhage, both on and off the future of both military and civilian battlefield,” said Pusateri.

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20 | ARMYMEDICINE.MIL NRMC NORTHERN REGIONAL MEDICAL COMMAND Best foot forward: Cadets ‘step into’ foot research By Kathy Eastwood, Pointer View Staff Writer

We are all constantly on our feet. device they previously used might resulting from training. We walk, run, jog, stand, and depend be a better method of measuring the The arch measuring device provides on our feet to support body weight. incoming cadets for footwear. information on arch height and A research study originating out of “The arch height measuring device stiffness, and functional data on Keller Army Community Hospital gives an objective measure on arch how the foot reacts to the load of at West Point is seeking to profile height,” said Neary. “What Lt. Gen. walking. The data was collected by the incidence of arch height and David Huntoon Jr. (former USMA pressure sensor mats from industry stiffness in military trainees and the Superintendent of West Point) wanted collaborators at Novel Electronics. correlation to overuse injury. The foot was a good fitting boot. If the boot “Novel gave us two pressure sensor study involves more than 1,000 cadet doesn’t fit right, it can slow the cadets machines and Temple University and volunteers and their Army-issued down and cause injuries. We knew we the Hospital for Special Surgery had boots. couldn’t pass this study by.” three additional systems we could The study, initiated by Col. Michael Funding for the measuring devices use,”said Neary. “The collaborators Neary, a podiatric surgeon at Keller came from the Center for Innovation also provided the manpower to run the Army Community Hospital, and Dr. and Engineering, directed by Lt. Col. software and hardware.” William Brechue, a Department of Bruce Floersheim. In addition to The new cadets’ feet were measured Physical Education professor, involves investigating a more effective method by students and faculty from Temple researchers from the U.S. Military for fitting footwear, the team set out to University, the New York College of Academy, New York College of collect data from the cadet volunteers Podiatric Medicine and the Hospital Podiatric Medicine, the Hospital for on their foot structure and function. for Special Surgery. Eighty volunteers Special Surgery in New York, Temple “We are measuring static and organized the research in coordination University in Philadelphia, and Novel dynamic characteristics of foot with the boot fit. Electronics. structure and function in the “For some perspective, it takes about When Neary arrived at West incoming cadet class in order to 10 years to gather that many subjects Point in 2010, he soon realized the understand what this population for a study,” Neary said. “We did it in instruments he used were somewhat generally looks like in terms of the two days with our team. limited. “I knew the instrument we proportion of high and low arches, used for prior boot fitting efforts flexible, and rigid feet,” Zifchock said. wasn’t functional (to study foot “We will then track their incidence of structure),” says Neary. He came to overuse injury to see if this correlates this conclusion while considering to their foot structure and function.” the relationship between proper boot Hillstrom said a cadet will carry fit and injuries he would see as a an additional 60-90 lbs. during a podiatrist on post. This concern was ruck march, a significant increase in urgent because he also inherited the body loading that only gets higher as task of setting up the boot fitting for training progresses. “It is an important the next incoming class. question to find out if the cadets have The study design began to take shape changes in foot structure and function, when Rebecca Zifchock, an associate and if the changes are temporary or A Temple University student prepares a new cadet’s foot to have it photographed to be viewed at a later professor in West Point’s Civil and permanent,” said Hillstrom. “The date for a study of the foot structure and function Mechanical Engineering Department, extra weight and the training cadets go in cadets during training. The project involves West Point, the Hospital of Special Surgery in New York, and Dr. Howard Hillstrom from through predispose cadets to injury.” Temple University, and the faculty of the New York the Hospital of Special Surgery in The team will follow the cadets and College of Podiatric Medicine. (U.S. Army photo by New York, came on board to discuss measure their feet at regular intervals Kathey Eastwood) a possible foot structure study and throughout their time at West Point thought an arch height measuring to check for changes in foot structure

21 | ARMYMEDICINE.MIL SRMC SOUTHERN REGIONAL MEDICAL COMMAND Soldiers with Army Mobile Entomology Lab Work to Prevent West Nile By Heather Graham-Ashley, Fort Hood Sentinel News Editor

Fort Hood’s preventive medicine The concentration for the testing “We’ve been at level 2 (low),” Gonzalez Soldiers are working collectively with remains in housing even though exact said, noting that 25 mosquitoes considered Carl R. Darnall Army Medical Center locations change when conditions evolve. West Nile capable have been captured. (CRDAMC) officials to prevent West Nile Other gathering efforts for the virus on West Nile virus was first detected in virus cases on the installation, one bug at the eastern side of the installation are North America in 1999, and has since a time. conducted by 3rd Cavalry Regiment spread across the continental U.S. and West Nile is a virus most commonly Soldiers. Canada. For those concerned about the spread by infected mosquitoes. The virus “Locations are random and based on virus, there are steps residents can take to can cause febrile illness, inflammation standing water and complaints from help prevent West Nile. of the brain, or meningitis, which is residents,” said Gonzalez. Standing water Eliminating standing water from pools, inflammation of the lining of the brain creates the ideal breeding ground for toys, tires and other objects lying around and spinal cord, according to the Centers mosquitoes that can carry dangerous helps by removing opportunities for for Disease Control and Prevention. diseases such as West Nile virus. infected females to lay their eggs since Each year for the past two years, West Nile virus is most dangerous for water is needed for the larva, Gonzalez from April through September, Soldiers the elderly, the very young, and those with said. “That’s the No. 1 way. Without water, assigned to the 224th Preventive Medical a compromised immune system. For most they have nowhere to lay their eggs.” Detachment (224th Prev. Med. Det.), 61st of the population, the virus manifests as If an outbreak were to occur, Soldiers Multi-functional Medical Battalion, and flu-like symptoms with mild headaches, from the 224th have a plan and the 1st Medical Brigade, head out into Fort Gonzalez added. equipment to eliminate the threat. Hood Family Housing to set traps to test “The average Soldier has probably had it “We have truck-mounted, backpack and mosquitoes for West Nile. and didn’t even know it,” she said. hand can sprayers,” said Johnson. Mosquito traps are set in housing At the lab, which is located in the unit’s But, the entomologists stressed, they do areas that have been deemed ideal areas motor pool, the traps are frozen to knock not want to use chemicals haphazardly. for a mosquito population. Traps and down the mosquitoes and other insects. “Last year, the focus was on prevention their contents are retrieved the following “Testing centers mostly on the females through habitat modification and control,” morning and taken to the 224th’s mobile because they are the only mosquitoes that said Gonzalez. entomology lab, the only operational one suck blood,” said Capt. Juree Johnson, of its kind in the Army. entomologist and executive officer, 224th Although CRDAMC started Prev. Med. Det. surveillance of West Nile in 2005, After freezing, each trap is emptied capturing and testing really heated up individually and first insects other than last year, said Capt. Amanda Gonzalez, mosquitoes are removed, then male and medical entomologist, CRDAMC. female mosquitoes are sorted by sex. According to Gonzalez, Fort Hood had Males are distinguished by their plumed two or three diagnosed cases of West Nile “mustaches.” virus in 2012. Specimen are placed in vials by sex This year more than 4,000 mosquitoes and location of capture and delivered to have been collected and no West Nile has Gonzalez. She then ships the mosquitoes been found so far, but the risk remains. to Public Health Command in San “Last year, the focus was in the Antonio for testing. Gonzalez receives Spc. Maxwell Murray, 224th Prev. Med. Det., sets up housing areas,” she said. “With all of the the test results back and shares them with a light trap to attractand capture mosquitoes as part of ongoing efforts to detect and prevent West Nile construction going on, a lot of places (of Fort Hood and posts the threat level on virus cases on the installation. Traps are set up each focus) have moved.” CRDAMC’s website. week from April through September to test for mos- quitoes carrying the virus. 22 | ARMYMEDICINE.MIL SRMC SOUTHERN REGIONAL MEDICAL COMMAND Army, Air Force Team Achieves Historic Trans-Atlantic Medical Mission By Elaine Sanchez, BAMC Public Affairs

A Brooke Army Medical Center consensus, they decided the best course directly from the battlefield to a stateside team made medical history last week by of action would be to bring the patient location, such as SAMMC, for their completing the military’s first trans- to SAMMC, where she could be recovery. The ultimate vision, he said, Atlantic movement of an adult on provided expert ECMO care around the is to create a military ECMO network external lung support. clock. around the world to ensure wounded A team of Army and Air Force doctors The hospital is one of a few adult and other critically ill service members and nurses treated the patient with ECMO-capable medical facilities in the and beneficiaries can receive the most extracorporeal membrane oxygenation, nation. The treatment is commonly used advanced care available anywhere. or ECMO, during a nonstop C-17 in neonatal intensive care units around “We’ve proven we can very safely Globemaster III flight from Germany to the world on newborns, including at take care of even the most critically San Antonio -- a 5,000-mile, 11-and-a- SAMMC, but adult applications are ill patients within the military health half-hour trek. just now emerging. Convinced by past system,” he said. “I look forward to a ECMO is a lifesaving heart-lung successes and new data supporting future in which these types of missions bypass system that circulates blood the use of ECMO in adults, Cannon aren’t a ‘first,’ but a routine part of our through an external artificial lung spearheaded the effort to offer the mission.” before sending it back into the patient’s treatment here several years ago. In bloodstream, giving a critically ill October 2012, he oversaw the care of patient’s lungs or heart time to heal, the hospital’s first adult ECMO patient, explained Air Force Lt. Col. (Dr.) and BAMC leadership officially stood Jeremy Cannon, ECMO director and up the program in May. trauma chief at San Antonio Military After the call from Zonies, Cannon Medical Center, BAMC’s inpatient swiftly assembled an ECMO team and facility here. flew to Germany while the patient was “This historic mission was a true moved from the German hospital to demonstration of our commitment to Landstuhl. The following morning, they caring for service members and their boarded a C-17 and flew nonstop to families,” Cannon said, “no matter how Kelly Air Force Base in San Antonio, ill or far away they are.” where they arrived July 10. A quick Cannon first learned of the patient, ambulance ride later, and the patient an active-duty Army spouse, late last was admitted and moved to the ECMO month. She had been admitted to unit in the Institute of Surgical Research a German civilian hospital with a Burn Center located in SAMMC. respiratory illness that was compounded Although still on ECMO, the patient by infection. She was treated and is doing well, Cannon said. “She even released to a rehab center, but a asked for pancakes in Germany, but downward spiral in her health spurred had to settle for a popsicle instead,” he her German providers to initiate recalled with a smile. “But we made sure A specialized medical team ensures a patient is safe and ready for takeoff in July from Ramstein Air Base, ECMO. she got her pancakes here.” Germany. A team of Brooke Army Medical Center The German doctors soon after “The trans-Atlantic trip signified doctors and nurses treated the patient with extra- contacted Air Force Lt. Col. (Dr.) David the last piece of the ECMO puzzle corporeal membrane oxygenation, or ECMO, during a nonstop C-17 Globemaster III flight from Germany Zonies, medical director of the ECMO at BAMC,” Cannon noted. He had to San Antonio. (U.S. Air Force photo by Senior Air- program at Landstuhl Regional Medical long envisioned a program in which man Hailey Haux) Center in Germany. With Cannon’s ECMO patients could be transported

23 | ARMYMEDICINE.MIL USAPHC U.S. ARMY PUBLIC HEALTH COMMAND Public Health Commander Leads by Example By Jane Gervasoni, U.S. Army Public Health Command

Maj. Gen. Dean G. Sienko, prevent or mitigate chronic diseases like commander, U.S. Army Public diabetes, heart disease and stroke. Their Health Command, understands the programs are individually tailored to importance of a ready and resilient meet client goals and address the whole force. He has deployed to Kosovo and person—body, mind and spirit. Kuwait, and he knows how the Army “Army Wellness Centers provide an surgeon general’s Performance Triad of overall assessment and the integration Activity, Nutrition and Sleep can affect of a holistic approach to wellness, and the health of deployed Soldiers as well Todd Hoover and the staff at the Army as those who support them. That is Wellness Center APG demonstrate a

why Sienko made a visit to the Army Maj. Gen. Dean G. Sienko, commander, U.S. Army high level of expertise,” said Sienko. Wellness Center, Aberdeen Proving Public Health Command, listens as Todd Hoover, Chris Sorrells, AWC APG’s director, Ground, Md., one of his first priorities. Army Wellness Center Program director, explains said she was very pleased that Sienko how metabolic testing equipment measures the “I was excited to learn how the amount of oxygen an individual uses to sustain had come to the AWC. She explained services such as metabolic testing, normal functions. (U.S. Army photo by Graham Sno- that since the opening in January, more nutrition counseling and stress dgrass, U.S. Army Public Health Command) than 550 clients from all over the APG management are being used to teach area have used AWC services. Soldiers, Civilians, Retirees and Family Then Sienko went on a treadmill to Sorrells encouraged others to members how to be healthy,” Sienko, determine his cardio-respiratory fitness make an appointment for a wellness who is also a physician, explained. level. assessment at the AWC, located at Kirk Todd Hoover, USAPHC Wellness “The screening information Army Health Clinic at APG–North. Center Operations Program manager, combined with metabolic testing, “The Army Wellness Center Program led Sienko through the steps that all body composition testing and other offers a great opportunity for everyone AWC clients experience when they information allows our health educators in the Army family,” said Sienko. “If make an appointment at an AWC. to write an exercise prescription to help you haven’t been to an Army Wellness All clients need to complete the meet the needs and goals of the clients,” Center, it is important that you go. Health and Wellness Questionnaire, said Hoover. This has been a valuable experience for a six-page, comprehensive health The exercise prescription helps clients me and my health.” assessment that asks questions about to set small attainable goals and helps sleep habits, nutrition, fitness and them learn strategies for enhancing overall well-being. This questionnaire their health. is located in the online Soldier Fitness “I am very pleased with my tailored Tracker AWC portal. fitness and nutritional plan that “The Soldier Fitness Tracker incorporates cardio, strength training AWC portal gives us a snapshot of and a balanced diet,” Sienko said. where people are before we begin a “The evaluation results give me some program,” Hoover explained to Sienko. insights on areas where I would like to “Responses provide a ‘wellness’ score improve, and I look forward to the next that lets us tailor services to meet each evaluation of my progress.” client’s needs.” Sienko’s background as a civilian public health expert makes him a Maj. Gen. Dean G. Sienko, commander, U.S. Army Hoover used resting metabolic testing Public Health Command, works out on a treadmill to to provide Sienko with nutrition committed advocate of prevention determine his exercise metabolic rate and assess his information such as the number of as the best way to build and sustain cardio-respiratory fitness level as Todd Hoover, Army good health. AWCs offer programs Wellness Center Program Director, monitors his calories needed to maintain basic body progress. (U.S. Army photo by Graham Snodgrass, functions such as heart beat, breathing and services that help their clients U.S. Army Public Health Command) and normal body temperature. achieve healthy lifestyle changes and

24 | ARMYMEDICINE.MIL RECOGNITIONS Frau Schirra Receives Meritorious Civilian Service Award By Chuck Roberts, Landstuhl Regional Medical Center Public Affairs

answer to almost any personnel question and assisted everyone with a wonderful caring attitude for 47 years,” said Lt. Col. Rodney Jorstad, the director of the Department of Pharmacy at the time of her retirement. “She left us her extensive data files she developed over her career that we refer to constantly. Frau Schirra is still caring for us even after her retirement.” Similar praise was bestowed upon Schirra by another former LRMC Pharmacy Director, retired Col. Curtis Hansen. “In addition to being a remarkably effective administrative secretary for one of LRMC’s largest Ruth Schirra receives the Meritorious Civilian Service Award from Col. (Dr.) Robert Fischer (left), LRMC Deputy Commander for divisions, Frau Schirra’s Administration, and former LRMC Command Sgt. Maj. Michael Gragg. reputation for personally assisting patients and fellow The matriarch of the Landstuhl Nuclear Medicine Department from 1969 staff members throughout these many Regional Medical Center Pharmacy has to 1993 as the administrative assistant, a years is truly legendary. Quite simply, concluded 47 years of selfless service position that has since been converted into Frau Schirra was the Heart of the LRMC for which she received the Meritorious three different positions. Pharmacy,” said Hansen. Civilian Service Award. Finally, in March 1993, Schirra found “I think back with gratitude, pride and It began when Ruth Schirra showed up her true home in the Department of tears in my eyes, however, with no regrets for work on April 4, 1966, at the LRMC Pharmacy as the administrative assistant whatsoever,” Schirra said in reflecting on Dental Clinic as a dental assistant. If you to the Chief of Pharmacy. Over the past her career. “Now a new era has started and planted an apple tree on that date, by now 18 years, Frau Schirra was the backbone my devotion belongs to my Family and it would have yielded 4,194 kilograms of of the Department of Pharmacy where to my too numerous to count projects. apples while contributing $16,729 toward she mentored and watched six different I miss all my friends at LRMC and the the economy and feeding 7,035 people. chiefs of pharmacy and hundreds of folks I have met throughout my 47 years Schirra has been equally fruitful. Soldiers, Sailors, Airmen, Civilians and working on the hill. I cherish every After her stint as a dental assistant, Local Nationals pass through the doors of moment and am thankful forever.” Schirra worked in the LRMC Data the pharmacy and adopted each and every Processing Branch and Medical Research person as one of her own. Department before settling in the LRMC “Frau Schirra quickly found the

25 | ARMYMEDICINE.MIL RECOGNITIONS Wolf Pack Winner (4th Quarter) U.S. Army MEDDAC, Fort Stewart Public Affairs

Congratulations to the Winn Army Community Hospital Physical Therapy team for winning the Army Medicine Wolf Pack Award. The Wolf Pack Award is a quarterly award created by the Army Surgeon General and the Chief of the Army Medical Department Civilian Corps to recognize exceptional teamwork by an integrated group of military and civilian team members focused on excellence in support of Army Medicine. The Winn ACH PT team won the award for fourth quarter FY13. They reclaimed physical therapy work that would have otherwise gone out to the TRICARE network. Their teamwork resulted in an annual savings of more than $1.5 million, as well as improved clinic productivity and value. They will now compete for the Annual Wolf Pack Award, which will be presented later this year.

Pictured front row: Theresa Rayner, Terecice Sibley, Katie Scott, Karen Taylor Second Row: Maj. Dan Fisher, Jayson Lane, Sgt. Kandyce Tucker, Kristine DeJoseph. Back row: Capt. Corey Harshey, Staff Sgt. Dan Miracle, Tobi Schaap, Anthony Lubrani, Capt. Pat Casey, Jeremy McMichael (Not pictured: Jeff Loomis, Capt. Erin Johnson, Capt. Julie Kujawa, Capt. Christine Koreerat, Capt. Nicholas Koreerat, Capt. Jeremy Fletcher, Sgt. Adrian Whitaker, Sgt. Sylvia Winn) Photo by Michelle L. Gordon

26 | ARMYMEDICINE.MIL RECOGNITIONS 32nd Medical Brigade Holds Best Warrior Competition By Esther Garcia, AMEDDC&S Public Affairs

Eleven noncommissioned officers and march in 1 hour and 17 minutes. “After Martinez. “They showed me the right way three Soldiers competed in the 32nd having been up for so long doing land to do things and taught me everything I Medical Brigade Best Warrior Competition navigation, it was the hardest road march need to know to be a good Soldier and how held in June at Joint Base San Antonio- I’ve ever done.” to conduct myself off duty.” Camp Bullis. Staff Sgt. Seamus Bradley Command Sgt. Maj. Jayme Johnson “I want to thank my fellow competitors, and Pfc. Rafael Martinez were chosen to of the 32nd Medical Brigade presented you definitely raised the bar,” Bradley represent the brigade at the U.S. Army various prizes and awards to the winners said. “I was chasing you the whole time, Medical Command level competition. and certificates of appreciation to all the trying to figure out where I stood. Every Day one of the competition began with participants at a special ceremony held in time I turned around, someone was doing the Army physical fitness test, weapons July at Beethoven Halle and Garten. something better. It was a team effort and a qualifications with an M16 rifle, daytime “I want to thank my company fun event.” land navigation, a multiple choice test and commander, my first sergeant, and all the an essay. The day ended with the night land NCOs for always teaching me how to navigation which, for some, did not finish maintain myself and be a Soldier,” said until 6 a.m. the following morning. After the second day began with a 6-mile road march through hills and uneven terrain, the competitors were tested on their knowledge of medical skills, warrior task and battle drills. Testing began with the assembling and reassembling of an M16 rifle, reacting to indirect and direct fire, reacting to an explosive device, and the treatment and evacuation of a wounded Soldier. The next competition - a mystery event the competitors had no prior knowledge of - tested the knowledge of a field ambulance. The final test was an oral board that consisted of a five-member panel of senior NCOs that covered 23 subject areas and four situational questions from each area. “It was very difficult. The hills were steeper than I thought they would be, the terrain was rougher and the rocks were Staff Sgt. Seamus Bradley pulls a wounded Soldier to Pfc. Rafael Martinez competing in the 6-mile road bigger,” said Bradley, who finished the road safety during part of the Warrior Tasks and Battle Drills march at Camp Bullis on June 29. competition at Camp Bullis on June 29.

27 | ARMYMEDICINE.MIL RECOGNITIONS Arkansas, Florida Army Guard Members Win Army Guard Best Warrior Competition By Sgt. 1st Class Jon Soucy, National Guard Bureau

A combat medic from the Arkansas Army on and I knew the end of the hill was going NCO of the Year and we would have been National Guard and an infantryman from to come sooner or later. Though, it came pleased.” the Florida Army National Guard have later rather than sooner.” For Calvi, the competition provided him been named the Army National Guard’s But getting through the competition, and with a chance to learn from those he was Soldier and Noncommissioned Officer of winning, wasn’t something Lopez and Calvi competing against. the Year. did on their own. Both said they couldn’t “We all have our strong points and our Sgt. Piero Lopez, assigned to the have done it without support from others. weaknesses here,” he said. “Not every Arkansas Army Guard’s Headquarters and “There was a lot of support from my competitor here is going to get first place in Headquarters Company, 2nd Battalion, coach and from my unit as well,” said every single event. It shifts around and you 153rd Infantry Regiment, was named Lopez. “I definitely couldn’t have done it learn from the other competitors and their Soldier of the Year and Sgt. Anthony Calvi, without them. They provided so much strengths. So that was really good training from the Florida Army Guard’s Company for me, especially when I was emotionally for me.” A, 1st Battalion, 124th Infantry Regiment, unstable or when I was down from some Calvi said those things he learned will was named NCO of the Year in an awards event. They always told me to focus on the benefit other Soldiers in his unit. ceremony following the 2013 Army next event and it’s key because it’s how you “I explain to them everything I do, how National Guard Best Warrior Competition, do on your next event that matters.” I do it and what I’ve learned,” he said. “I’m held at Camp Joseph T. Robinson, Ark. And the competitors themselves also just going to pass on all that I can to them.” The winners now move on to represent supported each other as they went through That makes for stronger Soldiers the Army National Guard in the the non-stop, three-day competition. throughout the Army Guard, said Conley. Department of the Army Best Warrior “They may have been in competition “They are the best of the best,” he said, Competition, to be held at Fort Lee, Va., with each other, but they were still of the competitors. “They’re amazing. They later in the year. For the winners, the comrades,” said Command Sgt. Maj. live the Warrior Ethos every day. (This competition was a grueling one. Brunk W. Conley, the sergeant major of the competition) gives them more tools to The physical and mental stamina of Army National Guard. “They were pulling infect others with that attitude, that way of the competitors was tested in a variety of for each other and helping each other and subjects to include weapons knowledge, rooting each other on. They didn’t want to casualty care, marksmanship and general lose, they wanted to win but, it wasn’t at Army doctrine. Additionally, competitors the expense of somebody getting hurt or had to negotiate various tactical scenarios somebody’s pride or not being supportive that involved engaging multiple targets, of the others.” transporting a casualty and responding And that, said Conley, ties into the to a number of different challenges and Army’s Warrior Ethos--which says to never surprises along the way. leave a fallen comrade. Following the For Calvi, the ruck march was among the Warrior Ethos, placing the mission first, more difficult events faced. never quitting, never accepting defeat and “Not knowing the distance (was tough),” never leaving a fallen comrade, was key to he said. “Depending on the distance, not only being able to win the competition, depends how you pace yourself. Not but also to simply compete in it as well. knowing if it was going to be seven miles, “It’s just never quitting,” said Calvi. “I eight, 10, 12, (was tough). You have to pace take the Warrior Ethos part of it and apply yourself, but you can’t fall too far behind.” it to my performances. As long as you do Army Sgt. Piero Lopez, a combat medic with the Calvi said he just kept pushing himself to your best, it will demonstrate out as seen Arkansas Army National Guard’s Headquarters and Headquarters Company, 2nd Battalion, 153rd the limit. here.” Infantry Regiment, rushes through the woodline to “Those two hills that were here (on the Each of the competitors embodied that assault a building during the urban assault course ruck march course), I underestimated same spirit, said Conley. portion of the 2013 Army National Guard Best Warrior Competition at Camp Joseph T. Robinson, them,” he said. “I can’t train for hills in “It was a tough competition,” he said. Ark., Tuesday, July 23, 2013. (U.S. Army photo by Florida. I just kept pushing it. You never “It was tight. Any one of those 14 Soldiers Sgt. 1st Class Jon Soucy) stop moving your feet. I just kept driving (that competed) could have won Soldier or

28 | ARMYMEDICINE.MIL RECOGNITIONS

doing business, and the Guard wins from of things to improve. I’ve been humbled to represent the Army National Guard at their experiences at this.” in this competition and I’m going to work the next level,” he said. “I’m going to do my For now, though, the focus for Calvi and on (those weak areas) to make them my best.” And, that’s what it takes. Lopez is getting ready for the competition strengths instead of my weaknesses.” “Anyone can do it,” said Calvi. “You just at Fort Lee. For Lopez, that means pushing himself have that mindset to never quit and keep “Right now, am I ready? I’m very sore,” further. pushing yourself.” said Calvi. “But, I would say I have a lot “It’s a pretty awesome feeling being able Fort Hood WTB Soldier ‘Knighted’ by Armor Community By Gloria Montgomery, WTB Public Affairs

Life in the Army for Warrior Transition tanks, so this just made sense to me.” kills, and is one of the few Americans with Brigade cadre, Staff Sgt. Roger Pates, has Being knighted also was the fifth and a confirmed kill of a T-34 tank,” wrote always been about the Abrams. It didn’t final career goal Pates had set for himself Sellers. matter if it was a 60-ton or a 70-ton tank, when he enlisted. Pates former company commander, he just wanted to be its master. “I wanted to make rank, be a tank Capt. Christopher Mitchell, also praised On August 1, surrounded by more commander, make master gunner, become Pates. than 400 warriors from his former unit a knight, and..,” said Pates, hesitating a bit, “He’s done some amazing things within --the 12th Cavalry Regiment, 3rd Brigade “Go to war.” the armor community throughout his Combat Team, 1st Cavalry Division-- the In 2003 Pates got his wish for war when Army career,” said Mitchell. “As my master master gunner achieved the pinnacle of his his unit was one of the first to invade Iraq. gunner, he built the company’s gunnery Army career: knighthood and membership “I was a little nervous at first because training plan from scratch and oversaw into the prestigious Order of St. George. I’m in a bomb on wheels,” the 37-year-old the training. He worked his butt off to get Lt. Col. Arthur Sellers, commander, Pates said, “but it was also pretty awesome everyone qualified. He’s very deserving of “knighted” the kneeling Pates with two because I’m in a practically indestructible this award.” saber taps on the shoulders and the war machine.” presentation of the order’s black medallion Pates credits Army training with that is given to “deserving junior officers preparing him for the fight. and enlisted tankers and cavalrymen who “It was exactly like our Army training, have demonstrated outstanding leadership only this time it was for real,” said Pates, and technical competence.” who deployed three times to Iraq. “There The order, which was established in 1986 were real bullets firing at real people, and by the United States Armor Association, real people firing back. It was a very surreal recognizes “the very best tankers and experience.” cavalrymen among its members.” Its origins When his third deployment ended, date back to a 12th Century Italian legend Pates had achieved all his goals except that depicts St. George slaying a dragon in knighthood. exchange for the community embracing Pates was nominated by Sellers for Christianity. his “demonstrated tactical and technical For Pates, who now works with brigade competence as an armored leader and for operations, the opportunity to get knighted his contributions to the mounted force.” was the driving force behind his decision to Sellers specifically cited Pates heroism Lt. Col. Arthur Sellers knights former armored cavalry enlist and go “armor” three months after his during the invasion of Iraq when, in the Soldier Staff Sgt. Roger Pates, who is now a member of distinguished Order of St. George. The order, which 1993 high school graduation. absence of a tank commander, he took was established in 1986 by the United States Armor “I just thought that being knighted was over the tank and is credited with fighting Association, recognizes “the very best tankers and cavalrymen among its members.” Its origins date the coolest thing I had ever heard about,” in seven major battles: As-Samawwah, Al- back to a 12th Century Italian legend that depicts St. said the Kansas native, who first learned Hillah, Al-Qut, Al-Mossayib, Karbala Gap, George slaying a dragon in exchange for the community about the order from an Army friend. “Ever Baghdad Airport and Baghdad. embracing Christianity. Since its inception into the U.S. Army, more than 10,000 Soldiers have been knighted. since I was a kid, too, I wanted to drive “He had numerous dismount and vehicle (U.S. Army photo by Gloria Montgomery, WTB PAO)

29 | ARMYMEDICINE.MIL RECOGNITIONS Vicenza EDIS Program Receives High Marks During Command Inspection The Vicenza Educational and occupational therapist has implemented 3. Validating the effectiveness of the Developmental Intervention Services a unique program to support the DOD Regional Medical Command oversight (EDIS) program has once again received school special education services. The of EDIS compliance and provision of an excellent rating after a recent two- key feature of this initiative involves the technical support to specific military day monitoring by U.S. Army Medical training of school personnel in fine motor treatment facilities within the Regional Command (MEDCOM). techniques to enable students to reach Medical Command. The July 16-17 monitoring was made educational goals. This approach not only “The EDIS team consistently to ensure the program’s compliance with benefits the special education students, but demonstrates respect for the concerns and Department of Defense regulations and the by building the skills of the DOD staff, it needs of eligible Families,” said Ardison. Individuals with Disabilities Education Act. helps all students. “Families understand the mission of EDIS The monitoring resulted in the Vicenza Another example of program excellence is and actively participate as equal partners in EDIS program receiving a Certificate of the program’s highly effective community- service delivery.” Full Compliance. What does this mean to based child-find activities that are “The Vicenza EDIS program provides our community? conducted in collaboration with agencies a significant value added in support of “It means that we are fortunate to have a both on and off post, thus insuring all the overall mission of the Army Medical highly skilled and competent EDIS Team eligible children have access to appropriate Department, the military treatment committed to implementing best practices services. facility and the Vicenza community and is in early intervention,” said Audrey Ardison, The inspection was part of the reflective of the overall Vicenza community the MEDCOM EDIS Program Manager. MEDCOM Organizational Inspection in supporting total inclusion for all “All of our providers are dedicated to Program with the goals of: children- probably the most important improving their skills and processes and to 1. Assessing the implementing status of feature of the whole program.” implementing best-practices in the field of the local EDIS program. early childhood intervention.” 2. Certifying compliance with DOD For example, the Vicenza EDIS standards, as applicable. CONNECT WITH ARMY MEDICINE CLICK ON A LINK BELOW AND JOIN THE CONVERSATION FLICKR FACEBOOK TWITTER

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30 | ARMYMEDICINE.MIL RECOGNITIONS The National Image Award honors military members and Department of Defense civilians who embody the core values of their service or agency HQDA is pleased to announce the and intuitive selection of topics have probability of adverse encounters. In fact, National IMAGE (Military) Award ensured that all training was relevant and his clinic recently achieved a 100% patient Recipients for 2013 is: Staff Sgt. Jerry interesting. His training has established satisfaction rating based on responses to M. McKissen, Jr. U.S. Army Medical EO as a top priority in the minds of all patient surveys. His steadfast commitment Command, U.S. Army Dental Activity, employees, enabling unit members to to equality and diversity has resulted in senior dental sergeant. McKissen identify potential issues at the lowest level, a pleasant work environment among distinguished himself by making significant resulting in no formal complaints within employees of vastly different backgrounds. contributions to the country in the area of the command. The distinctive accomplishments of Equal Opportunity/Equal Employment He also manages a diverse workforce as McKissen reflect great credit upon him, Opportunity, Civil Right Programs, and the Non-Commissioned Officer in Charge the United States Army, and make him public service to his local community. (NCOIC) of the Oral and Maxillofacial most deserving of the National IMAGE McKissen has distinguished himself Surgery Clinic at Brooke Army Medical Meritorious Service Award. by continually making significant Center. As part of his duties, he assists contributions to America in the areas of in the administration of a joint equal opportunity and public service both service oral and maxillofacial within the civilian community and the surgery residency program, the United States Army. largest such program in the McKissen serves as the equal opportunity Department of Defense. His (EO) leader for the Fort Sam Houston patient population includes Dental Activity. In this role he advises the numerous Wounded Warriors, commander on all EO matters pertaining many of whom have returned from to 41 Soldiers, 108 Department of Army overseas contingency operations (DA) Civilians, and 11 Contract Service to recuperate from battle injuries. Department of the Army National IMAGE Award recipi- Providers. His efforts were instrumental in These Soldiers and their Families ent, Staff Sgt. Jerry M. McKissen Jr. (standing), a senior ensuring a healthy command climate free of are under considerable stress and dental sergeant at U.S. Army Dental Activity, facilitates a discussion on diversity as part of the Equal Opportunity discrimination, harassment, and hostility. McKissen’s steadfast leadership training program. From L to R: Sgt. Tiffany Duffy, Staff Sgt. He has provided quarterly EO training to and sterling example ensure McKissen, Sgt. Tracy Ghee, and Staff Sgt. Obed Felix. The all Soldiers and employees assigned to the that his staff understands and National Image Award honors military members and De- partment of Defense civilians who embody the core values organization for the past twelve months. applies the principles of diversity of their service or agency. (U.S. Army photo by Master Sgt. His enthusiastic style of presentation and equality, minimizing the David J. Sheets) MEDCOM Clinical System Trainers Achieve Certification Thirty Clinical System Trainers assigned to various medical Pamela Favorite Keller Army Community Hospital, treatment facilities throughout the MEDCOM have received West Point, NY the American Health Information Management Association Kylee E. Pagan McDonald Army Health Center, (AHIMA) Health Information Technology Professional (HIT Pro) Fort Eustis, VA Competency Trainer Certification for demonstrating knowledge in key areas supporting Health Information Management / Angela S. Childress Martin Army Community Hospital, Information Technology and Training. Obtaining this certification Fort Benning, GA is a testament to their depth of knowledge and expertise which Michael R. Guthrie Martin Army Community Hospital, is heavily relied upon by the facilities as the primary workforce Fort Benning, GA responsible for training the MEDCOM staff on the Health Patricia S. Bush Martin Army Community Hospital, Information Technology systems. Congratulations to: Fort Benning, GA *For a list of additional winners, refer to the August 2013 Kevin Louris Martin Army Community Hospital, edition of the Mercury. Fort Benning, GA

31 | ARMYMEDICINE.MIL RECOGNITIONS MEDCOM Soldiers Compete for Best Warrior By Jane Gervasoni, USAPHC Public Affairs Office

Humidity and high heat smothered the 2012 NCO best warrior, announced the Eaton and certificates of achievement to all woodland. The only sounds were crickets competition winners. the competitors. hiding in the grass and cicadas humming Wayman named Sgt. 1st Class Ronnie Reynolds and Eaton will represent the in the trees. Suddenly a huge explosion Reynolds, a combat medic at the Army MEDCOM in the Army Best Warrior ripped through the morning and a scream Medical Department Center and School, as Competition Oct. 15–17 at Fort Lee, Va. echoed—“I’m hit; I’m hit.” the 2013 MEDCOM best NCO and Spc. Green smoke exploded, and the smell of Erik Eaton, a laboratory specialist from the NCO competitors also included: gunpowder and the noise of M16 rifle fire U.S. Army Medical Research and Materiel Sgt. 1st Class Ronnie Reynolds flooded the formerly peaceful scene. Command as the MEDCOM best Soldier. 68W40, NCOA, AMEDDC&S Thus began warrior tasks and the battle The winners competed against 16 other Sgt. Andrew Hinton, laboratory drill segment of the U.S. Army Medical MEDCOM Soldiers and NCOs. specialist, Landstuhl, Germany; Command’s Best Warrior Competition Competition actually began earlier Staff Sgt. Gregory Holman, combat hosted by the U.S. Army Public Health this year when local units selected their medic, Fort Carson, Colo.; Command Aug. 19–23, at Aberdeen best Soldiers and NCOs. Local winners Sgt. Mario Leon, veterinary food Proving Ground, Md. competed in each of five regional medical inspection specialist, Fort Schafter, Maj. Gen. Dean G. Sienko, USAPHC commands and the USAPHC, the Dental Hawaii; commander, represented Lt. Gen. Patricia Command, the AMEDD C&S, and the Sgt. Joshua Marrero, dental specialist, D. Horoho, Army surgeon general and Medical Research and Materiel Command Honolulu, Hawaii; MEDCOM commander, at the Aug. 23 for the finals on the Lauderick Creek Sgt. Justin Runyan, combat medic, award ceremony. Sienko and Command Military Reservation at APG. Schofield Barracks, Hawaii; Sgt. Maj. Donna A. Brock, senior enlisted The Best Warrior Competition consisted Cpl. Omar Smith, laboratory specialist, advisor to the surgeon general and of four days of rigorous events including Bethesda, Md.; MEDCOM command sergeant major, the Army Physical Fitness Test, rifle Sgt. Stacy Swayze, laboratory specialist, recognized the competition winners and all marksmanship qualification, day and night Aberdeen Proving Ground, Md.; the Soldiers who participated in the event. land navigation, Army warrior tasks and Sgt. Benjamin Taylor, behavioral health Brock congratulated all the competitors battle drills, a written exam and written specialist, Fort Hood, Texas. and said that this event had provided essay, and a mystery event. This consisted tough and realistic training. She said it of a 9-mm firing range, completion of an Soldier competitors also included: demonstrated the importance of Horoho’s obstacle course and a uniform inspection. Spc. Erik Eaton Performance Triad of Activity—which Members of the headquarters and 68K, USAMRICD, MRMC the competition provided in abundance; headquarters company at USAPHC and Spc. Kyle Biggs, animal care specialist, Nutrition—with the MREs Soldiers other USAPHC Soldiers spent several Fort Shafter, Hawaii; enjoyed in the field; and Sleep—which they weeks designing the course and setting Spc. Nelson Contreras, laboratory did not get in abundance during the event. up events for the competition. The specialist, Fort Riley, Kan.; Sienko quoted Horoho by saying the DENCOM, Northern Regional Medical Spc. Garrett Hetzel, dental specialist, winners should not allow this to be their Command and Medical Research Material Fort Campbell, Ky.; pinnacle of success. He said the competitors Command also provided Soldier support Spc. Michael Kerr, laboratory specialist, were the backbone of the Army and that during the event. Fort Bragg, N.C.; through this contest they had demonstrated Due to the sequester, MEDCOM had Spc. Connor Loehr, radiology specialist, their capability of supporting the Army. an extremely limited budget, and the Fort Polk, La.; Sienko praised the noncommissioned USAPHC was able to develop the course Pfc. Rafael Martinez, combat medic, officers and Soldiers, saying that the competition events within the budget. Fort Sam Houston, Texas; competition was not just a personal victory Brock commended the command for Pfc. Gyasi McKenzie, combat medic, but a victory for those with whom they will staying within the budget and developing a Katterbach, Germany; share their discipline and hard work within challenging competition. Pfc. Walter Schreiber, combat medic, the Army. Sienko and Brock presented Army Camp Stanley, Korea. Staff Sgt. Craig Wayman, MEDCOM’s Commendation Medals to Reynolds and

32 | ARMYMEDICINE.MIL RECOGNITIONS Congratulations To The Following Soldiers for Winning MEDCOM Best Warrior Competition: Sgt. 1st Class Ronnie Reynolds Spc. Erik Eaton 68W40, NCOA, AMEDDC&S 68K, USAMRICD, MRMC

Sgt. 1st Class Ronnie Spc. Erik Eaton, laboratory Reynolds, a combat medic specialist at the Medical at the U.S. Army Medical Research Institute of Department Center & Chemical Defense, School, Fort Sam Houston, Aberdeen Proving Ground, Texas, prepares to treat the Md., competes in the mock injuries of a Soldier Army Physical Fitness during Army warrior tasks Test section of the 2013 and battle drills section MEDCOM Best Warrior of the 2013 MEDCOM Competition. (Photo by Best Warrior Competition. Christina Graber, Visual (Photo by Christina Graber, Information Division, Visual Information Division, U.S. Army Public Health U.S. Army Public Health Command) Command)

“All the Soldiers were outstanding and represented their units and OUR AMEDD well!!!! The winners will represent the MEDCOM at the upcoming Army Best Warrior Competition at Fort Lee, VA in October 2013.” -Command Sgt. Maj. Donna A Brock

The following Soldiers were runners up: Sgt. Stacey Swayze Spc. Conner Loehr, 68KP9, USAMRICD, MRMC 68P, USAMEDDAC, FT. POLK, SRMC

I Am Army Strong—I Am MEDCOM’s Best I do this for—myself; my comrades; my unit; my leaders; Warrior to be the best; to be Army Strong.

I am—a combat medic; a behavioral health specialist; I am Serving to Heal … Honored to Serve! a laboratory specialist; a radiology specialist; a dental specialist; an animal care specialist; a veterinary food inspection specialist; an Army Medical Command Soldier.

I serve my country; I answer the call; I defend my country and its people; I am unique; I am a member of the team; I am part of a band of brothers and sisters; I fight for my country; I carry on tradition and history; I am proud; I am strong.

I test myself; I strive to be the best; I hone my strength and turn my weaknesses into strengths; I am challenged; I complete Soldier skills; I learn new ideas to share with my The U.S. Army Medical Command’s best warriors participated in the 2013 comrades; I set the example for other Soldiers; I learn from MEDCOM Best Warrior Competition held Aug. 19–23, at Aberdeen Proving the best; I enjoy a challenge; I am an example; I am the Ground, Md. (Photo by Christina Graber, Visual Information Division, U.S. Army future of the Army. Public Health Command)

33 | ARMYMEDICINE.MIL MEDCOM Team Profile Evidence-Based Practice Office Brings Best Practices to the Point of Care By Dr. Sara Pastoor, Clinical Capability Manager The Evidence-Based Practice (EBP) as diabetic meal plans and blood pressure disease and condition management, the Office at the Army’s Medical Command logs, are stored in a warehouse in San EBP office is the AMEDD lead agent for is a busy place, tucked into a basement Antonio and are available at no cost Population Health. Under the Population area of the MEDCOM headquarters to Army Medical Treatment Facilities. Health umbrella, numerous functions building at Joint Base San Antonio, Fort Many are also available free via internet have recently been brought to life as part Sam Houston. On any given day, seven download, and there are apps for mobile of the Patient Centered Medical Home Civilian staff can be found in the EBP devices currently in development. (PCMH) transformation, the evolution office hard at work supporting a variety of A unique and important feature of the and implementation of the Performance functions which have, over the past several VA/DoD CPGs is the use of algorithms to Based Adjustment Model (PBAM), and years of transformation to a System for aid clinicians with evidence-based decision the corporate culture shift from a health Health, become mission essential in Army support. These algorithms condense care system to a system for health. The Medicine. The relevance and importance the key scientific recommendations for EBP staff possesses impressive expertise in of the expertise in this tiny office of tightly condition management into charts and the areas of Healthcare Effectiveness Data packed cubicles has suddenly become flow diagrams which make evidence- and Information SET, case management, pivotal to the AMEDD’s success. based recommendations far easier to utilization management, disease Col. (Ret) Ernest Degenhardt is the consume than a text document hundreds management, and medical management, chief of the EBP office and expertly of pages long. However, a recent all of which are fundamental components manages his team as they support a variety partnership between the EBP office of the population health model of of high visibility projects. Some of the and the Triservice Workflow (TSWF) healthcare delivery. most important products of the office of Team has created the unprecedented Mr. Degenhardt sees evidence-based EBP are the VA/DoD Clinical Practice opportunity to insert these key scientific practice as the way ahead for the health Guidelines (CPG). Many don’t know it, recommendations into the workflow care industry and for the Army Medical but the Office of Evidence Based Practice of the outpatient clinics by leveraging Department, saying, “It supports the is the executive agent for the DOD in the the electronic medical record known as operating company model, saves money, Evidence-Based Work Group. This group AHLTA. The TSWF Team creates tools and imyproves outcomes.” has produced 24 CPGs on a variety of within AHLTA to help standardize and The Evidence-Based Practice office topics, with several new ones scheduled to optimize the documentation process of website is rich with resources which focus be released and several others scheduled to patient encounter notes. Through the use on evidence-based practice. Visit them be updated over the next year. According of these TSWF Tools (mainly Alternate at https://www.qmo.amedd.army.mil. to Degenhardt, the VA/DoD have been Input Method templates, or AIM forms), Customers may also contact the EBP recognized by industry professional many clinicians across the Military Health office via phone at 210-221-6527/DSN organizations as “some of the best CPGs in System now have evidence-based decision 471-6527. the world.” Moreover, the Evidence Based support available in an easily consumable Work Group has developed a platform format right at the point of care. As for interagency collaboration which is Degenhardt often says, “What we do in unsurpassed in the DOD. “All of our our office doesn’t matter if people don’t CPG’s are developed in close coordination use it.” He sees this partnership with with the VHA,” says Degenhardt. Each the TSWF Team as one of the most CPG is associated with tools for clinicians, remarkable breakthroughs of his career. patients, and Families. These tools, such In addition to the CPGs which focus on

34 | ARMYMEDICINE.MIL Technology & Research Operation Live Well Delivers First of Healthy E-Books

Operation Live Well wants to make Operation Live Well page on Health.mil cooking healthy, home-cooked meals to download and print your copy today. more affordable and easy for you. The Have you downloaded your copy of first downloadable e-book produced by the Operation Live Well recipe e-book Department of Defense’s wellness initiative yet? Go to: health.mil/Libraries/olw- went live today and features recipes for materials/2013_OLWRecipeEbook. a range of healthy dishes, from breakfast pdf?download=true items to soups, salads, vegetarian options Operation Live Well’s second e-book and desserts. There’s even a cooking is now LIVE on Health.mil. This edition Herb book glossary to explain kitchen terms to new is about growing and using fresh herbs in cooks. The e-book was an effort by the your meals and it also includes suggestions internal team to collect recipes they use for pairing herbs with your favorite dishes. with their own families and is designed DIRECT E-BOOK LINK: to help make the healthy choice easier for http://www.health.mil/Libraries/ the military community. All of the recipes olw-materials/201308_FINAL_ included in the e-book are dietitian- OLWHerbsEbook.pdf approved. Visit the nutrition section of the

Cook book

What is ‘Moving Forward?’

The Moving Forward training program several years is based on Problem-Solving Therapy and StartMovingForward.org can be used teaches skills for overcoming life problems. on a mobile tablet but is not optimized Its goals are to improve optimism, reduce for a smart phone. A companion mobile stress, improve emotional regulation, application, planned for release in early reduce avoidance and teach thoughtful, 2014, will provide quick, streamlined planful problem solving skills. It helps access to the training and tools of the web a person better understand their own course. problem-solving abilities and teaches new Moving Forward, a self-help web course skills to overcome the challenges of solving at www.StartMovingForward.org, is a things from daily nuisances to making joint development of the Department major decisions. of Defense and Veterans Affairs to teach The training program features first- skills for overcoming life problems. The person stories, video exercises, surveys and site, launched in November 2012, was resources to help anyone understand the designed for military service members,  importance of problem-solving skills. Veterans and their Families. The web course is based on a highly For more information about effective cognitive-behavioral treatment StartMovingForward.org, contact the program developed by Drs. Arthur and National Center for Telehealth and Christine Nezu and used successfully with Technology Public Affairs Office at Veterans across the country during the past [email protected].

35 | ARMYMEDICINE.MIL Serving To Heal...Honored To Serve