Volume 41, No. 8

A worldwide publication telling the Army Medicine Story ARMY MEDICINE MERCURY CONTENTS DEPARTMENTS FEATURE ARMY MEDICINE MERCURY US ARMY MEDICAL COMMAND ARMY MEDICINE PRIORITIES

Commander COMBAT CASUALTY CARE Lt. Gen. Patricia D. Horoho Army Medicine personnel, services, and doctrine that save Service Members’ and DOD Civilians’ lives and maintains their health in all operational environments. Director of Communications Col. Jerome L. Buller Chief, MEDCOM Public READINESS AND HEALTH OF THE FORCE Affairs Officer Army Medicine personnel and services that maintain, restore, and improve the Jaime Cavazos deployability, resiliency, and performance of Service Members. Editor Valecia L. Dunbar, D.M.

Graphic Designers READY & DEPLOYABLE MEDICAL FORCE Jennifer Donnelly Army Medicine (AMEDD) personnel who are professionally developed and resilient, Rebecca Westfall and with their units, are responsive in providing the highest level of healthcare in all operational environments.

The MERCURY is an authorized publication HEALTH OF FAMILIES AND RETIREES for members of the U.S. Army Medicine personnel and services that optimize the health and resiliency of Families Army Medical Department, published under the authority and Retirees. of AR 360-1. Contents are not necessarily official views of, or endorsed by, the U.S. SOCIAL MEDIA CENTER Government, Department of Defense, Department of the Army, or this command. FOLLOW US ON The MERCURY is published Army Medicine monthly by the Directorate of Communications, U.S. Army LTG Patricia D. Horoho Medical Command, 2748 CSM Donna A. Brock Worth Road Ste 11, JBSA Fort Sam Houston, TX 78234- 6011. BE CONNECTED ON Questions, comments Army Medicine or submissions for the MERCURY should be directed to the editor at SEE WHAT’S PLAYING ON 210-221-6722 (DSN 471-7), Army Medicine or by email; EXPLORE OUR PHOTOS ON Army Medicine The deadline is 25 days before the month of publication. Unless otherwise indicated, all photos are U.S. Army photos. START PINNING TODAY ON The MERCURY submission Army Medicine and style guide can be accessed JOIN THE CONVERSATION ON Army Medicine

3 | ARMYMEDICINE.MIL TSG SPEAKS! Surgeon General says Brain Health ‘New Frontier’ By Lisa Ferdinando, ARNEWS This article discusses key themes of the Army first place, he said. surgeon general’s remarks and others to the “I can remember this day almost as if Brain Health Consortium April 10-11, Defense it was yesterday. The light bulb went off,” Health Headquarters, Falls Church, Va. said Schoomaker, noting that was the start Brain health is the “new frontier” in of the Comprehensive Soldier and Family science, said Lt. Gen. Patricia D. Horoho Fitness program. as she kicked off a two-day consortium on Sleep, activity, nutrition, community the topic. relationships, and social interactions were Tapping into the full potential of the all areas that needed to be addressed for brain can have immense benefits for resiliency and fitness of the force, he said. Soldiers, their Families and the nation, The Army was looking at fusion said the Army’s surgeon general in of mind and body for the fitness and opening remarks of the Brain Health readiness of Soldiers and their Families, Consortium April 10 at the Defense he said. Health Headquarters. Good Leadership Key to Hardy Force “I think the brain fascinates us, and it’s Lt. Gen. Patricia D. Horoho Col. Shawn F. Kane, deputy command truly a unique organ,” Horoho said. She Disturbing Trend surgeon with the Army Special spoke before an audience that included Horoho’s predecessor, retired Lt. Gen. Operations Command, talked about a Soldiers, doctors, academics, and health Eric Schoomaker, said in his 30-plus years “hardy, resilient force.” industry experts. in the military there was “hardly a day” Relaxation, nutrition, and fitness The brain is the only organ in the when the country wasn’t in conflict. make a difference and make people more human body that has self-awareness, she Around the time he became the Army resilient and hardy, he said. There is said. It has evolved the ability to predict surgeon general in 2007, he said, he and “concrete evidence” backing that up. threats and act proactively. then-Chief of Staff of the Army Gen. “We all have the risks of serious physical “Ultimately, the decisions made by the George W. Casey talked about a trend injury, mental challenges, etc. in the line brain impact our overall health and also that was “quite disturbing” across the of work that our Soldiers do,” he said. our well-being,” Horoho said. “The brain, military, especially in the Army. “But by being a resilient and hardy force through our daily decisions, becomes the With multiple deployments that lasted you can take that opportunity and kind of gatekeeper of the health and fitness of our 12 to 15 months in length, and very little grow from it.” bodies.” rest time between deployments, Soldiers A healthy, motivated and successful The brain needs to be a central focus were becoming fatigued. The result of that population is one that doesn’t focus since better decisions made by the brain stress was showing up in war zones and on the “victim” role, being depressed, will lead to better health, she said. when the Soldiers returned home, he said. unmotivated or stressed, he said. To that end, Army Medicine has Contact with the enemy was higher As a whole, humans are highly resilient. initiated the Performance Triad program, in many respects than it had been in Otherwise, they would never have which promotes a three-fold approach previous wars; Soldiers were exposed to survived through time if they did not have to total health. That approach includes killings and deaths of both the enemy and the ability to bounce back. a focus on proper sleep, activity, and their battle buddies, he said. “Resilience is the most common nutrition, she said. Suicides rates increased; there were drug reaction to an event. As a people, we are Small changes in behavior done in and alcohol addiction problems, he said. very resilient,” he said. a consistent manner lead to improved Schoomaker briefed Casey on the many It cannot be stressed enough the role health, she said. A healthy, well-rested and Army programs to help Soldiers with their leadership has in promoting a healthy and well-fueled brain makes better decisions. problems. But that’s not what Casey was resilient force, Kane said. “At war, that equates to a combat interested in, he said. “Leadership will make any program advantage,” Horoho said. “In life, that Casey wanted to know what the Army succeed or fail,” he said. equates to a better you. It equates to a was doing to improve the well-being of “I think that is a key part of all of this better family, and it equates to a better Soldiers, strengthen the force and prevent ... that good leaders can help with the community.” Soldiers from entering this phase in the hardiness and the resilience of their force,” he said. 4 | ARMYMEDICINE.MIL AMEDD GLOBAL Center for the Intrepid is the Winner of the Army Medicine Wolf Pack Award The Center for the Intrepid (CFI) Their successful teaming approach at Brooke Army Medical Center is the supported the CFI mission of patient winner of the Army Medicine Wolf care, education and training, and Pack Award for the 2nd Quarter FY14. research. Since opening in 2007, the The Wolf Pack Award recognizes a Center has served over 1,000 individuals collaborative team effort by military with functional limb loss. This team’s and Department of the Army civilians, remarkable interaction and motivation and sometimes contractors, working resulted in “graduates,” from this together to make a significant comprehensive physical rehabilitation contribution to Army Medicine. For program, returning to active duty or

this quarter, the award recognized the retiring and successfully returning to The symbol of a broken ring, cracked but still talented, caring, and compassionate civilian life. Congratulations to Team intact, marks the entrance to the Center for the Intrepid, a 65,000 square foot rehabilitation team of professionals at CFI for their CFI for their dedication and exceptional center next to Brooke Army Medical Center in San phenomenal interdisciplinary teamwork. achievement! Antonio, Texas. (Photo by Daren Reehl) Army Medicine’s Brain Health Consortium Just a Beginning By Mike O’Toole, Army Medicine Public Affairs We have more than 70,000 thoughts a and Resiliency; Cognitive Performance; but achieves a state of mindfulness day. One person’s brain generates more Neuroplasticity; Mindfulness Training, with a “diminishing emotionality” electrical impulses each day than all the the Human Dimension Program and better suited to deal with uncertainty. telephones in the world combined. more. Other participants defined desired Army Medicine has taken a major Within the presentations, perhaps the outcomes as “hardiness” and “grit.” By first step in partnering with academia, greatest challenges were the expectations the symposium’s end, however, there the healthcare industry and a variety of sought by a pair of battle-tested combat was general agreement that a definition thought leaders to better understand leaders: TRADOC Commander Gen. of “brain health” was elusive for the brain health for Soldiers, the Army David Perkins and 4th ID 1st Brigade moment, pending additional discussions Family, and society as a whole. Commander Col. Dave Hodne. Perkins, and research. Lt. Gen. Patricia Horoho, the Army defining his command as the “architects” Lt. Gen. (ret.) Eric Schoomaker, surgeon general and commanding of the Army, called the brains of its former Army surgeon general, echoed general, U.S. Army Medical Command, Soldiers the ultimate weapon: “We are the combat commanders’ call for their hosted the inaugural Brain Health banking on our cognitive capability.” Soldiers to be given a “new set of Consortium April 10-11, at Defense Hodne spoke of the long-held ethos tools to make judgments,” capable of Health Headquarters, Falls Church, Va. of “sleep as a crutch” disappearing due “attentiveness, tolerant of uncertainty, Military professionals, researchers in to evidence showing its lack not only agility and flexibility.” Schoomaker asked neurology, neuroscience, psychiatry and undermines resilience, but exacerbates how the Army could achieve that: “We psychology, and other clinical and public conditions like post traumatic stress are a requirements-based Army. The big health experts converged and engaged and suicidal ideation. Both combat challenge is taking a range of trainings in challenging, spirited discussions on commanders stressed mind fitness “to that can be done to impact the brain ways to define and improve brain health. reinforce strategic leadership and address and translate that into practical solutions The consortium sets the stage for all of organizational uncertainty.” for an Army that demands specific us, our Soldiers, our spouses, and our The question was raised: “What is requirements.” children to optimize how we think in brain health and how does it relate One of the civilian participants order to make the very best decisions to military performance?” Some proposed a “BFT -- brain fitness test,” possible. symposium participants defined a which other participants likened to In keeping with the event’s theme, healthy brain as one that could optimize an existing psychomotor vigilance “Brain Health: Partnering to Explore the its dynamic range in its ability to test, administered at different levels New Frontier,” subject matter experts’ adapt to any challenge presented to it, to different skill groups, and with presentations, panel discussions, and especially the unknown. One participant competition fostered to excel at the test, breakout sessions explored such topics as ventured that a healthy brain, as seen with time off as a possible incentive. Performance Triad (Sleep, Activity and in refinement and efficiency measured Nutrition) and Brain Health; Readiness in sports performance, “is not noisy,”

5 | ARMYMEDICINE.MIL AMEDD GLOBAL Brain Health Consortium

Another participant referenced the organizational psychologists, because TRADOC commander’s call for training implementing any activity institution- that shows “how to adapt to unusual wide is as much as “training issue” as it is situations,” then asked “are we funding a health issue. the right research?” “We can share what we started here,” Other participants also believed a Horoho said in her closing remarks. brain health index for Soldiers and The surgeon general recounted the story Families would potentially be useful. of Sgt. Brandon Marrocco, who, after They added that elements used to losing all of his limbs from a roadside Brig. Gen. Pat Sargent, deputy chief of staff define brain health include: measures G-3/5/7, U.S. Army Medical Command, speaks at a bombing in Iraq, underwent a successful of cognition; effects of sleep quality Brain Health Consortium panel at the Office of the double arm transplant. Someone had a Army Surgeon General in Falls Church, Va., Apr. 10, and duration, nutrition, and substance 2014. (U.S. Army photo by David Vergun) “vision” over 15 years ago challenging abuse; measures of mood and the role what is possible that made such a brief their senior leaders as part of their of social connectedness. They called for medical milestone a reality. Horoho mission analysis; creation of reparative the development of biomarkers to assess asserted to the participants: “Now we gaming/technology like ‘HALO’ for brain health. are at a similar precipice, we need to Soldiers’ use and as a way to incentivize Recommendations posed by be asking the questions and finding and earn promotion points for participants include: Having TRADOC answers to something that could make completing Performance Triad training. make the Performance Triad a part of a difference 15-20 years from now. I’m Schoomaker and others called for regular Army training doctrine, with hoping this is only the beginning.” more consultation from educators and subordinate commanders required to Nursing Students from the University of Japan Visit Tripler By Spc. Paxton Busch, Pacific Regional Medical Command Tripler Army Medical Center hosted 84 nursing students from the University of Japan for a learning experience with American civilian and military nurses on March 25. The guests received a tour of Tripler, a mission brief and visited Labor and Delivery, Intensive Care Unit, Emergency Department, and the Directorate of Hospital Education Training (DOHET) where they watched a training simulation. “After being introduced to the simulator they are able to listen to heartbeats and lung sounds. They are able to see everything we can do with Students from the University of Japan examine a simulation patient during the first stop of their tour at Tripler a patient and I show them how the Army Medical Center in March. (U.S. Army photo by Spc. Paxton Busch, PRMC) simulator works,” says Teah Karamath, nurse educator at Tripler. come here and watch us and see what first toured Tripler in 2010 and have Karamath hopes that the students are we do,” said Karamath. It is also good returned every year because of their able to take away how the hospital is to be transparent in our medical care so positive experience. passionate about patient care and the that they can take something back with The students made a financial donation friendliness of staff. them and hopefully utilize what they’ve to the Fisher House to support the “I really think the tour is significant learned. facility’s mission and to show their because for one, the Japanese medical Karamath says the university students gratitude to the hospital. community finds it very exciting to

6 | ARMYMEDICINE.MIL AMEDD GLOBAL Army Medicine’s Secure Healthcare Messaging Fielding Near Completion By Kirk Frady, Army Medicine Public Affairs As of March 1, more than 234,000 their treatment facility network.” providers and more than 17,500 primary Army Medicine healthcare beneficiaries Many MTFs have been using care team members using the system. and almost 3,000 Army providers have creative marketing ideas to inform their The civilian healthcare sector is also signed up for the Army Medicine Secure beneficiaries about the AMSMS and the moving towards offering more patient Messaging Service (AMSMS). AMSMS many reasons why they should be using portals since this service will assist their allows patients and providers dispersed it. Clinics have been placing posters at beneficiaries in making smarter non- across 52 military treatment facilities facilities and updating their waiting room urgent care decisions rather than sitting (MTF) worldwide to communicate on videos to include AMSMS information. in a waiting room or going to an urgent a secure network regarding non-urgent Although many MTF’s AMSMS care facility. healthcare concerns. programs had not been up and running Newton said, “The AMSMS is an The AMSMS network also allows until recently, a few locations currently easy to use secure communication tool beneficiaries to view their electronic leading in participation are Fox Army that has the potential to significantly personal healthcare record, request Health Center, Lyster Army Health impact care to beneficiaries by engaging appointments, request medication refills Clinic, Keller Army Community them in convenient ways and times to or renewals, as well as allow providers to Hospital, and Dunham Army Health build relationships, improve access to push important preventative care updates Clinic. Many of the practices have over information, and reduce the need for so to their patients. 60 percent of their beneficiaries using the many visits to their primary care clinic.” Overall, Soldiers, their Families, and AMSMS. He added, “Secure messaging is a critical beneficiaries using the AMSMS can “These MTFs have had the support tool in helping Army Medicine to achieve expect a decrease in trips to the Military of their leadership and are utilizing high the Quadruple Aim of; improving Treatment Facilities (MTFs) and more performing teams to make their practices the patient’s experience, improving personal communication with their more team-based and patient-centered population health and readiness while healthcare team. through the robust use of tools such as reducing per capita costs.” According to Dr. Terry Newton, M.D., the AMSMS,” said Newton. A recent secure messaging satisfaction information technology clinical capability How does AMSMS compare with survey demonstrated that 97 percent of manager, “Army Medicine issued nearly others? over 12,000 survey respondents were 3,000 AMSMS licenses to healthcare Although they use a different name satisfied with their secure messaging providers during Phases I and Phase II for their secure messaging system, both transaction and more than 86 percent in 2012 and 2013.” He added, “Over the Air Force and Navy have made agreed it helped them avoid a trip to the next six months, we will complete considerable progress signing up users. an emergency room or an MTF for a deployment of over 1,000 additional Both sister Services have roughly 573,000 medical problem. licenses to primary and specialty care users combined now enrolled, as of To find out more about AMSMS ask clinics. Similarly, the other branches of March 1. This joint venture has more your healthcare team during your next military service are also executing the than 850,000 combined users through visit. Click here to view a video about same secure messaging capability across all services, as well as roughly 7,600 secure messaging: dvidshub.net/r/2heb7z

7 | ARMYMEDICINE.MIL AMEDD GLOBAL DTHC Renames “Fit To Win” in Former Commander’s Honor By DiLorenzo TRICARE Health Clinic Marketing Office It is said that Dr. (Col.) D. Kenneth only secured the resources needed for good fortune of having a bigger-than- Block’s spirit flows through the halls the operation of a world class health life person who was the ‘wind beneath of the DiLorenzo TRICARE Health promotion program, but allowed Fit our wings’.” Clinic at the Pentagon. As the former To Win to grow to become more commander, he impacted the clinic relevant and valuable to the Pentagon greatly, specifically the Fit To Win community from one year to another,” Wellness Program. Jacobs said. A March 27 ceremony held in Block’s The renaming ceremony came honor renamed the program the “D. after a two-year process of proposals Kenneth Block Pentagon Fit To Win in which Fit To Win and DTHC Wellness Center” ensuring his good leadership fought to honor Block’s nature, professionalism, and spirit accomplishments and support to the continues on. program. Mark Jacobs, chief of Fit To Win The ceremony came after 27 years spoke to a crowd of the honoree’s friends of success from Fit To Win and aimed and family taking them on a journey at celebrating the program’s growth, Dr. (Col.) Joseph Pina, DiLorenzo TRICARE through the program’s growth with triumphs, and special events that could Health Clinic director, and Cindy Block, wife of Dr. D. Kenneth Block who was the clinic’s Block’s support. not have been possible without the former commander, cut the ribbon marking the “First as commander of the Pentagon support of the honoree. official renaming of the D. Kenneth Block Fit To Win Wellness Center March 27 in the clinic. The Military Health Clinic from 1994 to “We are stronger, more relevant, and red ribbon was cut using the same scissors her 2000 and then as commander of DTHC with a larger participant population husband used at the official groundbreaking of the DiLorenzo TRICARE Health Clinic 14 years earlier. from 2002 to 2012, Dr. Block not than ever,” Jacobs said. “Thanks to our MRICD Explores Collaborative Research Opportunities with Allied Labs By Cindy Kronman, USAMRICD Information Management Office This winter, the U.S. Army Medical IIBR’s new general director, Professor scientists to discuss research in the Research Institute of Chemical Defense Shmuel Shapira, Esther Krasner, chief development of several chemical agent (USAMRICD) hosted separate visits scientist in the Office of the Assistant and neurotoxin medical countermeasures from representatives of the Swedish to the Minister of Defense, and Gideon to include bioscavengers, Defense Research Agency (FOI) Meretz from International Cooperation, neuroprotectants, and reactivators. They and the Israel Institute of Biological Office of the Assistant Minister of also received a tour of the USAMRICD’s Research (IIBR) to discuss common Defense for Chemical Biological nearly completed replacement facility. research interests and potential areas of Radiological and Nuclear (CBRN) collaboration. Defense, met with senior USAMRICD Discussions with the Swedish delegation, which included Dr. Anders Bucht, the research director of FOI, Göran Olofsson, director of engineering, and senior scientists Dr. Lina Thors and Dr. Fredrik Ekström, focused on the use of Raman spectroscopy for a number of defense research applications and identification of better reactivators of the enzyme acetylcholinesterase (AChE) to improve protection against chemical nerve agents. Included in the discussions USAMRICD staff and scientists with the Swedish visitors: Back row (left to right): Lt. Col. Kevin Pitzer, Dr. were presentations by scientists from James Dillman, Mr. Richard Sweeney, Dr. Ernest Braue, Dr. Todd Myers, Dr. Irwin Koplovitz, and Col. Bruce both organizations on current research Schoneboom. Front row (from the left), Dr. John McDonough, Mr. Goran Olofsson, Dr. Fredrik Ekstrom, Dr. Lina Thors, Dr. Anders Bucht, Dr. Tsung-Ming Shih, and Dr. Robert Kan. (U.S. Army photo by Darrell Jesonis, efforts. USAMRICD)

8 | ARMYMEDICINE.MIL AMEDD GLOBAL FEATURE National Mental Health Awareness Month By Army Medicine Public Affairs Congress has designated the month of May as National Mental Health Awareness Month. Since 1949, the activities associated with National Mental Health Awareness Month have increased public awareness of behavioral health (BH) issues and the reality of BH illness. Each year the Army leans forward with various organizations, community groups, Families and well-being of Soldiers Families, and the realignment of existing BH individuals across the country in this Civilians. During National Mental programs, integrating them into 11 public campaign to raise awareness, Health Awareness Month the Army clinical programs under a Department promote prevention, early detection takes this opportunity to further of BH, which establishes true program and treatment for BH diagnosis such provide education and awareness on BH standardization with full operating as depression, post-traumatic stress diagnoses and symptoms and get the capability for the BHSL scheduled disorder (PTSD), and a host of other word out about the array of BH services, to occur no later than FY16. The BH diagnoses impacting Soldiers, programs and new initiatives available Army built and staffed EBH clinics Families, Veterans, and Civilians. This to support Soldiers, Families, and and now has 44 established across the year the Army’s theme is “Let’s TALK Civilians in garrison and operational force. EBH has been associated with about it.” The Army is determined to environments who may benefit from statistically significant decreases in decrease stigma and get help to those seeking help for BH challenges. suicide attempts and hospitalizations who need it, by encouraging leaders, The U.S. Army Medical Department as well as improvements in other key Soldiers, Families, Civilians and (AMEDD) is transforming from a measures of Soldier health and safety. communities to start talking, engaging, “healthcare system” to a “System for In FY13, for the first time in the recent taking personal responsibility, learn Health.” The BH component of this past, the rates of hospitalizations for appropriate interventions, and build safe effort is known as the Behavioral acute psychiatric issues and suicide and supportive communities where help Health Service Line (BHSL). The decreased. The Army believes this can be sought out and received by those BHSL, standardizes delivery of decrease indicates that Soldiers are who need it. behavioral healthcare across the Army receiving care earlier so that their Behavioral healthcare is an important to identify, prevent, treat, and track conditions do not progress to the point factor in the readiness of the Army. BH health issues affecting Soldiers of crisis. According to Army data systems, 8 and beneficiaries. The service line The Army is taking aggressive and percent of deployed Soldiers have implements enterprise standards to offer far reaching steps to remove stigma received a diagnosis of PTSD. Military Soldiers and Families a uniform care associated with seeking behavioral research shows that approximately experience at all locations. Through the healthcare and ensure that an array of 15 percent of Soldiers deployed BHSL consistent and ready access to BH BH services are available to Soldiers during Operation Iraqi Freedom have services will be provided throughout the and their Families dealing with BH symptoms of PTSD, and another Soldier Life Cycle (initial entry through diagnoses and symptoms. The increase 10-15 percent will experience other transition). The BHSL places emphasis in behavioral health related encounters BH problems that could benefit on education, screening, and treatment suggest that more Soldiers are seeking from treatment. The number of BH and includes programs such as the care earlier and stigma associated encounters across the Army increased Embedded Behavioral Health (EBH), with seeking behavioral healthcare from 991,655 in FY07 to 1,899,660 in Patient Centered Medical Homes, and is decreasing through establishment FY13; a 91.5 percent increase, reports School Behavioral Health that reach of innovative efforts, expansion of Cmdr. Kathleen Watkins, chief of Soldiers and Families where they are validated programs, and improved access policy development, Behavioral Health located to improve access to care and to care in close proximity to Soldiers Division, Office of the Surgeon General. reduce perceived stigma associated with and Families. The Army is committed to seeking behavioral healthcare. strengthening the BH and overall In FY13, the AMEDD completed

9 | ARMYMEDICINE.MIL AMEDD GLOBAL FDA Approval Clinical Trial Underway for CRI By Steven Galvan, USAISR Public Affairs Officer Researchers at the U.S. Army Institute compensate to maintain a constant blood blood going out into the vessels. of Surgical Research (USAISR) at Joint pressure when there’s internal bleeding,” “Each time the heart pumps, a pulse Base San Antonio-Fort Sam Houston, he said. “The blood pressure can seem of blood creates an arterial pressure Texas, are conducting a clinical trial on stable, but the patient can be losing wave that is actually made up of two the Compensatory Reserve Index (CRI) their ability to continue to compensate. waveforms,” he said. “The first waveform to gather data for submission to the When the patient gets to the end of their called the ejected wave is caused by the Food and Drug Administration (FDA) compensation, their blood pressure falls blood leaving the heart, and the second for 510(K) clearance. The FDA uses rapidly, referred by some as ‘falling off a wave called the ‘reflected’ wave is caused the 510(K) premarket submission to cliff,’ and now they are in shock.” by the blood being reflected off the ensure that a medical device is safe for That’s because medics, corpsmen, and arteries back to the heart. These events use on patients and can then be made happen so quickly that the two pressure commercially available. waves are merged so they look like a The tactical combat casualty care single waveform. research task area team led by Victor “So with newly advanced computer A. Convertino, Ph.D., will use a lower technologies, we now have the capability body negative pressure (LBNP) chamber to measure features of each arterial during the clinical trial to gather the waveform that reflect the sum of all data. Research participants are placed in mechanisms of compensation that affect the LBNP chamber which draws their the heart (ejected wave) and the arteries blood to their lower bodies. (reflected wave),” said Convertino. “We “It’s a way of ‘bleeding’ someone call this measurement the ‘compensatory’ Drs. Victor Convertino and Carmen Hinojosa- without taking a drop of blood,” said Laborde place the Compensatory Reserve Index reserve. Convertino. (CSI) and other monitoring equipment on a “If you’re monitoring blood pressure The CRI was developed by Convertino research participant’s fingers for a clinical trial in a in a patient with internal bleeding, you lower body negative pressure chamber. in collaboration with colleagues at the may not notice the problem because the University of Colorado, Children’s body is compensating for the blood loss,” Hospital Denver, and Flashback emergency medical service providers he said. “The algorithm can gauge how Technologies Inc. It uses an algorithm have traditionally been trained to watch much the body is compensating and how that is designed to take information from patient’s blood pressure. With this new much the body has left to compensate.” a patient using a non-invasive finger technology they will get a better idea of Convertino said that this technology pulse oximeter and gauges whether how the body is naturally compensating is so new that they really have to immediate medical attention is needed and when a patient is in danger of going demonstrate that it works. even though the patient may seem alert into shock. “No one has done this before, but and responsive. In order to measure a patient’s reserve we’re pretty confident that we can meet “That’s because the human body has to compensate, Convertino focused on FDA requirements,” he said. many physiological mechanisms that an arterial waveform that is created by “Caring for Military Families” Event Former Senator Elizabeth Dole (R- recently published. The study estimates NC) greets Brig. Gen. Norvell Coots, that there are 5.5 million military U.S. Army assistant surgeon general for caregivers in the U.S.; it describes who force protection at a “Caring for Military they are, “the burden of care they bear, Families” event in Washington D.C., their support needs, the constellation of April 1. The Elizabeth Dole Foundation, programs and other resources that exist which “seeks to uplift American military to support them, and the areas where caregivers,” commissioned a study by the additional support is needed.” Rand Corporation whose findings were

10 | ARMYMEDICINE.MIL Military Health System Enters Colorado’s Health Information Exchange The new engagement will be invisible to beneficiaries but the benefits may save lives By USA MEDDAC-Fort Carson Public Affairs

The recently established Defense system. Thirty-five of the top 50 care provided to our beneficiaries, and Health Agency’s Colorado Springs TRICARE network healthcare providers the quality of follow up and future care.” Military Health System has entered used by Colorado Springs’ TRICARE The second phase starts when military the state’s health information exchange enrolled beneficiaries are participating. treatment facilities fully interact with the (HIE) which is a formal way to improve The first phase allows military medical HIE system. Those same participating medical information flow between providers to quickly access TRICARE community and state-wide providers will military and civilian providers. beneficiaries’ network clinical results. have access to TRICARE beneficiaries’ Evans Army Community Hospital “Patients referred to a CORHIO community health records, to include and the medical clinics at the United participating civilian provider or facility demographic information, lab/ States Air Force Academy, Peterson, will have results in the HIE system pathology, radiological and transcribed and Schriever Air Force bases will be without requiring a separate fax or follow reports, medical and medication able to share electronic health data up phone call,” said Lt. Col. Francisco C. history, immunizations, and past with all hospitals in the local Colorado Dominicci, the CSMHS’s chief medical hospitalizations. The system will notify Springs region, all hospitals in the state information officer. “Results should be the network providers that their patient with greater than 100 inpatient beds, available by the time patients return to is a TRICARE beneficiary and for the all major laboratories in the state, and their military healthcare providers.” first time, they will be able to access their more than 460 office-based healthcare This simplified access to patients’ medical information. providers in Colorado’s El Paso & Teller health information will eliminate “Having this information readily Counties. redundant appointments, opening available to participating providers and “This partnership will improve more military healthcare facilities medical facilities will improve healthcare care quality and coordination while appointments. Additionally, nurses who for our TRICARE beneficiaries,” said reducing costs in the TRICARE provider currently need to track down clinical LeMaster. “Without delay, these network,” said Col. Timothy D. Ballard, results also will be freed to focus more on providers will have each patient’s most the Colorado Springs Military Health preventive care. complete and up-to-date medical System’s director. “It will reduce “Using the HIE system, nurse case information available to them, so they redundant diagnostic exams and labs, managers and Patient Centered Medical can make better informed diagnosis and eliminate barriers to care for community Home healthcare teams will be able to decisions.” referrals, reduce the workload on records follow up more quickly and improve To protect personal health sections in tracking referral reports, and patient interaction,” said Col. Dennis information, the HIE system operates provides us near real-time visibility of P. LeMaster, commander U.S. Army in a secure environment, only allowing beneficiaries using civilian facilities.” Medical Department Activity-Fort access to providers who have a need The nonprofit, public-private Carson and Evans Army Community to know. All access to a patient’s partnership agency providing this Hospital. “We send many pediatric information is logged and the requestor capability is the Colorado Regional and adult long-term complicated care identified. Monitors review access Health Information Organization. patients to Denver hospitals. Having records to ensure only authorized CORHIO has been able to connect visibility of those records will help case providers are accessing patients’ 23 disparate types of electronic health management and primary care manager information. record systems and the military health teams increase the awareness of medical

11 | ARMYMEDICINE.MIL Military Health System

“We are confident the HIE security redundant laboratory tests by up to 49 technological solution to electronic features will protect our beneficiaries’ percent. Other studies reported that medical record interoperability,” said personal information,” said Dominicci. emergency department use of HIEs Ballard. “The HIE will not only improve HIE systems research by the Agency improved access to patient information. care delivered to beneficiaries, it will for Healthcare Research and Quality This ultimately reduced the number improve community partnerships, supports what healthcare providers have of medical facility admissions and the simplify our business processes and long known: sharing health records overall cost of ED visits by an average of practices, saving money; it’s a win-win benefits patients by reducing exposure $29 compared to a control group. situation for everyone involved.” to radiological imaging, reducing “This is a tremendous opportunity… unnecessary admissions, and eliminating employing an HIE system is a low-cost National Nurses Week: May 6-12, 2014 By Dr. Valecia L. Dunbar, Army Medicine Public Affairs National Nurses Week will be Team. Our officer, civilian, and enlisted celebrated from May 6 - 12, and the service member’s dedication and theme for 2014 is “Nurses Leading the commitment to care for America’s sons Way...” Additionally, International and daughters represent the best of the Nurses Day is celebrated around the nursing profession. world on May 12th of each year. Efforts to recognize the role of nurses Army Medicine asks that we join in in our nation’s healthcare system began celebrating the men and women who in 1982, when the American Nursing serve this country by caring for its Association (ANA) Board of Directors citizens and recognize the dedication, formally acknowledged May 6, 1982, contributions, and selfless service of the as “National Nurses Day.” In 1993 the more than 40,000 Army nurses who The U.S. Army Nurse Corps (ANC) was established ANA board designated May 6 - 12 as commit themselves to the care of our in 1901 as a permanent corps within the U.S. Army lasting dates to observe National Nurses Medical Department because of legislation passed wounded, ill, and injured, and their due to the efforts of Dr. Anita Newcomb McGee Week which culminates on the birthday Families. and advocates for a professional nursing element of Florence Nightingale. Read more As patient advocates, guided by their within the U.S. Army. about the history and view archival core values, Army Nurses demonstrate opportunity to reflect on the photos at: army.mil/article/124742/ daily that patients come first. nursing profession and recognize the National Nurses Week is a great contributions of our Army Nursing May is Better Hearing and Speech Month! This annual event provides quality of life for those who experience opportunities to raise awareness about problems with speaking, understanding, communication disorders and to or hearing. Learn more at: http://www. promote treatment that can improve the asha.org/bhsm/

12 | ARMYMEDICINE.MIL National Physical Fitness and Sports Month By Army Medicine Public Affairs May is designated National Physical includes Sleep, Activity, and Nutrition costs. Fitness and Sports Month to raise which supports the Army’s Ready and To achieve substantial health benefits, awareness about the important role Resilient Campaign Plan. guidelines recommend that adults physical activity plays in maintaining The strength of the Army is its Soldier perform at least 150 minutes a week of health. According to the 2008 Physical – personal performance directly impacts moderate-intensity aerobic activity, or 75 Activity Guidelines for Americans, a unit’s readiness. Musculoskeletal minutes per week of vigorous-intensity physical activity can help control weight, injury was the number one leading cause aerobic activity, or an equivalent improve mental health, and lower the of medical evacuations during 2002- combination of moderate- and risk for early death, heart disease, type-2 2010 and the second leading cause of vigorous-intensity aerobic activities. The diabetes, and some cancers. Physical hospitalizations, resulting in 10 million guidelines also recommend including activity also can improve cardiovascular limited duty days per year. muscle-strengthening activities that and muscular fitness. In 2011, however, Regular exercise and physical activity involve all major muscle groups on two only one in five U.S. adults participated can lead to long-term health benefits, or more days a week. in enough physical activity to gain reduce ones risk for many chronic Additional information about physical substantial health benefits. diseases such as depression, diabetes, activity and resources for increasing National Physical Fitness and Sports heart disease, high blood pressure, participation in physical activity are Month advances Army Medicine’s obesity, stroke, and some forms of available at health.gov/paguidelines and Performance Triad initiative which cancer. And, it helps to reduce healthcare http://www.cdc.gov/physicalactivity. National Women’s Health Month National Women’s Health Month is about taking steps to improve your physical Visit a healthcare professional to receive celebrated in May and is an opportunity and mental health: regular checkups and preventive screenings; to educate and increase awareness of a get active; eat healthy; pay attention to wide range of Women’s Health programs mental health, including getting enough and initiatives aimed at improving the sleep and managing stress; and avoid Lifespace of Army women. The objective unhealthy behaviors, such as smoking, is to educate female Soldiers, spouses, and texting while driving, and not wearing a other beneficiaries about the resources and seatbelt or bicycle helmet. programs available in Army Medicine that Army Medicine is committed to make women’s health a top priority. preserving the health and viability of our Additionally, National Women’s female and is actively engaging current Health Week is an observance led by the issues in order to ensure the highest U.S. Department of Health and Human standards in healthcare for all beneficiaries Services Office on Women’s Health. The regardless of gender. goal is to empower women to make their Throughout May, MEDCOM health a priority. National Women’s Health facilities and Medical Treatment Facilities Week also serves as a time to help women (MTFs) will participate in presentations understand what it means to be well. and briefings, at health fairs, town hall What does it mean to be a well woman? meetings, and community events to raise It’s a state of mind. It’s being as healthy awareness about Women’s Health issues. as you can be. And, most importantly, it’s For more, visit: army.mil/article/102516/

13 | ARMYMEDICINE.MIL Breast-feeding Support Group Celebrates Support to Mothers, Healthy Babies By Keller Army Community Hospital Public Affairs

The West Point Breastfeeding Support Group (BSG) celebrated its one- year anniversary with a “play date” at the post’s community service center. Mothers and their babies who have participated in the group assembled to express their appreciation for the support and valued resources available through the group. “All new mothers are informed of the benefits of breastfeeding – from bonding and the health benefits to the cost savings for both baby and mom,” said Capt. Bridget Owens, Keller Army Community Hospital The West Point Breastfeeding Support Group (BSG) celebrated its one-year anniversary with a “play date” dietitian. “However, the reality is that at the post’s community service center. Standing (L to R): Shelly Ariosto, Lisa Pokorny, Capt. Bridget Owens, Maj. Vickie Schnackel, Nina Wilson, Jane Dorsch, Col. Llyonetta Artis Sitting (L to R): Doris Fanyui, breastfeeding is not as easy as it seems.” Stephanie Forlenza, Molly MacCalman, Sarah Gray, and Anna Prince. (U.S. Army photo by Britney Walker, The importance of mothers exclusively Keller ACH) breastfeeding their infants for the first six concerns and child development. know that I was not alone. The advice months is recognized by both the World There is also a question and answer and support that is provided with this Health Organization and the American forum for participants to share current group is extremely helpful.” Academy of Pediatrics. However, the breastfeeding concerns and suggest best According to many participating Center for Disease Control states that in practices. mothers there, the group addressed and the United States, 75 percent of babies According to Owens, four women with relieved anxieties and answered a number start out being breastfed with only 15 babies in tow attended the first meeting. of questions they may have been too percent continuing to be exclusively After word spread, a total of 13 moms embarrassed to ask in other forums. breastfed for the first six months. and their babies came to the next group “This group was a great help right Data from the West Point session just two weeks later. after I had my son. I am a first time Breastfeeding Support Group exceeds There were babies as young as five days mom and had a lot of uncertainties,” these goals with over 80 percent old at the second group session. Some said Alicia Hartman, group participant. of mothers who attend the group mothers moved from supplementing “I ran into problems the first couple of exclusively breastfeeding their infants for feedings with formula due to poor infant weeks breastfeeding. This group provided at least six months. weight gain and supply concerns, to relevant information and support that The group’s primary purpose is to exclusively breastfeeding just a few weeks led me to still be breastfeeding today.” provide professional nutrition and later, she added. It has been a truly fulfilling experience lactation support for moms and babies “I really struggled with breastfeeding to organize and offer such an important in the local area. Meetings are held with my first born. I felt very alone and service to promote the importance of every other Tuesday and Thursday for 90 overwhelmed,” said Tera Quink, support breastfeeding and ensure that mothers minutes during lunchtime. During each group participant. “The group started who choose to breastfeed are successful, session, the group discusses hot topics when my baby was about four months stated Owens. of interest such as: nutrition, growth old. It was such a pleasure to be able to and development, sleep, pediatrician meet with other breastfeeding moms and 14 | ARMYMEDICINE.MIL SYSTEM FOR HEALTH.

Commanding General Observes Medical Services Progress for Soldiers By Blanchfield Army Community Hospital Public Affairs Before the 101st Airborne Division and Fort Campbell Commander General Maj. Gen. James C. McConville led the Screaming Eagles to assume responsibility of the combined joint task force in eastern Afghanistan in March 2013, McConville encour- aged the Fort Campbell hospital leadership to continue to expand services for Soldiers with behavioral health concerns and brain injuries. McConville returned to Blanchfield Army Community Hospital services recently to see the progress and expansions made a year later. McConville walked through the construction of the Fort Campbell National Intrep- id Center of Excellence Satellite, observing the progress to expand treatment capabili- ties for traumatic brain injury and post-traumatic stress. 101st Airborne Division and Fort Campbell Com- mander Maj. Gen. James C. McConville asks lead “I think this is very important because it’s making sure our Soldiers get world-class psychiatrist for the 3rd Brigade Combat Team Em- care and this center is going to provide that type of care,” said McConville. bedded Behavioral Health Clinic Capt. Michelle McConville was pleased to see the behavioral health support now offered within each Hornbaker-Park questions about the services offered within the facility March 31. Before deploying to Af- brigade combat team’s footprint. ghanistan, McConville was eager to see embedded “We want to have the care right where the Soldiers are, being in close proximity to behavioral health facilities within each brigade com- where the Soldiers work makes it much more available so they will actually use the bat team footprint. care,” said McConville. As the 101st Airborne Division and Fort Campbell commander, McConville is proud to be a part of this community. “I think we’re very blessed to be in the 101st Airborne Division and serve at Fort Campbell. We have fabulous Soldiers and a wonderful community that supports us in every way they can and really the support that the medical personnel give our Soldiers is just world class.” Nashville Country Music Artist Jamie Tate Plays an Intimate Show for Military Families Nashville country music artist Jamie Tate plays an intimate show for the Families of wounded, ill, and injured Soldiers at the Fort Campbell Fisher House March 31. “I like to play at the Fisher House to give back to the Families,” said Tate. “I find that the Families are a really big support system.” The Fisher House is a home away from home for Families of patients receiving medical care at Blanchfield Army Community Hospital. (U.S. Army photo by Sgt. Eric Lieber/RELEASED)

15 | ARMYMEDICINE.MIL SYSTEM FOR HEALTH.

10,000 Steps Per Day - March Madness Army Medical Command’s (MEDCOM) Performance Triad guidelines determine that at least 10,000 steps per day -- approxi- mately five miles -- are a suitable activity benchmark. On April 4, much of the staff at the Office of the Surgeon General (OTSG) headquarters in Falls Church, Va., got in “part of your activity today, a mile and half,” said Maj. Gen. Brian Lein, Army deputy surgeon general. This event’s theme was “March Madness,” paying homage to the college basketball tournaments going on during its original scheduling, which was postponed once due to most unseasonal snowy weather. Participants sported sweatshirts, tees, and team mascot hats paying homage to their college loyalties. This is the second such event at OTSG headquarters. Last December it was inaugurated as the “Jingle Walk” in keeping with the holiday spirit of the season, with participants attired in reindeer antlers and Santa hats atop their physical training (PT) gear. (U.S. Army photo by Mike O’Toole) Read the full article at: http://www.army.mil/ article/123374/ Wounded Warriors Climb to New Heights The Kilimanjaro Warriors celebrate reaching the summit of East Africa’s Mount Kilimanjaro, the tallest free-standing mountain in the world stretching 19,340 feet above sea level. The team of wounded service members and veterans reached the summit on the seventh day of their journey, Feb 15. Among the members of Team Kilimanjaro reaching the summit are Steve Martin, Marine Veteran Erich Ellis, retired Air Force Lt. Col. Steve Connolly, Air Force Capt. Sarah Evans, Air Force Capt. Joseph Evans, and Mark Heniser, a physical therapist with the Center for the Intrepid, Brooke Army Medical Center. (Courtesy photo by Bevan Bell) For more photos visit: http://www. army.mil/article/122707/

16 | ARMYMEDICINE.MIL AMEDDC&S U.S. ARMY MEDICAL DEPARTMENT CENTER & SCHOOL The Chaplain Assistant and the Emergency Medical Ministry Course By Chaplain (Maj.) Robert Miller

On December 28, 1909, General Order No. 253 was issued by the War Department, establishing the Chaplain Assistant for the purpose of assisting the Chaplain in the performance of their official duties. In October 2001, the Chaplain Assistant was established as a separate career management field, with the Military Operational Skill (MOS) identifier of 56M. The chaplain assistant, as a member of the U.S. Army Chaplain Corps, is a Soldier, which provides expertise in religious support and religious support operations. Chaplain assistants, working closely with their respective chaplains, support the religious mission of the commander in responding to the needs of Soldiers, Family members, and other authorized personnel. Chaplain assistants provide a unique blend of technical religious support and tough Soldier competence. Unlike the chaplain, the chaplain assistant is a combatant. Chaplain assistants are skilled in a variety of weaponry and are the “force protection” of the Unit Ministry Team. In addition to specialized religious tasks, the chaplain Chaplain assistants undergo three days of intense training. They face the rigors of reaction to indirect and assistant performs and coordinates direct fire, convoy operations, mass casualty exercises, Ramp Ceremony, and Memorial Ceremony exercis- the necessary security requirements to es while providing “force protection” and religious support for each mission. (Courtesy photo) conduct religious support operations and minimize the personal security in a Trauma 1 medical facility; while providing “force protection” and risks of the chaplain. responding to trauma alerts and religious support for each mission. The Emergency Medical Ministry interacting with military and civilian Upon completion of the course, Course for chaplain assistants is patients. chaplain assistants receive a certificate conducted concurrently with the During the field training exercises of graduation and an additional skill Combat Medical Ministry Course for chaplain assistants are tested and excel. identifier of “1M,” setting them apart chaplains, and allows both the chaplain In three days of intense training, they as proven warriors and an integral assistant and the chaplain to hone face the rigors of reaction to indirect member of the Army Chaplain Corps. their respective skills together during and direct fire, convoy operations, mass classroom learning, field training casualty exercises, Ramp Ceremony exercises and approximately 12-hours and Memorial Ceremony exercises

17 | ARMYMEDICINE.MIL ASBP ARMED SERVICES BLOOD PROGRAM Cellular Therapy and Apheresis Section Saves Lives at SAMMC By Mark Salcedo, ASBP Blood Donor Recruiter, Fort Sam Houston, Texas

According to the C.W. Bill Young Apheresis section has had a direct responsible for processing, packaging, Department of Defense Marrow Donor impact on the long-term quality of labeling and cryopreservation of Program website, each year, more than health for military beneficiaries being hematopoietic progenitor cells, stem 12,000 people are diagnosed with treated at the San Antonio Military cells, and sometimes bone marrow. We diseases that require an infusion of Medical Center. can also receive and ship products for stem cells, but more than 70 percent “Most patients seen by the Cellular transplant to and from other hospitals of patients are unable to find an Therapy and Apheresis team have been around the United States,” added appropriate match within their own diagnosed with leukemia, multiple Weigand. Family and will require an unrelated myeloma, Hodgkin’s disease or non- For patients at the San Antonio donor. Hodgkin lymphoma,” said Linda Military Medical Center, transplant The San Antonio Military Medical Weigand, technical supervisor and or “engraftment” procedures usually Center has the proud distinction of program quality assurance manager. happen within a couple months after being the only Department of Defense “We generally provide this service to their collection. The two major medical facility that collects autologous patients who have tried other therapies transplant approaches used are and allogeneic transplants for patients. which were not successful. autologous, which uses the patient’s Tucked away in the corner of the “Our nursing staff collects autologous own cells, and allogeneic, which uses fourth floor is Blood Services’ Cellular and related (Family member) allogeneic cells from related or unrelated donors, Therapy and Apheresis section. With hematopoietic progenitor cells using peripheral stem cell collection. a staff of eight military and Civilian an automated apheresis procedure. The bone marrow transplant employees, the Cellular Therapy and The Progenitor Cell Processing Lab is program at the Brooke Army Medical Center and the Wilford Hall Medical Center – a joint program at the time – was first accredited in 1988 by the Foundation for the Accreditation of Cellular Therapy. FACT is the only accrediting organization that addresses all quality aspects of cellular therapy treatments to include clinical care, donor management, cell collection, cell processing, cell storage and banking, cell transportation, cell administration, cell selection, and cell release. For more information or questions about how you can sign-up to be a blood donor or a potential bone marrow/stem cell donor for the San Antonio Military Medical Center, please call the Akeroyd Blood Donor Center blood donor recruiter directly at (210) 295-4655 or (210) 295-4989. Walk-in donors are always welcome at the Akeroyd Blood Donor Center. Elisa Jackson, a medical technologist in the Progenitor Cell Processing Lab, prepares a microbiology sample for a recently collected hematopoietic stem cell product

18 | ARMYMEDICINE.MIL ERMC EUROPE REGIONAL MEDICAL COMMAND

Chaplain (Captain) Anne Morrissette speaks with a patient being unloaded from an ambulance bus on July 2013 at Landstuhl Regional Medical Center, Germany. (U.S. Army Photo/Phil A. Jones) Canadian Casualty Support Team Ends LRMC Mission By Chuck Roberts, Landstuhl Regional Medical Center Public Affairs

When Wounded Warriors from the been very honored to work with such Lee paid tribute to the important role U.S. are lowered from the ambulance a high caliber of physicians, nurses, the Casualty Support Team played in bus to a team of military providers at and support personnel,” said 1st Lt. being there for their fellow Canadians. Landstuhl Regional Medical Center, Kelsey E.N. Penner, an aeromedical “There is no greater sight when you’re Germany, seeing a familiar unit patch evacuation nursing liaison officer a casualty than to see someone in your worn by liaison officers from their speaking at the ceremony. “We have own uniform.” Lee joked that she command is always a welcomed sight. always received the highest quality hoped she wouldn’t be seeing another It’s been the same for Canadian of support, and have been treated as CST at LRMC again in the near future, Soldiers seeing the Red Maple Leaf an integral part of the liaison team at but noted that if future hostilities did worn by members of the Canadian LRMC. We are greatly appreciative of require the team here again, she knew Armed Forces Casualty Support Team all of the support that we have received the transition would be an easy one. who served at Landstuhl Regional here, as well as from organizations such At its peak, CST consisted of eight Medical Center (LRMC) from 2006 as the 86th Contingency Aeromedical multidisciplinary members, consisting until its closing ceremony March 20, Staging Facility at Ramstein Air Base, of a commanding officer, nurses 2014. The ceremony coincided with Germany. In addition, the Families (including specialists in aeromedical the ending of Canada’s military mission of those with significant injuries were evacuation), medical technician, in Afghanistan where its commitment hosted at the LRMC Fisher House and chaplain, administrative officer and to the war in Afghanistan included received tremendous support from the clerk, and a technician specializing in 158 fatalities and 2,000 injured. The clinical and pastoral staff. Without IT systems. The team was responsible Casualty Support Team (CST) served the outstanding support of LRMC for liaison with U.S. medical personnel, the almost 400 Canadian Wounded command, medical, and support staff, facilitation of evacuation back to Warriors treated at LRMC. the Canadian mission in Afghanistan Canada or back to the combat theatre, “Myself, as well as all of the liaison would not have been possible.” and personalized, individual support nurses that have preceded me, have LRMC Commander Col. Judith to casualties and their Families while at

19 | ARMYMEDICINE.MIL ERMC EUROPE REGIONAL MEDICAL COMMAND Canadian Casualty Support Team

LRMC. space provided by LRMC facilities. This was particularly important The liaison nurses were granted access during the deployment of personnel to U.S. clinical systems instrumental from French-speaking areas of Canada. in providing medical reports back to Canadians were one of 55 Coalition Canada. Additionally, this allowed Forces treated at LRMC, and the the nurses to print electronic health Maple Leaf became a common sight records and scan them into Canadian worn on the distinctive green uniforms systems. A Canadian Medical worn by Canadian staff, as well as Technician was embedded with the the Canadian flags displayed outside 86th Contingency Aeromedical Staging patient rooms of the fellow Soldiers Facility at Ramstein Air Base, and this they served. unit provided outstanding support to Canada’s role in the Afghanistan war Lt. Col. B.L. Bowerman (center) presents a certifi- outbound Canadian AE missions. began in late 2001 after the September cate of appreciation to LRMC Command Sgt. Major As Canada began withdrawing Timothy Sprunger and LRMC Commander Col. Judith attacks on the United States. In Lee during the March 20, closing ceremony for the from Kandahar in 2011, the Casualty February 2002, the first contingents Canadian Armed Forces Casualty Support Team at Support Team at LRMC was downsized Landstuhl Regional Medical Center, Germany. (U.S. of regular troops were deployed, and Army photo by Phil A. Jones) to reflect a decrease in Canadian Operation APOLLO was established. casualties. In the meantime, CST In March 2002, snipers from the 3rd nursing staff from the Canadian Forces personnel increased their contribution Battalion Princess Patricia’s Canadian medical unit located in Geilenkirchen, to LRMC operations, volunteering Light Infantry fought alongside U.S. Germany, were assigned the task. their time in clinical areas, with the Army units as part of Operation As casualties continued to increase, American Red Cross, LRMC Trauma ANACONDA, and Canadian troops however, it was quickly determined Program, Fisher House, Wounded provided garrison and security support that this arrangement was not Warrior Project, and the 86th CASF, throughout Afghanistan. The Canadian sustainable, and in February 2006 the all in the hopes of “giving back” to commitment was originally planned first Canadian Aeromedical Evacuation the community for their tremendous to last until October 2003; however, Nursing Liaison Officer (AENLO) was support. in August 2003, Canadian troops deployed to Landstuhl. The Canadian flag in Kabul was moved to the northern city of Kabul to In 2006, the Taliban conducted a lowered on March 12 and the final become the commanding nation of the major offensive in the Kandahar and Canadian Armed Forces personnel were newly formed International Security Helmand provinces, and by the end withdrawn. Although there will no Assistance Force. of the year 36 Canadian Soldiers lost longer be full-time personnel deployed As hostile operations increased, their lives as a result of operations, to LRMC, Canada will maintain a Canada began to take increased and 96 Canadian casualties were presence. The physical infrastructure casualties in Afghanistan. A sustainable treated at LRMC. The year 2007 saw of the office trailer will be maintained patient evacuation plan was required, a similar number of casualties, and the by personnel from the Canadian and the U.S. government signed an AENLO and small medical team from Operational Support Hub (Europe) agreement to provide Aeromedical Geilenkirchen became overwhelmed. located in Cologne, Germany, and Evacuation to LRMC. Canadian In February 2008, Canadian medical liaison responsibility will patients were transported by the Expeditionary Force Command return to the clinic in Geilenkirchen. U.S. Air Force to LRMC where they deployed the first Casualty Support This arrangement will allow Canada to received definitive surgical care while Team to LRMC with plans to rotate in continue to provide support to patients awaiting aeromedical evacuation back new personnel every six months. from various operations throughout to Canada through the Canadian The team worked out of transient the world. The Casualty Support Team Aeromedical Evacuation System. office space at LRMC and nearby will transition to “Caretaker Status” It was quickly determined that Ramstein Air Base. In the spring of and is able to be reactivated on short a patient liaison element would be 2008, an office trailer was installed notice in response to another large scale required at LRMC, and medical and by the Canadian government on a operation such as Afghanistan.

20 | ARMYMEDICINE.MIL MRMC U.S. ARMY MEDICAL RESEARCH AND MATERIEL COMMAND Burn Center ADL Put to Full Use By Steven Galvan, USAISR Public Affairs Officer Ask any injured service member who is a patient at the U.S. Army Institute of Surgical Research Burn Center what they want to achieve while rehabilitating and chances are that they’ll say “to get back to living a normal life.” While some injuries require more rehabilitation than others, the staff members at the Burn Center Rehabilitation Clinic are there to provide the injured warriors with the best therapy to help them realize their goals. An addition to the rehab center which recently became available is now being taken full advantage of. The Activities of Daily Living (ADL) skills room, a mock-up of a one bedroom apartment, gives patients

the opportunity to experience living 1st Sgt. Matthew Deller shops at the post commissary to cook his first meal in months at the Burn Center independently before being discharged Activiites of Daily Living Skills room--the first burn patient to fully utilize that room. (U.S. Army Photo) from the Burn Center. “It’s a way for patients who have been Deller said that it felt good to be out Deller recently attended a graduation here for months to transition back into shopping at the commissary. ceremony at the battalion where he is a routine without leaving the hospital,” “I needed to see how it was going charged with training and graduating said USAISR Burn Rehabilitation to be and how much my body can top-notch medics. Occupational Therapist, Emily Welsh. tolerate,” he said. “Out of nowhere he goes up to “They get to spend the night and do The oldest boy of 10, Deller had the stage and delivers a speech to the things for themselves like what they’ll always been independent. He said that students for 15 minutes,” said Welsh. have to do when they are discharged.” he was looking forward to cooking his “It was inspiring and motivating. That’s The first patient to experience full first meal in the ADL, something he just the type of Soldier that he is.” use of the ADL was 1st Sgt. Matthew had not been able to do in months. Deller was discharged from the Burn Deller, a member of the 232nd Medical “It was a good experience for him,” Center March 27 after spending 109 Battalion at Joint Base San Antonio- said Welsh. “One of the biggest fears days being treated for a burn that Fort Sam Houston, Texas. Prior to that some Wounded Warriors have covers 77 percent of his body. He was spending the night in the ADL, Deller is learning how to get back into a burned at home when a cracked gas was taken to the post commissary to routine. Going to the commissary and line ignited while starting a fire in his shop for items to cook supper that spending the night in the ADL eases fireplace. He will spend at least another evening. that tension.” year at the Burn Center rehab gym “The purpose of the trip to the Welsh also said that she feels good working on getting his “normal” life commissary is to acclimate the patient about Deller getting back into a back. back into the community,” said Maj. routine. “I know that he will,” said Welsh. Erik J. Johnson, chief of Burn Rehab. “He is a special Soldier,” she said. “That’s how he is. He’s always looking “It gets them to interact with people “He has had a remarkable recovery and at what’s next. He’s remarkable.” and to see how they react to their is always pushing himself to get back to injuries.” where he was before.” 21 | ARMYMEDICINE.MIL NRMC NORTHERN REGIONAL MEDICAL COMMAND Eustis Soldier Wins NRMC Best Warrior Competition By Senior Airman Teresa J.C. Aber, 633rd Air Base Wing Public Affairs Affairs Using perseverance, strength and mind. I just went in there knowing it and many other scenarios that would sheer will power, U.S. Army Soldiers was a great opportunity to represent my come up in the competition. endured strenuous circumstances organization.” ”Menchaca is a high caliber Soldier, for four days to compete during the Competitors from eight bases trained but he’s not exposed to a lot of the Northern Regional Medical Command with sponsors to prepare them for the components they were going to test best warrior competition at Fort Bragg, various segments of the competition, him on in his daily duties,” said March 23-27. including day and night land Vecchione. “My main objective was to The winner of the competition, Spc. navigation, weapons qualifications, drill make sure we got him up to speed on Hector Menchaca, McDonald Army and ceremony procedures, and the Air those things that he probably hasn’t had Health Center optical laboratory Assault obstacle course. to deal with since basic training such specialist, had just two weeks from the Staff Sgt. Matthew Vecchione, as weapons, tactical gear, and the other time he was notified to prepare for the MCAHC Troop Medical Clinic 2 hands-on portions of the competition.” competition. noncommissioned officer in charge, Menchaca believes the competition “I felt honored to be able to represent was Menchaca’s sponsor for the tested his resiliency and pushed him MCAHC and being chosen this year competition. Vecchione ensured to see his true potential, both mentally really humbled me,” said Menchaca. Menchaca was prepared to deal and physically. “Given such short notice about the with first-aid, communication skills, “I didn’t expect the events to be event, I was just going in with an open building raids, dealing with casualties, as challenging as they were, but I strived to stay motivated and maintain a positive mental attitude,” said Menchaca. “It builds self-esteem and allows you to really test your limits to see you’re capabilities and I believe the competition brought out the best in me.” Best Warrior competitions celebrate what it means to be a Soldier on a day-to-day basis, according to Vecchione. “To me, it’s a celebration of what it is to be a Soldier. They helped each other and acted like the ultimate battle-buddies to make sure everyone made it through the competition,” said Vecchione. “Even the competitors who don’t win end up succeeding because they learn what they are made of. They exemplify the Soldier mentality and discover what it means to be a true warrior.” Menchaca will go on to represent NRMC, Fort Eustis and MCAHC at the U.S. Army Medical Command competition at Camp Bullis training Site, Joint Base San Antonio- Fort Sam Houston, May 2-9.

22 | ARMYMEDICINE.MIL PRMC PACIFIC REGIONAL MEDICAL COMMAND Tripler Fisher House Gets a Visit from Spouse of Republic of Korea General By Ana Allen, Pacific Regional Medical Command

Hyun Sook Lee, spouse of Gen. Yo Hwan Kim, commanding general for 2nd Operation Command, Republic of Korea Army, paid a visit to the Fisher House at Tripler Army Medical Center on April 4. During the visit, Lee spoke of the sense of comfort, warmth, and love she felt the home brought to its temporary residents and praised Fisher House Manager, Anita Clingerman on a well- run program. According to the Fisher House website, a Fisher House is “a home away from home” for Families of patients receiving medical care at major military and Veterans Affairs (VA) medical centers. The homes are normally located within walking distance of the treatment facility or have transportation available. There are 62 Fisher Houses located Anita Clingerman (right), Fisher House manager, gives the grand tour of Fisher House II to Hyun Sook Lee on 23 military installations and 23 VA (far left), spouse of Gen. Yo Hwan Kim, commanding general, 2nd Operational Command, Republic of Korea (ROK) Army, along with other visitors from ROK while visiting with residents of the comfort home at Tripler medical centers. Many more houses are Army Medical Center on April 4. (U.S. Army Photo) under construction or in design.

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23 | ARMYMEDICINE.MIL SRMC SOUTHERN REGIONAL MEDICAL COMMAND Wounded Warrior Art Show By Wesley Elliott, DDEAMC Public Affairs Officer For over two years, the idea of an Tankersly, the museum’s volunteer were dealing with from their experience art exhibition at the Morris Museum and outreach coordinator, to teach serving in a combat zone. featuring artwork by the service different types of medium such as water The therapy is centered on Greek members of the Fort Gordon Warrior colors, sketching, linoleum carving, ink mythology where returning Soldiers Transition Battalion (WTB) has been a drawing, and oil painting. would gather outside the city and dream of Elin Rock and Jenna Tankersly. On alternate months, Rock and therapists come out to meet them and “We have been working closely Susanne Steele escort a group of service help work with them to process what with Jenna, the community outreach members to the Morris Museum where they had experienced. [representative] at the museum to the staff has them study a specific type of They would create a shield with the coordinate the show and haven’t had an art, or project for the day and then takes inside being decorated with personal opening, but two weeks ago she called them to create their own design from the motivations and thoughts and the and said her boss finally agreed,” said inspiration. outside with harsh things they had to Rock, a certified occupational therapist “Each month after the sessions, the deal with stemming from combat. at the WTB. service members are asked if they would “Our Soldiers chose the design of The show will run from June 10 like to donate what they made to the the shield to look like the body armor through June 29, at the Morris Museum museum for a potential future art show they wore while deployed and as they of Art in Augusta, Ga., and will provide and since then we have quite a few items worked on the shield you could see the service members of the WTB with a collected,” said Rock. them transform over time. The added way to express themselves in ways they Steele has previously used art therapy experience of leaving behind the military may not be able put into words. as part of her “Transition to Success” post and going to neutral ground was “This will be such an exciting exhibit. program in working with Soldiers that good for them and helped with their We utilize art for stress management and have post traumatic stress to get them recovery,” said Steele. thru the medium most of the service out into the community. The art therapy program is growing members show decreased stress levels The Fire House Gallery in Louisville, and recently the American Legion, after an activity,” said Rock. Ga., worked out a way to have three Unit 192, donated funds to purchase The artwork at the showing came from WTB Soldiers travel to the gallery art supplies for the Soldiers and to take art donated by the service members twice a month for six months to work the Soldiers out into the community to during the once a month visit from on building an Achilles shield where different art shops where they can make the Morris museum, who sends Jenna they could express different issues they projects. The WTB Occupational Therapy and the Eisenhower Army Medical Center (EAMC) Psychiatric unit also receive craft kits provided by the Help Hospital Veterans organization. The various donated kits can include painting projects, models, needlework, woodwork, and leather projects. The projects are given out to the Soldiers who want to create things over the weekends and during their free time between medical appointments. “I keep in touch with many of my former Soldiers and they are all doing very well. They all talk about how art therapy was one of the programs that Soldier’s from the Fort Gordon Warrior Transition Battalion art program create shields that are intended to help them express experiences from serving in a combat zone by using art as part of the occupational helped them the most,” said Steele. therapy art program. (U.S. Army photo by Judith Thompson, Eisenhower Army Medical Center (EAMC) Supervising Occupational Therapist) 24 | ARMYMEDICINE.MIL USAPHC U.S. ARMY PUBLIC HEALTH COMMAND Ergonomics Meets Munitions--Keeping Workers Safe By Jane Gervasoni, Public Affairs Office, U.S. Army Public Health Command

A quality work environment is a principles to the industrial hygienists can call me for assistance as they develop collaborative effort to keep workers and safety office personnel, ergonomists their local ergonomics program.” safe and healthy. In a facility like the Kevin Purcell, AIPH, and Tricia Salzar, A worksite assessment provides the Anniston (Ala.) Munitions Center, many Public Health Command Region--South, “ergonomic big picture” of the workplace factors influence the work environment assessed industrial and administrative and is an integral part of an installation’s and can be modified to improve worker areas around the munitions center. ergonomics program, according well-being. “These types of missions help to Purcell. An assessment involves U.S. Army Public Health Command installation personnel learn the observations and discussions with ergonomists went to Anniston, Ala., ergonomic principles needed to supervisors and employees to determine recently to survey facilities, evaluate work run their own basic program at the the types of work done in the facility and processes and provide training to local installation level,” explained Pentikis. “By any specific concerns they may have. industrial hygienists and safety personnel- combining assessments with training, “In the case of Anniston,” said Purcell, -all to help enhance the working the installation gets a chance to see how “we looked at a wide range of facilities environment at the facility. we (ergonomists) go through a facility including offices, inventory buildings, By looking at the tools; physical reviewing processes and determining inspection areas, receiving and shipping activities, such as bending or lifting, areas of concern.” facilities, a wood shop and unpacking that affect the body; and environmental “It was great that I was able to be part areas.” factors such as noise and lighting that of this assessment since the facility is Each area offers unique ergonomic might affect hearing, vision or comfort, located in my area of responsibility,” said challenges to employees and ergonomists can suggest modifications Salzar. “I began to develop a relationship opportunities to recommend that enhance worker health. with the individuals at the installation, improvements. While John Pentikis, USAPHC Army which helps them feel more comfortable Much of the work done at Anniston Institute of Public Health ergonomist asking questions and getting help when involves unpacking, moving and and team leader taught ergonomics needed,” she said. “They also know they disposing of unused and outdated military shells, rockets, missiles and similar explosive material. Because of the concerns about static electricity, grounded metal plates are placed in work areas, according to Purcell. The metal plates create a hard work surface, in turn creating an ergonomic hazard that needs to be mitigated. “One of our suggestions was to replace the metal plates with grounded rubber mats so that workers would not have to stand on the unyielding metal plates,” he explained. “The use of anti-fatigue mats would be a less expensive, ‘quick fix’ for those who stand in place much of the day.” Employees in the Anniston (Ala.) Munition Center administrative area are constantly looking up at monitors. “I think these types of quick fixes USAPHC ergonomists recommended that employees have sit-stand work stations to vary their positions during the work day. (U.S. Army photo by Tricia Salzar, USAPHC)

25 | ARMYMEDICINE.MIL USAPHC U.S. ARMY PUBLIC HEALTH COMMAND Ergonomics

go a long way towards fostering support and unloading and the use of a winch environment.” for larger more expensive projects. In on a fork lift instead of manually pulling “We left the munitions center having addition, by modifying a small portion heavy containers from the trucks. provided ergonomic training to both of the task we can hopefully reduce the Workers had their own suggestions to management and line-workers as well as stress and strain on the employee, which improve other processes. They included information on how to establish their in turn usually makes them wonderful putting wheels on tables used to move own ergonomics program,” according to advocates for ergonomics,” explained rockets and other large projectiles and the Pentikis. Salzar. fabrication of special stands that are sized “The ergonomic training was very “We make suggestions to make the to fit their jobs. informative for the industrial hygiene, workplace fit the worker,” said Purcell. “Ergonomics, safety and good business safety and others who attended,” “We talk with the people who do the practices overlap when we look at the said Anthony Burdell, deputy to the work to get an understanding of how processes at an installation,” said Purcell. commander at Anniston. they do their work.” “Most of the time they all go hand-in- “During the ergonomic survey the Much of the work at Anniston begins hand to protect the workers and increase auditors also provided ergonomic at the loading docks. Containers of production. information to our workforce to include materiel to be destroyed are shipped “We were very impressed with the how office equipment should be set in Army trailers that have rollers, but ingenuity of the workers in the facilities up for each individual,” according to Purcell noted that the loading docks were who had modified equipment or the Burdell. “They also instructed ANMC at a bad angle that did not facilitate easy environment to make their work team members how to get ergonomic loading and off-loading of the trucks. easier and safer,” said Purcell. “When information from the Public Health The ergonomic team’s suggestions for we complimented their changes, Command Web site. The visit was very improvement included pouring a new we explained how they had applied beneficial for the ANMC Team.” concrete pad to better facilitate loading ergonomic principles to their work CONNECT WITH ARMY MEDICINE CLICK ON A LINK BELOW AND JOIN THE CONVERSATION FACEBOOK FLICKR TWITTER

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26 | ARMYMEDICINE.MIL WRMC WESTERN REGIONAL MEDICAL COMMAND Sesame Street Friends Help Military Children Move By Joint Base Lewis-McChord National Center for Telehealth and Technology (T2)

Moving can be challenging, especially and playground friends. Finally, at the the Defense Department, to help military for preschool children. Military Families new house, children help their muppet Families with deployments and life move often—the average military unpack, settle into the home, and make transitions. While developed specifically child moves six to nine times between new friends. for military Families with children 3 to 5 kindergarten and high school. The Big “Sesame Workshop has always been years old, it is useful for all Families with Moving Adventure mobile application, at the forefront of creating resources young children experiencing a move. developed for the Department of Defense for Families with young children to The mobile app is available for in partnership with Sesame Workshop, help address some of life’s most difficult download from the App Store, Google the nonprofit educational organization issues,” said Dr. Jeanette Betancourt, Play, and Amazon for Kindle Fire. Users behind Sesame Street, lets kids create senior vice president for Community and have downloaded the free app more a muppet friend to help through the Family Engagement at Sesame Workshop. than 130,000 times since its release in moving process. “The Big Moving Adventure is part of December. “Moving can be stressful, and kids need Sesame Workshop’s contribution to About T2 to express feelings and say goodbye to military Families who face the challenge The National Center for Telehealth people and things,” said Dr. Kelly Blasko, of helping a child cope with this major and Technology (T2), located at Joint psychologist at the National Center for transition and help our kids reach their Base Lewis-McChord, Wash., serves as Telehealth and Technology. “The muppet highest potential.” the primary Defense Department office characters in this app help make the Military parents face unique challenges for cutting-edge approaches in applying move a fun experience.” during a move, and the app helps their technology to psychological health. T2 Children can use the app to help young children through the experience. is a component center of the Defense their muppet friend make decisions A separate parents section contains Centers of Excellence for Psychological on a variety of move-related issues like additional move-related topics and tips. Health and Traumatic Brain Injury, and which toys to pack in a box and which The Big Moving Adventure mobile aligned with the U.S. Army Medical to take along in their backpack. Children app is the newest addition to a portfolio Research and Materiel Command. For watch the muppet say goodbye to their of multi-media resources developed by more information, visit us at http://www. house, military base, and classroom Sesame Workshop, in collaboration with t2.health.mil

27 | ARMYMEDICINE.MIL WTC WARRIOR TRANSITION COMMAND Warrior Games Regional Trials for Soldiers and Veterans Fort Campbell Hosts Georgia Soldiers The Fort Campbell Warrior Transition Battalion hosted regional Warrior Games trials April 14 to 17 at Fort Campbell, Ky. These preliminary trials selected active duty and Veteran athletes to compete for a spot on the 40-person Army team in the 2014 Warrior Games to be held at the Olympic Training Center in Colorado Springs this October. This Paralympic-style competition allows wounded, ill, and injured athletes from all military branches to compete against one another in seven different events, including track and Benning, and Fort Gordon, Ga. permanent limb dysfunction as well as field, swimming, shooting, archery, Active duty Soldiers and Veterans who non-permanent injuries such as post- cycling, sitting volleyball, and wheelchair meet the following criteria are eligible for traumatic stress disorder, traumatic brain basketball. the regional trials: permanent physical injuries, or orthopedic injuries. The regional trials include Soldiers disabilities such as amputations, spinal and Veterans from Fort Campbell area as cord injuries, visual impairments or well as Soldiers from Fort Stewart, Fort

28 | ARMYMEDICINE.MIL RECOGNITIONS Bitterman Receives ACHE Regent’s Award Col. David A. Bitterman, Fellow of the American College of Healthcare Executives (FACHE), chief of staff, Southern Regional Medical Command, JBSA-FSH, Texas received the American College of Healthcare Executives Senior- Level Healthcare Executive Regent’s Award. The Senior-Level Healthcare Executive Regent’s Award recognizes ACHE members who are experienced in the field and have made significant contributions to the advancement of healthcare management excellence and the achievement of ACHE’s goals The American College of Healthcare Executives Senior-Level Healthcare Executive Regent’s Award was Members are evaluated on leadership bestowed on Col. David A. Bitterman (right) by Maj Gen. Jimmie O. Keenan, commander, Southern Regional ability; innovative and creative Medical Command. (U.S. Army photo by Erin Perez) management; executive capability in leaf clusters), the Meritorious Service member of the Order of Military Medical developing their own organization Medal (eight oak leaf clusters), the Army Merit. and promoting its growth and stature Commendation Medal (five oak leaf Bitterman received his bachelor of in the community; contributions clusters), the Joint Services Achievement science degree in biological sciences to the development of others in the Medal, the Army Achievement from the University of California, Davis, healthcare profession; leadership in Medal (two oak leaf clusters), and the Calif.; a master of health administration local, state or provincial hospital and Meritorious Unit Citation. He also degree from Baylor University, Waco, health associations; participation in proudly wears the Expert Field Medical Texas; and a master of strategic studies civic/community activities and projects; Badge, the Parachutist Badge, and the degree from the Army War College, participation in ACHE activities; and Air Assault Badge. Bitterman is board Carlisle, Pa. interest in assisting ACHE in achieving certified in Healthcare Management The American College of Healthcare its objects. and is a Fellow in the American College Executives is an international Bitterman has served as the SRMC of Healthcare Executives (FACHE). professional society of more than chief of staff since September 2013. He also serves as the consultant to 40,000 healthcare executives who lead Prior to this, he served as chief of staff, the surgeon general for healthcare hospitals, healthcare systems, and other U.S. Army Medical Command, JBSA- administration. He was awarded the “A” healthcare organizations. ACHE offers Fort Sam Houston, Texas. Proficiency Designator by the surgeon its prestigious FACHE® credential, Bitterman’s awards and decorations general for demonstrated proficiency as signifying board certification in include the Legion of Merit (two oak a healthcare administrator, and he is a healthcare management. WRMC Civilian Employees of the Year Congratulations go out to Holly Army Community Hospital, Fort Community Medicine at General Berens, Dawn Vita and Diane Hell, the Riley, Kan. Leonard Wood Army Community Western Regional Medical Command’s Category II: Hospital, Fort Leonard Wood, Mo. Civilian Employees of the Year for Dawn Vita, Human Resource Liaison 2013. Holly, Dawn, and Diane have Specialist at Munson Army Health demonstrated a commitment to Center, Fort Leavenworth, Kan. excellence in their support of the Army Category III: Medical Department mission. Diane Hell, Health System Specialist Category I: and Administrative Officer, Holly Berens, Clinical Nurse at Irwin Department of Primary Care and

29 | ARMYMEDICINE.MIL RECOGNITIONS BAMC Honors Retired Soldier with Purple Heart Ceremony By Jen Rodriguez, BAMC Public Affairs Retired Sgt. Jon Armbrust, an something higher than themselves.” instrumental in his care, and devotion to infantryman who served with Company B, The oldest military decoration in the helping him receive the combat decoration. 2nd Battalion, 27th Infantry, 3rd Brigade world, the Purple Heart is an American “I appreciate everyone that came here Combat Team, 25th Infantry Division, decoration awarded to members of the today; this means a lot to me,” he said. “I received a Purple Heart, April 1, during Armed Forces of the United States who are appreciate all the hard work that my AW2 a Purple Heart ceremony at the Warrior wounded by an instrument of war in the (Army Wounded Warrior Program) did to and Family Support Center Purple Heart hands of the enemy. put in for it (Purple Heart), he did a lot of garden. Brig. Gen. John Poppe, Medical legwork.” According to ceremony host Lt. Col. Command Staff for Support deputy chief A native of Roanoke, Va., Armbrust was Eric Edwards, commander of the Warrior and U.S. Army Veterinary Corps chief, injured July 30, 2007, in Iraq, while serving Transition Battalion, the purpose of the was the guest speaker, who presented as a gunner for his sergeant major on ceremony was to celebrate and pay tribute Armbrust’s Purple Heart medal and mounted patrol when his vehicle was struck to a service member of the generation that’s certificate, while Armbrust’s mother Mary by an improvised explosive device (IED), still answering today’s call. Abele stood beside her son. resulting in his combat injuries. “Sgt. Armbrust’s service carries the same Poppe said he was honored to be present Recalling that day, Armbrust said, commonality as with the Soldiers of Gen. at the ceremony, especially “to honor a great “Funny thing, I told him (sergeant major) Washington’s day as they too volunteered Soldier, Sgt. Armbrust, for his service to if I was going to put an IED anywhere, I’d to step forward and defend their country in his nation…” and for “great service as an put it right underneath that cinder block. the hour of need,” said Edwards. “Today, infantryman in the U.S Army.” Rode passed it, and it blew up on us. He he’ll join the honored company of well Surrounded by comrades, Family, friends, didn’t think it was that funny right after it over half a million Purple Heart recipients and members of the Military Order of the happened, but when he was director of the who are still alive today, who all served Purple Heart, Purple Heart Association sergeant major’s academy, he told that story and sacrificed so very much in the name of Chapter 1836, Armbrust thanked everyone with a good sense of humor about it.”

Brig. Gen. John Poppe, Army Medical Command (MEDCOM) deputy chief of staff for support, G1-4-6 and chief, U.S. Army Veterinary Corps, pins retired Sgt. Jon Arm- brust with a Purple Heart on April 1 while Armbrust’s mother looks on. (U.S. Army photo by Robert Shields)

30 | ARMYMEDICINE.MIL RECOGNITIONS Convertino Receives 2014 TACSM Honor Award By Steven Galvan, USAISR Public Affairs Officer The highest recognition that can be graduate students, a perspective that their imagine the use of new computer-based awarded by the Texas Regional Chapter training in exercise science, particularly technologies that can measure the ability of of the American College of Sports physiology, lays a firm foundation for a the body to compensate for the demands Medicine (TACSM) was given to Victor career path with unique opportunities for of physical work or exercise and ultimately A. Convertino, Ph.D., a physiologist/ developing solutions that can translate predict or enhance physical performance.” researcher and the tactical combat casualty to real-world operational problems,” It is that imagination that Convertino care research (TCCCR) task area program said Convertino. “I described that the has relied on while conducting his studies manager at the U.S. Army Institute of approach for developing technologies for during the last four decades which has Surgical Research (USAISR) at Joint Base diagnostic and therapeutic applications earned him recognition from within the San Antonio-Fort Sam Houston, Texas. in the care of prehospital patients with combat casualty care arena. The 2014 TACSM Honor Award for his life-threatening hemorrhage could be used “Perhaps the most gratifying aspect of “Outstanding Contributions to Exercise to assess and manage healthy individuals this award is that it was presented by a and Sports Medicine in the State of during the stress of exercise or as life-saving professional organization that is outside Texas” was presented during the TACSM interventions in athletes who are severely of combat casualty care,” Convertino said. Annual Conference held at Texas Christian dehydrated or develop shock due to heat “This award recognizes the impact of the University in Fort Worth. exposure or heat exhaustion.” research being conducted by the TCCCR As part of the recognition, Convertino Convertino was also invited to serve as task area which has broad implications was invited to be the speaker at the Raven a judge during the “Student Bowl,” the for advancing the understanding of Lecture, a keynote address given each year conference kick-off event which had 30 mechanisms and relationships fundamental during the Texas Chapter annual meeting teams from 18 universities from Texas as to physiology.” and named in honor of one of the chapter’s competitors. Convertino also stated that such founders Dr. Peter Raven. His lecture, “During my lecture, I told the students implications were evident by two which was presented to more than 400 that I was impressed with their mastery of new collaborations that evolved from researchers and students from academic knowledge displayed during the ‘Student investigators who attended the lecture and government institutions, was entitled Bowl.’ But I reminded them that Albert and are interested in the applications of “Career Paths with Training in Exercise Einstein challenged us with the notion diagnostic algorithms developed by the Science: 40 Years of Lessons Learned,” that ‘imagination is more important than TCCCR task area, one for management which focused on research from when knowledge’,” he said. “It is our imagination of exercise performance and the other for he was a graduate student to his current that allows us to take our knowledge and monitoring women who undergo epidurals studies at the USAISR. develop new concepts and technologies and hemorrhage during childbirth. “The primary focus of my lecture was to that can be used to improve human quality “I believe we will change the physiology present to the audience, which were mostly of life. So I challenged the audience to textbooks” Convertino said. Congratulations to Army Medicine’s Newest PCMHs Army Health Clinic Grafenwoehr C. Thomas Moore Health Clinic Fort Hospital’s Pediatric Clinic has been has been recognized by the National Hood has been recognized by the National recognized by the National Committee for Committee for Quality Assurance as a Committee for Quality Assurance as a Quality Assurance as a Level 3 PCMH. Level 3 Patient Centered Medical Home Level 3 PCMH. Kamish Clinic-Fort Wainwright has been (PCMH). Family Medicine Residency Center Fort recognized by the National Committee for Bennett Health Clinic Fort Hood Hood has been recognized by the National Quality Assurance as a Level 3 PCMH. has been recognized by the National Committee for Quality Assurance as a SHAPE Army Health Clinic has been Committee for Quality Assurance as a Level 3 PCMH. recognized by the National Committee for Level 3 Patient PCMH. General Leonard Wood Army Quality Assurance as a Level 2 PCMH. Russell Collier Health Clinic Fort Hood Community Hospital has been recognized Troop Medical Clinic JBER has been has been recognized by the National by the National Committee for Quality recognized as a Level 3 practice and meets Committee for Quality Assurance as a Assurance as a Level 3 PCMH. the requirements to be named an Army Level 3 PCMH. Bayne-Jones Army Community PCMH.

31 | ARMYMEDICINE.MIL RECOGNITIONS NRMC NCO Excels in Equal Opportunity Career By Gigail Cureton, Northern Regional Medical Command

Working long hours as a military equal gathered for a recent Irish heritage opportunity professional requires listening- celebration to watch a group of dancers. -lots of it. “The staff, the patients, they all enjoy these With four daughters at home, Sgt. 1st events.” Class Jason Zielske gets lots of practice. Zielske says the compliments from both “There’s always something going on at staff and patients are one of the highlights home; some crisis to resolve,” Zielske said. of his tour at WRNMMC. The other is “Having four daughters made me a much watching the Soldiers he mentors, like Staff better conflict manager. My Family life Sgt. Daniel Abeyta, excel. Abeyta, a former prepares me for being a good EOA.” WRNMMC equal opportunity leader, was Good enough to be the Army Medical named the MEDCOM Equal Opportunity Command (MEDCOM) Equal Sgt.1st Class Jason Zielske talks to Navy Petty Leader of the Year. Equal Opportunity Opportunity Advisor of the Year. Officer 1st Class Emmanuel Ilfraim, microbiology Leader is an entry-level unit position laboratory technician, during a Walter Reed National Becoming an EOA wasn’t part of Zielske’s Military Medical Center Irish heritage event at the working under the direct supervision of an career plan when he began his Army career medical center. Zielske, the medical center senior EOA. Army equal opportunity advisor, was recently named 15 years ago as an air and missile defense the 2013 Army Medical Command Equal Opportu- Zielske credits Abeyta as one of the main crewmember. He enjoyed his job and knew nity Advisor of the Year. (U.S. Army photo by G.H. reasons he was recognized as MEDCOM’s he was a Soldier for life. “I joined the Army Cureton/Northern Regional Medical Command) best EOA. “Sgt. Abeyta is an outstanding to make it a career; I wanted to do at least opportunity program is about breaking young Soldier and leader. He put a lot of 20 years.” down walls and helping people accept time and effort into being successful as But a Soldier’s life is not easy and bad differences and celebrate the similarities,” an EOL. I’m more proud of him being knees led Zielske to a career crossroads-- the Amherst, Ohio, native continued. selected than I am for myself. When you find another opportunity to excel in the “Sitting in a room with the other service have great Soldiers, it’s easy to be good.” Army. He found it in a little known but members who are as committed to working “Success in any program, to include important career field. together and creating a positive work programs like what Sgt. Zielske supports, After graduating from the three-month environment is one of the things that I have depends on having troops who buy into course at the Defense Equal Opportunity embraced about Walter Reed Bethesda. I the program and that buy in can have Management Institute (DEOMI) in think it makes this place special.” an impact on not only the organization 2011, Zielske was assigned to the former On any given day, Zielske and a team of but the individual,” said Command Sgt. Walter Reed Army Medical Center before Soldiers, Sailors and DOD Civilians are Maj. Benjamin H.S. Scott Jr., command transferring to Walter Reed National asked to find ways to support a positive sergeant major, Northern Regional Medical Military Medical Center (WRNMMC) command climate and help lessen the Command. and helping to set up the equal opportunity negative impact intolerance creates in the With his tour of duty at WRNMMC program here. workplace. scheduled to end in October, Zielske, a The transition from an Army hospital to “What we do is very important to self-described family man, says he is ready a joint service facility with a strong naval ensuring that our staff is free to work in an for his next challenge. The Army agrees and tradition was his first, and, Zielske admits, environment that is supportive,” he said. he was recently selected for promotion to sometimes an enduring challenge. “Quality of work life is important to overall master sergeant. “We wear the uniform of the U.S. quality of life.” “The EOA position here was a stepping military, but there are different customs And while being the senior EOA at one stone to the next level and I am grateful to and traditions and you have to be sensitive of the largest hospitals in the military keeps have served with an awesome joint service to that,” he said. “My DEOMI training Zielske busy, he does get to have fun. team. I would like to think my team and was helpful during the first months of our “I’m most proud of helping to get the I helped to set the tone for a joint EO transition from the old Walter Reed Army multicultural committee up and running,” program with diplomacy, empathy and [medical center] to Walter Reed Bethesda. he said. He serves as its chairman and patience--all the things we learn in our It is about adapting to a culture that says we oversees the planning of up to 13 annual training.” are all one team with the same mission. cultural events. “It’s great to see people They are also skills that come in handy in “I like to keep in mind that the equal smile, he said, pointing out to the crowd a house with four daughters.

32 | ARMYMEDICINE.MIL RECOGNITIONS Wong Relinquishes Command of NRMC, Retires after 30 years Maj. Gen. M. Ted Wong, commanding direct funding authority. general of the Northern Regional Medical Wong completed his General Dentistry Command (NRMC), will relinquish Residency Program at Fort Sill, Okla., and command May 5 to Col. (P) Robert D. an Advanced Prosthodontic Residency Tenhet in a ceremony officiated by Maj. Program at Fort Sam Houston, Texas. Gen. Brian Lein, deputy surgeon general, He is a graduate of the Army Medical U.S. Army Medical Command. Department Officer Basic and Advanced After the relinquishment of command, Courses, Combined Arms Services Staff Wong will retire after 30 years of service. School, Command and General Staff Tenhet will leave his current position as College, U.S. Army War College, and Executive Officer of the Office of the Army Joint Medical Executive Skills Institute Surgeon General to take command during CAPSTONE Symposium. a ceremony at Fort Belvoir, Va. Wong is the 26th chief of the Army As the commanding general of NRMC, Dental Corps and, before assuming Maj. Gen. M. Ted Wong, commanding general of Wong was responsible for leading Northern Regional Medical Command and Chief, command of the Northern Region, and strategically positioning the most U.S. Army Dental Corps, coaches Soldiers April 1, he served as the commanding general, on the eve of the event timed 12-mile road march complex healthcare delivery system in the which is the last training event for military personnel Southern Regional Medical Command, Department of Defense. He managed participating in the Expert Field Medical Badge deputy commanding general for readiness, competition where medics tackle more than 60 numerous competing priorities within medical and Army Warrior Training Tasks vying for Western Regional Medical Command a region that consists of over 400,000 the coveted EFMB Army skill badge. and the commanding general, William enrolled beneficiaries, 13,000 personnel, Beaumont Army Medical Center, El Paso, one medical center, two community Elements, four medical activities, numerous Texas. hospitals, a direct report Warrior Transition health clinics, 12 sites that support reserve Brigade, two Battalion Level U.S. Army component training, and over $1 billion in Outstanding Coordinator Creates Blood Drive Legacy By Erin Longacre, ASBP Blood Donor Recruiter, Fort Gordon, Ga.

Since 2003, Soldiers and cadre from as most people know him, is preparing the 187th Ordnance Battalion at Fort to leave Fort Jackson for his next duty Jackson, S.C., have been rolling up their assignment, but not before being sleeves regularly to give blood to the Armed recognized for his support of the blood Services Blood Program. More than 2,000 program during an awards ceremony at his ordnance warriors have donated at the battalion. battalion over the last decade, motivated Staff Sgt. Daniel Ward, by the extraordinarily dedicated Master noncommissioned officer-in-charge Sgt. Timothy Dlutowski, who is the most of Fort Gordon’s Kendrick Memorial successful blood drive coordinator the Blood Center, the donor center that has ASBP has ever had at Fort Jackson. conducted the blood drives at the 187th educated about donating blood for the The 187th Ordnance Battalion, which over the last decade, presented Dlutowski military Family. trains highly proficient warrior mechanics with a plaque featuring a Soldier medic to maintain the Army’s wheeled vehicle sculpture. fleets, has a proud blood donation history In all his efforts, Dlutowski got the thanks to Dlutowski. Master Sgt. “Ski,” 187th’s Warrior Mechanics motivated and

33 | ARMYMEDICINE.MIL RECOGNITIONS Killinger Selected as 2013 BAMC American Red Cross Volunteer of the Year By Steven Galvan, USAISR Public Affairs Officer “She represents the model traits of volunteer when her son enlisted in the make a positive difference. what we should all strive for—selflessness, Army knowing that he would eventually “She is able to communicate the stories empathy, loyalty, and a strong sense of deploy. In early 2013 she took some time of those patients who have come before and duty to serve others.” That’s how the 2013 to care for him when he was injured while persevered,” wrote Mittelsteadt. “This vital Brooke Army Medical Center (BAMC) deployed in support of Operation Enduring information gives hope and comfort to the American Red Cross Volunteer of the Year Freedom. Families and patients. Most importantly, Catherine “Cathy” Killinger is described. “I now know firsthand what our Families she does this in a non-judgmental and Since 2006, Killinger has been a go through as they wait and visit their loved warm manner.” volunteer at U.S. Army Institute of Surgical ones,” she said. Killinger was selected from more than 40 Research Burn Center (USAISR) collocated After deciding to volunteer for the American Red Cross volunteers at the Burn at the San Antonio Military Medical American Red Cross, she asked to be a Center and will now compete for the JBSA- Center at Joint Base San Antonio-Fort Sam volunteer at the Burn Center since she Fort Sam Houston individual Volunteer of Houston, Texas. Lt. Col. Paul Mittelsteadt, understands firsthand of what a Family the Year award as well as the San Antonio the USAISR Burn Center chief of nurses, goes through when a loved one suffers from United Way individual volunteer award. nominated Killinger because, “she has the a trauma and ends up there. Her brother She said she was honored to be recognized knack for understanding people and a was electrocuted and spent time in a burn for this award. genuine desire to assist others in their time center. “There are so many wonderful people of need.” “I remember how my parents were so who volunteer here at the hospital. Some “I was very surprised [about being appreciative of the doctors, nurses, and staff people give money, some give time,” said selected Volunteer of the Year],” said who were there to help them during their Killinger. “It’s such a wonderful experience Killinger. “I have missed some time difficult time,” she said. knowing that you have made a difference, this year since my son was injured in In the volunteer of the year nomination even if it’s small, a hug, smile, or simple Afghanistan.” package, Mittelsteadt wrote that Killinger touch. It’s priceless.” Killinger became a Burn Center is a shining example that one person can

Catherine “Cathy” Killinger, the 2013 Brooke Army Medical Center American Red Cross Volunteer of the Year talks to Thessalonia McClure at the Burn Intensive Care Unit waiting room. (U.S. Army Photo by Steven Galvan) 34 | ARMYMEDICINE.MIL JUST IN...

MEDCOM Team Receives Army Financial Management Award By Dr. Valecia L. Dunbar, Army Medicine Public Affairs

Army Medical Command’s (MEDCOM’s) Integrated Resourcing & Incentive System (IRIS) Development Team is the winner of the FY13 Outstanding Resource Management Team Award (Above ACOM) presented by the Assistant Secretary of the Army (Financial Management and Comptroller) or ASA(FM&C). The award recognizes the exemplary efforts of MEDCOM’s Assistant Deputy Chief of Staff Resource Management /G8, for their multidisciplinary team effort resulting in an integrated resourcing system to support Medical Treatment Facility (MTF) cost management while maximizing the value of patient care services.

IRIS is MEDCOM Resource Management Directorate’s answer to the Army surgeon general’s call for an enterprise funding methodology that would support the vision to achieve a System for Health by aligning efforts while meeting the expectations of stakeholders. The IRIS funding model is designed to distribute over $6.3 billion in Defense Health Program funding, while taking into account mission variability and accomplishments at the MTF level.

A significant achievement of IRIS is the flexibility it gives commanders to manage mission change.

“We are extremely proud of our team and what they have accomplished over the past year,” said Col. David Dunning, health services comptroller consultant to the surgeon general, G8/ADCS Resource Management Directorate. “For the first time ever, the MEDCOM was able to distribute budget guidance and targets ahead of the start of the new fiscal year which allowed us to maintain prudent financial risk management at the MEDCOM level, while still providing a stable environment to the Regional Medical Commands and Medical Treatment Facilities.”

The annual Assistant Secretary of the Army (Financial Management and Comptroller) ASA(FM&C) Resource Management Awards Program recognizes and encourages outstanding performance of individuals, teams, and organizations at all command levels. It complements installation, major command, and field agency recognition programs by focusing attention on the most deserving and commendable individuals, teams, and organizations that make significant contributions to the improvement of resource management.

In addition to the team award, individual MEDCOM winners of the FY13 Financial Management Award are:

• Isabelle Matthews, (SRMC) - ASA (FM&C) Civilian Capstone Award • Isabelle Matthews, (SRMC) - Budgeting (Civilian category/Below ACOM) • Maj. Jarrod McGee, (ERMC Bavaria) - Resource Management (Military category/Below ACOM) • Victor Stansberry, (RM Finance & Accounting Division) – Auditing (Civilian category/Above ACOM)

Additionally, Michael Johnson (RM Finance & Accounting Division) received the “Meritorious Award” from the National American Society of Military Comptrollers Awards Program in the Financial Systems Category.

Col. Dunning acknowledged that during this time of transformation from a healthcare system to a System for Health, these recognitions highlight the exemplary efforts of MEDCOM team members who continue to push the effort to move the U.S. Army MEDCOM another step closer to full implementation of the Operating Company Model.

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