army medicine - amops

ARMY MEDICINE:

Ensuring Health, Performance, and

Trauma Care in the Soldier-Athlete

Prepared from Lessons Learned, Research and Experience

for

AMOPS

MG Philip Volpe United States Army

3 May 2013

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Active/Reserve

10 / 16 Combat Spt Hosp (CSH)

16 / 22 FWD Surg Tm (FSTs)

97 / 0 Other Active Units

0 / 54 Other Army NG Units

0 /138 Other Army AR Units

123/54/176 AC/NG/AR

Deployable Units

(353 Total)

9 Medical Centers

15 Army Community Hospitals

7 Army Health Centers

10 Army Health Clinics (supporting an installation)

128 Army Health Clinics

47 Army Troop Medical Clinics

18 Army Occupational Health Clinics

147 Dental Clinics

172 Veterinary Clinics

31 Research and Development Laboratories

32 Prevention Facilities

616 Total

TDA Facilities

FY12 SRC08

EAB TOE Units

Resourcing

$13.7B DHP

26,827 Total AC Military

47,939 Civilians

7,309 Contractors

2,326 Total NG/RC Military

84,401 Total

576K Active Duty (AD)

906K Family Members (FM) (AD)

225K Dependent Survivor

152K Eligible NG/R

228K Family Members of NG/R

754K Retired

868K FM Retired

239K Other

3.95M Total

Beneficiaries AMEDD Personnel

World Wide

4,349 Medical Corps Officers

981 Dental Corps Officers

11,283 Other Officers

36,376 Enlisted

52,989 Total AC

7,309 Contractors

49,241 Civilian

50,002 Total NG/RC

159,541 Total

OTSG/MEDCOM Personnel

Army Medicine Today

Select SLIDE MASTER to Insert Briefing Title Here

2-May-13 Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address

MEDCOM Commands

EUROPE RMC

TAMC

Japan Korea

PACIFIC RMC

NORTHERN RMC

Ft. Belvoir

FSH BAMC

WBAMC

WESTERN RMC

JBLM

MAMC

Readiness

Division

Readiness

Division

CRDAMC

DDEAMC

WAMC

Readiness

Division

Readiness

Division

SOUTHERN RMC

APG

PUBLIC HEALTH COMMAND (P)

MEDICAL RESEARCH &

MATERIEL COMMAND

Ft. Detrick

WARRIOR TRANSITION COMMAND

Crystal City

AMEDDC&S

DENCOM

FSH

FSH

MEDCOM

FSH

Readiness

Division

http://en.wikipedia.org/wiki/Image:US-O6_insignia.svg







Environment

Spiritual Psychological

MIND Behavioral Social & Family

Physical Nutritional

BODY Medical

Environment

Total Force Fitness for the 21st Century



GENERAL OVERVIEW

1. Disease and Non-Battle Injuries (DNBI) are Still #1 Cause for

seeking Healthcare in Garrison and on Deployments --- not

Combat Injuries or Wounds.

2. Musculoskeletal System makes up the Vast Majority on

DNBIs.

3. Focusing Efforts on Injury Prevention, Performance

Optimization (and Resilience), and Early Intervention /

Rehabilitation has Greatest Opportunity to decrease Morbidity

and increase Military Readiness.

4. 91% Combat Survivability is the highest ever and is due to

advances in Protective Gear and Pre-Hospital Trauma Care.



• Injuries from Physical Training are largest cause of morbidity & mortality in peacetime military.

•MSK Injuries cause significant morbidity during deployment.

Musculoskeletal Injuries in the Military

*Sick Call Visits? Injury = Illness

*Lost Duty Time? Injury >> Illness

*Injury with highest number of lost

duty days? *ACL Ligament Tear



Musculoskeletal Injury and Disability

• Leading Cause of Disability in US Armed Forces:

• 22 – 63% of Disabilities.

• Mental Disabilities are 2nd (10-21%).

• 34% of ALL V.A. Disability Compensation .



M/S Injury & Early Discharges

• 22.1% Males

• 24.6% Females

• 81/100 Soldiers/year

• 60% unable to return to full duty

•Primarily during routine physical training

Knapik JJ et al, Discharges during U.S. Army basic training: Injury rates

and risk factors. Military Medicine; 166:641-647.

Risk of Injury in Soldiers

Tomlinson et al. Military Medicine 1987; Vol 152.



Musculoskeletal Injury Study

• 3,195 infantrymen

• 95 injuries /100 /year

• 46% running or marching

• 15.5 days light-duty

compared to only 2.1

days for illness

Smith TA, Cashman TM. The incidence of injury in light infantry soldiers.

Military Medicine 2002 Feb;167(2):104-8.



Musculoskeletal Injuries in 1 Brigade

•Average of 30% of Soldiers have:

– Undiagnosed injuries

– Incompletely evaluated injuries

– Not getting satisfactory care

Source: BCT Pre and Post-Deployment HRA II Data from SWAPP (2010)



CHAMP: A USUHS Initiative

CHAMP

USUHS Consortium for Health

and Military Performance

Optimizing Human Performance: the process of applying

knowledge, skills and emerging technologies to improve and

preserve the capabilities of DoD personnel to execute essential tasks.



Vision and Mission Statements

“To be the premier medical

resource in military

unique human

performance

optimization.”

“.. to promote basic, clinical and

translational research, education,

and clinical expertise in optimizing

the functional capacity of the

warfighter, with the objective of

maximizing performance in the

operational environment.”



Improve Health and Stamina

Sleep Activity Nutrition

http://www.healthkicker.com/705014480/stairs-are-always-the-better-option/

Military Power, Performance, & Prevention (MP3)

Mobility

Speed

Agility Power

Strength

• Performance Nutrition

– Nutrient needs

– Ideal body composition

– Supplements

• Mental Toughness

– Ideal Performance State

– Fatigue counter-measures

– Endurance events

• Functional Fitness

– Strength

– Endurance

– Movement skill

• Sports Medicine

– Prevention/early intervention

– Finishing rehab

– Multi-disciplinary team

Ranger Athlete Program

Get Healthy Ranger onto Target

Injury Prehabilitation (Fitness/Nutrition)

Daily Acute and Chronic Health Care

Immunizations/Chemoprophylaxis

Routine physical examinations

Psychological Screening

Pre-Deployment SRP

Preventive Medicine

Bring Healthy Ranger Home from Target

Injury Rehabilitation (Fitness/Nutrition)

Post-Deployment SRP

Psychological Support

Care Coalition Support

Casualty Tracking

Keep Ranger Healthy while on Target

Tactical Combat Casualty Care

Care Under Fire

Tactical Field Care

Casualty Evacuation

Healthy Ranger through Healthy Ranger Family

Liaison Efforts

Direct Care

TARGET

CONCEPT OF MISSION SUPPORT

USASOC Human Performance Program 9 Installations/ 2 OCONUS

18 Units

Tactical Human Optimization, Rapid Rehabilitation and Reconditioning

1/10 SFG 1/1 SFG 3rd SFG (A)

5th SFG (A)

7th SFG (A)

10th SFG (A)

1st SFG (A) 75th RR

1/75th RR

2/75th RR

3/75th RR

HQ 160th SOAR

3/160th SOAR

4/160th SOAR

SWCS

528th

95th CA

4th MISG

Tactical Human Optimization, Rapid Rehabilitation and Reconditioning

https://asociweb.soc.mil/CA/index.html

United States Army Institute of Surgical Research Combat Casualty Care

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Battle Injuries by Body Region

Source: JTTR September 2001 – September 2011

Face 7%

Eye 3%

Head/Neck

2%

Head/Neck

27%

Chest 5%

Abdomen 6%

Pelvis/ Urogenital 3%

Trunk/Back/Buttock

1%

Torso

15%

3%

Spine/Back

3%

Shoulder/Upper Arm

6%

Forearm/Elbow 6%

Wrist/Hand/Fingers

7%

Other 3%

Upper

Extremities

22%

Hip/Upper Leg/Thigh

5%

Foot/Toes 5%

Knee/Lower Leg/Ankle

9%

Lower

Extremities

31%

Other 12%

Other 2%

Head/Neck Unspec

3%

Brain Injury (TBI)

12%


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Dominant Mechanism of Injury


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Cause of Injury

*Includes both battle and non-battle injury

70.7 78.2 76.0

89.8 87.8 90.0

0

10

20

30

40

50

60

70

80

90

100

WW II KOREA VIETNAM OIF OND OEF

Equipment Doctrine Medical Materials Training

% S

urv

ivabili

ty

Improving casualty survivability

20% Increase in past 65 years!

TACTICAL COMBAT CASUALTY CARE, “TCCC”

Three Objectives (1) Treat the patient

(2) Prevent additional casualties

(3) Complete the mission

Three Phases of Care (1) Care under fire

(2) Tactical field care

(3) Casualty evacuation care

Butler FK, Hagmann J, Butler EG. Tactical combat casualty care in special operations. Mil Med 1996;161(Suppl.):3-16.

Hypothermia Infection Pain Documentation Evacuate to surgical capability

TCCC = Prehospital Battlefield

Trauma Care Clinical Practice Guidelines

* In 2001, CoTCCC established to review and update TCCC.



Hemorrhage Control

One-handed tourniquet 2001

Hypotensive resuscitation 2003

CAT Tourniquet 2005

HemCon (Chitosan) dressing 2005

IV hemostatic drugs 2008

Combat Gauze 2009

Tranexamic acid 2011

Significantly Reduced Battlefield Death Rates due to Hemorrhage



Compressible Hemorrhage –

Tourniquet

•All soldiers must have a suitable tourniquet

readily available at a standard location on their

battle gear and be trained in its use.

•All troops in theater fielded the CAT

Combat Application Tourniquet (CAT) Cravat – Not changed since WWII



Tourniquet Studies

COL John Kragh USAISR

•Get tourniquets on BEFORE the onset of shock – Mortality is very high if casualties are already in shock before

tourniquet application

• If bleeding is not controlled and distal pulse is not

eliminated with first tourniquet – use a second one

just proximal to first – Increasing the tourniquet WIDTH with a

second tourniquet controls

bleeding more effectively

and reduces complications


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Can We Have An Impact? YES we can!



Hypothermia Prevention and

Management Kit

Dimensions: 7.5” x 9.5” x 3”

Weight: 2.5 lbs.

Part Number: 80-0027

NSN: 6515-01-532-8056

Contents:

1 x Heat Reflective Skull Cap

1 x Self Heating, Four Cell Shell Liner

1 x Heat Reflective Shell

STRATEGIC AE

BAS / CCP

ROLE 1

Definitive Care

ROLE 4 / 5

Casualty Care from the Battlefield to Home

or

CASEVAC

MEDEVAC

CSH, EMEDS,

EMF – ROLE 3

C MED / Fwd Surg Tm

ROLE 2

POINT OF INJURY SURV: 91%

RTD 97%

MEDEVAC

INTRATHEATER

MEDEVAC

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“The Future of MEDEVAC is Critical Care,

Intensive Care, and Onboard Hospitalization”

This is what a Critical Care Patient looks like

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