Senior decision makers with the Mission and Installation Contracting Command (MICC) at Fort Sam Houston, TX, have a new planning tool that allows them to better gauge their effectiveness in executing the acquisition mission.
The Capacity and Capability Model, or CAP2, provides a methodology to measure the capacity and capability of MICC mission contracting centers (MCCs), mission contracting offices, and installation contracting offices throughout the Nation to perform their missions for customers.
“Developed by a cross-functional team of contracting, financial, and personnel experts, the CAP2 was designed to support the MICC’s transformation and delegated authority to regional mission contracting centers,” said Pat Hogston, Director of MICC Contract Support, Plans, and Operations (CSPO).
MICC restructured its contracting centers and installation contracting offices under seven regional MCCs in 2011 to improve customer service and workload distribution while establishing a more effective span of control that contributes to the standardization of procedures and processes.
Fielding of the CAP2 Model to MCC directors follows a 100 percent data validation screening involving MICC contracting offices.
The capacity and capability components of the CAP2 Model take a deliberate approach, matching necessary manpower and skills.
Capacity takes into consideration whether MICC contracting offices have the resources available to sustain the contracting activity required to meet customer demands for acquisition services. It is supported by a MICC internal manpower model, which is fashioned after the U.S. Army Training and Doctrine Command (TRADOC) manpower model. The MICC model is based on process-oriented, statistically based studies of a variety of actions commonly performed by contracting offices. The MICC internal manpower model goes beyond the TRADOC studies by accounting for recent changes in the resources required for multimillion-dollar task and delivery orders, as well as contract administration efforts.
Capability measures the MICC contracting activities’ performance relative to personnel qualifications, certifications, skill attributes, and experience. It also captures statistics necessary for succession planning and other management considerations.
The capacity and capability components of the CAP2 Model take a deliberate approach, matching necessary manpower and skills.
“While other contracting metrics and manpower models are available, one aspect that distinguishes the CAP2 is the side-by-side view of resources needed and qualitative measures reflecting the ability of existing resources to perform the mission,” said Alix Gayton, Chief of the Workload Assessment and Management Branch for the MICC CSPO Plans and Programs Division.
She added that MICC leaders will continue to use situational information on various mission sets among the different units served. With the assistance of the CAP2, decision makers can baseline functions and assess norms across their respective families of work.
The capacity and capability components roll up into a dashboard presentation, offering MICC leaders at all levels a snapshot of opportunity and risk assessment by area of responsibility.
- MICC PUBLIC AFFAIRS
What does the Soldier need? That’s what the Field Assistance in Science and Technology (FAST) team asks, and they go straight to the source for the answer— the Soldier.
FAST team members include U.S. Army Medical Department (AMEDD) officer scientists, NCO medical officers, and U.S. Army Medical Research and Materiel Command (USAMRMC) personnel. Dale Frazier, FAST Team Coordinator, said the medical officers volunteer their services “to help ensure the survivability of the warfighters.”
The FAST team first deployed in September 2005 to support the U.S. Army Research, Development, and Engineering Command in Operation Iraqi Freedom (OIF). The team helps commanders find solutions to enhance mission capabilities and to improve safety, training, and operations.
When a forward medical unit identifies a Soldier need and writes a Request for Information, the FAST team communicates with USAMRMC for analysis and solution. To bridge or eliminate a capability gap, the FAST team works with various groups, such as product developers, subject-matter experts, and combat developers across the Army.
Working with so many different people and agencies “ensures the correct and most knowledgeable person is contacted for their input or guidance,” said Frazier.
The team also collects feedback on prototype technologies to meet Soldiers’ needs.
Over the years, the Medical Support Systems Project Management Office (MSS PMO) has worked with the FAST team many times, but the most notable collaboration was on the Joint Urgent Operational Needs Statements for the first 16 Mine Resistant Ambush Protected (MRAP) ambulances. The result was four MRAP-variant ambulances and their MRAP medical equipment sets (MES).
“The MRAP MES is a modular, ready-to-go set that impacted the war effort,” said Jaime Lee, Product Manager for MSS PMO.
In addition, MSS PMO and AMEDD’s Directorate of Combat and Doctrine Development worked with the MRAP Joint Program Office to develop and field casualty evacuation kits for six MRAP variants, including the MRAP All-Terrain Vehicle (ATV). More than 1,200 M-ATV CASEVAC (casualty evacuation) kits are now being fielded to Operation Enduring Freedom (OEF).
The most recent collaboration of the FAST team and MSS PMO led to sending troops a device to help stop bleeding. Because hemostatic agents and tourniquets cannot control high junctional hemorrhages (in areas where limbs attach to the torso), the medic’s only option in such cases is to apply pressure, with follow-on surgery if the casualty survives the initial hemorrhage.
In search of a solution, OEF Soldiers asked for a product to provide compression to junctional hemorrhage sites. Based on recommendations from the Committee on Tactical Combat Casualty Care, MSS PMO purchased several combat-ready clamps, known as CRoCs, to send to the FAST team. The use of CRoC has been approved by the U.S. Food and Drug Administration and the committee’s Integrated Product Team, and is now being evaluated by Special Forces and conventional Army units.
The FAST team requested a hands-free litter to allow Soldiers to rescue a wounded comrade while still engaging the enemy. MSS PMO searched the civilian market and found several products with potential.
The Tactical Combat Medical Care team evaluated the material of the litters. Vendors added straps and quick-release buckles to commercial-off-the-shelf litters. Several of these litters were sent to Soldiers for concept exploration and feedback.
Upon the return of the Soldier surveys, MSS PMO, the Directorate of Combat and Doctrine Development, the Tactical Combat Medical Care team, and the Medical Evacuation Proponency will meet to discuss this potential capability gap and to determine a path forward.
To immobilize patients with suspected head, neck, or spinal injuries, the FAST team requested immobilization straps. Securing wounded Soldiers is imperative in preventing further injury during transportation. With all the armor and equipment Soldiers must wear, often the strap can barely secure a wounded Soldier to the spine board. Medics require longer straps to secure larger patients in full-body armor, and MSS PMO has been working with industry to create a prototype from a commercial-off-the-shelf Spider Strap that is larger, has better adhesion points, and is manufactured in the Army’s olive drab color.
An evaluation by combat medics found the Spider Strap to be “faster, easier to use, and well constructed,” so now it is available for medics to use on larger Soldiers.
Continuing Their Work
Since the FAST team first deployed, members of the FAST team have joined Soldiers in OIF on 14 different occasions and in OEF five times.
Elements of the FAST team continue to exist at unit-level commands, with requests routed through the FAST coordinator at USAMRMC. The MSS PMO continues to work on solutions to medical technology gaps, focusing on speed, efficacy, and affordability.
- ANGELA POFFENBERGER is the Technical Writer for the USAMMDA MSS Project Management Office. She holds a B.S. in English from Frostburg State University and an M.A. in English from National University.
HUNTSVILLE, AL—Eight civilian members of the Army acquisition corps were introduced to the Competitive Development Group/Army Acquisition Fellowship (CDG/AAF) program during the CDG/AAF Orientation, Induction, and Graduation hosted by the U.S. Army Acquisition Support Center (USAASC) March 20-22. The event served as the capstone event for the 11 members graduating from the program, as well as orientation for the newest fellows.
“I did not realize how reputable the program is and how many CDG graduates are in such high visible positions within the Army,” said Chenxi Dong-O’Malley, a Year Group 2012 (YG12) CDG/AAF fellow and assistant product manager for Program Executive Office (PEO) Soldier.
“The week exceeded my expectations. I learned so much about the CDG program that I truly believe that the possibilities for exceptional professional develop for the next three years is endless,” said Karen Short, also a YG12 CDG/AAF fellow and assistant product manager for PEO Missiles and Space.
CDG/AAF is a three-year program that offers developmental assignments in PEOs, Assistant Secretary of the Army for Acquisition, Logistics, and Technology (AL&T) offices, U.S. Army Materiel Command Headquarters, and functional organizations. The program provides expanded training, leadership, experiential, and other career development opportunities.
“I finished my MBA last year and realized I needed to continue to grow professionally and put myself in the best position possible for a promotion and future meaningful assignments. I think the CDG program can help me with this goal,” explained Short.
“I felt that CDG/AAF was the vehicle for me to get exposure at a higher level and have the leadership training opportunities that I wouldn’t be able to have without the CDG fellowship,” said Dong-O’Malley.
The three-day event opened with the orientation for YG12 members, covering basic administrative topics and expectations of the program. Mr. Craig Spisak, director of USAASC, opened the second day of the event, which was highlighted by a program management panel discussion. The final day of the event featured a Q&A panel consisting of previous members of the CDG/AAF program, remarks from BG Joseph L. Bass, commanding general of the Expeditionary Contracting Command, and a senior leader dialogue panel. A dinner reception was held the final evening, which included the official induction and graduation ceremony.
The YG09 CDG/AAF graduates include:
- Tamera A. Balch
- Alvin Bing III
- Jeffery D. Burgess
- Danny W. Davis
- Peter L. Degenaar
- Gloria J. Hemphill
- Jeffrey A. Hensley
- Ryan S. Johnson
- Darold V. McCloud
- Phillip K. McDonald
- Joel A. Price
YG12 CDG/AAF inductees are as follows:
- Aladrian Crowder
- Chenxi Dong-O’Malley
- Timothy Hoy
- Adam Morse
- Craig Riedel
- Stephen Roberts
- Karen Short
- Matthew Whitworth
- The U.S. Army Acquisition Support Center (USAASC) supports Army Soldier readiness by developing a world-class professional acquisition workforce, effectively acquiring and stewarding resources and providing customers with the best possible products and services. For more information about USAASC, visit http://asc.army.mil.
Did you know a person is considered legally blind when the best corrected visual acuity is 20/200 or the visual field is 20 degrees or less, meaning that he or she can only see the “E” on the eye chart?
Seventy percent of people who are blind lack employment, but the National Industries for the Blind (NIB) has a vision to change that statistic.
Look at the pad of paper you’re using to take notes. Look at the pen you’re using. Do they say SKILCRAFT? If so, then they were manufactured by NIB. Employees who are blind have manufactured or assembled those supplies for decades—and that’s not all they’ve manufactured.
“There is great pride in knowing we are doing our part to support our servicemen and women while sustaining and creating jobs in one of the country’s most densely populated areas for people who are legally blind,” said Brenda Mee, Director for New York City Industries for the Blind’s (NYCIB) Business Development. “This is truly a win-win for all.”
NIB and the U.S. Army Medical Materiel Development Activity (USAMMDA) Medical Support Systems (MSS) Project Management Office have worked together for years under the AbilityOne program. AbilityOne is a federal purchasing program that implements the Javits-Wagner-O’Day Act, a federal law that requires federal agencies to purchase products and services from nonprofit agencies employing people who are blind or have other disabilities. NIB has 90 associated nonprofit agencies all over the country.
MSS works with the NYCIB on the patient litter straps that secure a wounded Soldier to the litter, and with Arizona Industries for the Blind on the litters that transport injured Soldiers from the battlefield.
NYCIB has not always manufactured the litter straps, but people who are blind have. In the early 1990s, Helen Keller Services for the Blind (HKSB) made the straps. When it closed, Lighthouse International of New York City bought the equipment and inventory and hired the HKSB employees to continue manufacturing the litter straps.
When the manufacturing division of Lighthouse International of New York City closed, NYCIB was created, hiring all of the displaced blind employees. Successful in securing the Defense Logistics Agency contract for the litter strap, NYCIB has made them ever since, providing approximately 45,000 straps a year to the military.
Now that the litter straps are changing, MSS began searching for a strap alternative and teamed up with NYCIB to develop prototypes with buckle release options that offer greater safety and reliability. Testing showed that the prototype featuring a strong, load-bearing, quick-release buckle with a two-part fastener was more reliable. The new litter strap requires additional stitching, which creates new jobs at NYCIB.
The litter straps are in approximately 75 different medical equipment sets, such as the ground, air, and Mine Resistant Ambush Protected (MRAP) ambulance sets. The U.S. Army Aeromedical Research Laboratory is finalizing airworthiness certification, and the new straps will be available in 6 to 12 months.
“This new strap has surpassed our expectations at meeting a capability gap and will greatly improve our ability to evacuate casualties safely,” said Jaime Lee, USAMMDA Product Manager.
Standardization of Litters
Arizona Industries for the Blind (AIB) began building litters for the Army in 1982 and has been improving them ever since.
The litters transport wounded Soldiers, while helping to prevent further injury. The litter covers are made from a polypropylene mesh material, which is flame-retardant and resistant to chemical warfare agents and decontaminating solutions. The litter supports up to 1,600 pounds and collapses for shipping and storage. Retractable handles allow for easy grip, and aluminum legs provide strong support. All of the components for the litter are machined and assembled by 25 employees at AIB. Each year AIB provides the military with about 20,000 litters.
Now AIB and MSS are working together to modernize the current litter and make a single, cost-effective litter that is compatible with all casualty evacuation platforms, including standard ground ambulances, MRAP ambulances, Black Hawk MEDEVAC helicopters, and fixed-wing aircraft.
“Standardization of litters in the Department of Army is a big issue, and this is the first step in the right direction to address this,” said Lee.
This effort began with a Request for Information from the Field Assistance and Science Technology Team on the many types of litters on the battlefield. With all the different types of casualty evacuation and MEDEVAC platforms, litter standardization needs to be addressed. Currently, the standard NATO litter does not fit in the MRAP ambulances. The new litter will include the strengths of the standard NATO litter, such as the ability to decontaminate and fold them, and will work in any of our ground and air evacuation assets. In addition, the litter needs to be functional, simple to operate and assemble, compact, and lightweight.
In addition to reasonable pricing and employment opportunities, by working with NIB, MSS has a long-term supplier for its products.
- ANGELA POFFENBERGER is the Technical Writer for the USAMMDA MSS Project Management Office. She holds a B.S. in English from Frostburg State University and an M.A. in English from National University.
In the military, it is rare that families or individuals remain in one place for an extended time, with the frequent travel and relocations to new duty station. To provide the best care for its beneficiaries, DoD’s health care system, like many civilian health care providers, is using medical devices and electronic health records to track and treat patients.
The U.S. Army Medical Research and Materiel Command’s Joint Program Committee-1 (JPC-1) Medical Training and Health Information Sciences Research Program and Telemedicine and Advanced Technology Research Center (TATRC) are collaborating with the TRICARE Management Activity staff to lead a working group focused on developing acquisition language and policies to improve medical device interoperability and safety and to reduce costs.
The electronic health record ensures that important medical information stays with the patient regardless of location, which is a tremendous advancement in patient care. Information about patients can be transmitted between medical devices and from medical devices to an electronic health record. Interoperability between the devices and records is vital; both must work to provide a benefit to patients and providers.
For medical devices to share information, they must be connected to a network, much as computers transmit information via the Internet. Just as computers can be hacked, the security on medical devices can also be breached if the network is not secured. Electronic health records contain vital patient information, also known as personally identifiable information, including names, addresses, birth dates, and Social Security numbers. While the information collected and shared by medical devices and electronic health records is needed to treat patients, it must be kept secure.
DoD has an immense interest in keeping this information not only safe and secure but also reliable and accurate. JPC-1 identifies the needs of the Military Health System and applies funding and resources, in this case TATRC’s, to address those needs. The work being done by JPC-1, TATRC, and TRICARE ensures that medical devices and medical records used to treat and track military beneficiaries are safe, reliable, and capable.
- ROBERT E. CONNORS, a retired U.S. Navy Commander, is an Executive Health Information Technology Manager at the Henry M. Jackson Foundation for the Advancement of Military Medicine. He is assigned as a government asset to U.S. Army Telemedicine and Advanced Technology Research Center, Fort Detrick, MD. Connors has 32 years of leadership experience in the Military Health System. He holds an M.S. in information systems management and a Master of Health Administration from The George Washington University. Connors maintains credentials as a Fellow, American College of Healthcare Executives and a Project Management Professional.
In today’s military environment of tightened budgets and staffing, empowering existing staff to organize, manage, share, and edit documents quickly and easily is critical to the success of the U.S. Army Medical Research and Materiel Command (USAMRMC).
To maintain maximum efficiency, immediate access is necessary for effective collaboration on mission-critical information. With this access, USAMRMC can spend more time doing what it does best: getting new medical capabilities to those who need them. As organizations within USAMRMC evolve and as individual projects grow and move forward, managing the thousands, or even millions, of paper and electronic documents can be both time-consuming and costly. Much of this information can become buried within email systems, lost across shared drives, or even hidden somewhere on individual workstations. Consolidating information assets in a secure, centralized repository can significantly reduce the amount of time spent managing and sharing documents.
The Electronic Document Management System (EDMS) is an existing system, in place and functioning today for USAMRMC. EDMS is based on LiveLink, a commercial-off-the-shelf software product for enterprise content management from OpenText Corp. that remains on the Army’s Certificate of Networthiness list. The USAMRMC Enterprise Information Technology Project Management Office (eIT PMO) has configured and conducted extensive testing to maintain compliance with two key groups: DoD Information Assurance and the U.S. Food and Drug Administration (FDA). EDMS is part of a suite of products offered by the eIT PMO. The eIT PMO, whose most recent Authority to Operate was received in June 2011, provides medical research information technology capabilities in a secure, reliable, and FDA-compliant environment.
Fully integrated, Web-based, and designed for enterprise-wide implementations, this system provides the ability to store, manage, access, edit, and collaborate on millions of files in a centrally organized and hierarchical structure tailored specifically to USAMRMC and organizational needs. Version control and audit functions promote ease of collaboration on all content, while powerful search functionality allows users to find what they need, when they need it. Users from outside of the U.S. Army Medical Department (AMEDD) may obtain account access to EDMS through an account authorization process. For new EDMS users, critical information from across their respective organizations can easily and quickly be migrated into EDMS using the familiar Windows Explorer interface. In addition, everyday users can easily accomplish bulk loading of historical documents.
Within EDMS, each command or organization maintains complete control of access, storage, and design for their organizational areas, allowing documents to be stored in a manner that is intuitive to each area. Content and information can be shared only with those chosen by the organization. Each user is in complete control of an assigned Personal Workspace area, which can be customized to suit individual preferences.
With more than 400 users so far, EDMS averages 26 new users per month and continues to expand. Its target is to have 2,000 users by 2015.
EDMS is currently used by 14 USAMRMC organizations and 15 subordinate commands. Advanced Development Medical Integrated Product Teams have recently started using EDMS in their business procedures, with more than 69 percent of the IPT chairs obtaining accounts. With the command endorsing EDMS as the enterprise solution, collaboration efforts continue to improve within USAMRMC, across other DoD agencies, and even throughout nongovernment organizations. In light of this success, the eIT PMO will continue to release future capabilities, which will allow EDMS to serve as a versatile collaborative tool for the medical research community.
If you answer “Yes” to any of these questions, EDMS can help you and your organization:
- Do you need to share and collaborate on information, not just within but also outside of AMEDD?
- Do you work with industry and/or academia?
- Do you have a difficult time tracking document updates and inputs?
- Do you send documents back and forth via email, and run into mail system space limitations?
- Do you know if you are using the latest version of a form or document?
- Has someone else ever “accidentally” deleted a document from a shared drive?
- Do your data need to reside on an FDA-compliant system?
- CPT BRUCE W. BARNES is the Military Deputy Project Manager for the Enterprise Information Technology Project Management Office, USAMRMC. He holds a B.S. in information technology from the United States Military Academy. Barnes is also a graduate of the U.S. Army Medical Service Corps Officer Basic Course and Medical Information Management Course.
A public university in one of the most concentrated military corridors in the Nation has teamed up with DoD in a major initiative to address the post-deployment health concerns of service personnel, veterans, and their families.
With the sheer number and diverse reintegration challenges of returning personnel—and the alarming increase in the suicide rate for combat veterans—DoD and the U.S. Department of Veterans Affairs (VA) are building and strengthening civilian partnerships to expand their capabilities to meet urgent and ongoing needs.
Operation Re-entry North Carolina is a growing research and development partnership led by East Carolina University (ECU) in Greenville, NC. It was funded in September 2011 with $2.1 million for its first year through a cooperative agreement with the U.S. Army Medical Research and Materiel Command’s Telemedicine and Advanced Technology Research Center (USAMRMC TATRC).
Many ECU faculty members were already conducting military health research projects with nearby partners such as the Marine Corps Wounded Warrior Battalion and the Naval Hospital at Camp Lejeune, NC; the Warrior Transition Unit and Womack Army Medical Center at Fort Bragg, NC; and the Durham VA Medical Center and its rural outpatient network. But Dr. David Cistola, ECU Associate Dean for Research and Director of the new program, explained that Operation Re-entry North Carolina allows the university to collaborate more effectively with the military.
“It creates synergy among projects,” he said. “We’re now coordinating several common elements, such as navigating the military’s regulatory process for research studies, so each project can achieve what it couldn’t separately.”
The program was chosen for funding by TATRC after an extensive peer review process. TATRC has defined the gaps where research is needed and has worked with ECU to choose pilot projects that appear to hold the most promise for addressing these gaps.
“We asked our researchers to align their strengths with the stated needs and apply to be part of the program. With this process, as well as TATRC’s help in connecting with the many agencies in the military health care system, we hope to move quickly to making a real difference for our service members,” Cistola said.
Coordinated research areas focus on rehabilitation sciences, behavioral health, and telemedicine. Ten pilot projects were chosen for funding in this first year. Projects and their investigators include:
- “Efficacy of Heart Rate Variability Biofeedback Combined with Neurofeedback in Reducing Symptoms of PTSD”—Carmen Russoniello.
- “Essential Life Skills for Military Families—Single Service Member Version” —Elizabeth Carroll.
- “Sensory Reweighting in Trauma- or Blast-induced Dizziness”—Kristal Mills, Sherri Jones, Blaise Williams, and Leslie Allison.
- “Development of a Personal Telemedicine Device for Health Assessment and Improvement”—Carmen Russoniello.
- “Effective Use of Interactive Metronome with Marines Suffering from TBI”—Leonard Trujillo.
- “Identification of Blood microRNA Biosignature for TBI”—Baohong Zhang and Xiaoping Pan.
- “Integrated Care for Military Families”—Angela Lamson.
- “Virtual Reality-based Home Safety Inspection System”—Irene Hamrick, University of Wisconsin-Madison.
- “Heal the Hearing: From Combat to Re-entry”—Jason Yao and Gregg Givens.
- “Re-entry with Recovery: Supporting Veteran Recovery from Substance Abuse, Mental Illness, and Mild TBI”—Paul Toriello.
Some of the projects are farther along in development than others. If all goes well, Russoniello’s work on integrating biofeedback into a game that may help prevent symptoms of post-traumatic stress could be ready for field testing this year.
Mills’ team is working on a rehabilitation strategy for trauma-induced dizziness based on recent ECU findings.
“With this process, as well as TATRC’s help in connecting with the many agencies in the military health care system, we hope to move quickly to making a real difference for our service members.”
“One of the main symptoms of brain injury is dizziness and difficulty with balance, but it wasn’t clear exactly what mechanism was at play here,” said Cistola. “Our research with Marines from Camp Lejeune has shown that it’s not inner ear damage, as commonly thought, but a problem with how the brain integrates this sensory input. Now we can develop treatments based on this new understanding.”
Another project closer to actual use is the work of Yao and Givens on an Internet-based portable audiometer that would allow for a full hearing evaluation of a service member in theater. Hearing loss is a common risk in the field; currently, a Soldier must be pulled from his or her unit and transported to Germany for assessment by an audiologist. With the new device, an audiologist anywhere in the world could conduct an evaluation via telemedicine. ECU holds the patent on the device, and the research team is working with TATRC to make it compatible with military requirements.
“These pilot projects are high-risk, high-reward studies that could help speed exciting ideas to the next step and, ultimately, greatly improve the care of our warfighters,” said COL Karl Friedl, TATRC Director.
Cistola noted that, as a public university, ECU has a mission to serve its region, which includes many veterans and active-duty military members.
“We must look to the future,” Cistola said. “For instance, we’re not satisfied with the kind of care we can currently offer someone with a blast-induced brain injury. Operation Re-entry North Carolina seeks to improve clinical and support capabilities.
“We feel a solemn obligation to do all we can to mobilize our expertise and resources to help those who have put their lives on the line for our country. It’s embedded in our mission and embedded in our souls.”
TATRC partners with other USAMRMC units to provide leadership in military-focused research efforts. For more information on TATRC’s research funding and collaborative opportunities, visit www.tatrc.org. For more information on Operation Re-entry North Carolina, visit http://www.ecu.edu/cs-dhs/ah/ornc.
- BARB RUPPERT is is a science and technology writer for USAMRMC TATRC. She holds a B.A. in English from the University of Virginia and an M.A. in education from Virginia Tech.
Maintaining a healthy lifestyle depends partly upon nutrition. Unfortunately, Soldiers are continually subjected to pressures from obesity-producing environments and the marketing of dietary supplements. The poor choices that can result make it difficult to regulate personal body mass, maintain a proper balance of nutrients and, most troubling, have nutritionally valuable meals.
Twenty-first century Soldiers conduct battle tasks of varied duration and intensity in adverse environments with multiple stressors. Given these factors, it is difficult to determine how the metabolic consequences of intense physical and cognitive effort, restricted replenishment of nutrients, fluids and sleep, and exposure to climatic extremes influence the effects of nutrients in the rations provided during military missions.
Novel nutritional strategies that enhance metabolic processes are required to sustain peak physical readiness at all times. Feeding plans and healthy weight management programs tailored for military effectiveness are also critical. These will promote effective training before deployments, enhance physiological recovery after redeployments, and support optimal garrison health between deployments.
Army research under the Military Operational Medicine Research Program (MOMRP) takes a multifaceted approach, involving scientists from many specialties working together to understand and develop solutions to the military’s nutritional shortcomings. The research begins with the collection of descriptive data acquired during field studies that involve military units and personnel both deployed and in garrison training, to document and characterize problems related to nutrition.
Experimental models—human, animal, tissue, cell, and molecular—are used to further elucidate the metabolic mechanisms underlying those problems, along with possible solutions. Based on mechanistic research findings, nutritional solutions are proposed, and initial efficacy tests are conducted using experimental human and animal models. Finally, fielded pilot studies are performed with the appropriate military populations to validate laboratory findings and demonstrate feasibility for implementation.
Novel nutritional strategies that enhance metabolic processes are required to sustain peak physical readiness at all times. Feeding plans and healthy weight management programs tailored for military effectiveness are also critical.
The scientific activities of this research exploit intramural resources and leverage extramural relationships with academia and industry. The products are transitioned to customers who make operational rations (the Combat Feeding Directorate of the U.S. Army Natick Soldier Research, Development, and Engineering Center (NSRDEC), Natick, MA); produce educational materials (U.S. Army Public Health Command, Aberdeen Proving Ground, MD); publish doctrine that is used by all services and DoD personnel (U.S. Army Medical Department Center and School, San Antonio, TX); develop and implement health policy; and produce Soldier materiel (Program Executive Office Soldier).
A recent success of this directed effort is the First Strike Ration (FSR). The FSR is a lightweight ration that incorporates eat-on-the-move nutrient delivery systems and nutritionally optimized components. Research performed at the U.S. Army Research Institute of Environmental Medicine through the MOMRP has helped to develop the FSR, in partnership with the NSRDEC Combat Feeding Directorate, to meet the requirements of today’s Soldier on the asymmetrical battlefield, while also addressing the Future Force Warrior capability for a lightweight, efficient ration.
In 2008, the FSR was validated to be nutritionally optimized, and it outperformed the ration then in use. Research to optimize rations continues, with the ideal ration being modified frequently to meet the emerging nutritional needs of the Soldier.
Even with these years of research to optimize the military ration so that it will contain the proper nutrients, Service members often supplement their food supplies. These supplements include vitamins, potentially performance-enhancing compounds, and many other manufactured dietary additives that have not been scientifically proven to produce the promised results.
The Defense Health Program supports an initiative known as the Center Alliance for Dietary Supplements Research (CADSR). Its mission is to monitor the use, adverse effects, safety, and efficacy of the dietary supplements being used by the military; examples of these include omega-3/fish oil, DMA (dimethylaminoethanol), and caffeine. The CADSR provides research and information to support policy decisions to the appropriate DoD elements, including the Office of the Secretary of Defense for Health Affairs, and the Service Surgeon Generals. As advertisements for new supplements appear daily on the Internet, service members may be in danger of taking unsafe combinations of these commercially available dietary additives. It is important that they receive proper guidelines and educational materials regarding such products. The CADSR strives to inform Service members of the true efficacy of various dietary supplements while presenting to them the adverse events that could occur.
Future work in the area of Soldier nutrition includes an in-depth study of military dining facilities and their impacts on eating behavior. Although healthy options are available in these facilities, a strong inclination exists for service members to choose the less healthy and, theoretically, more appetizing sweets and fried choices. Through education and by modifying dining facility practices, it may be possible to promote healthy eating choices during military deployments and at home with family members. With the growing epidemic of obesity, it remains critical to provide the most nutritious options for Soldiers en route to healthy eating behaviors.
As the saying goes, “We are what we eat.” The optimal performance and operational success of our military, and ultimately our Nation, depend greatly on the healthy and safe nutritional practices of our service members.
- DR. VALERIE A. TRABOSH is the Physiological Health Portfolio Manager for the Military Operational Medicine Research Program of the U.S. Army Medical Research and Materiel Command. She holds a B.S. in biochemistry and molecular biology from Dickinson College and a Ph.D. in biochemistry and molecular and cellular biology from Georgetown University. She maintains oversight on projects involving nutritional research, as well as sleep, fatigue, and physiological resilience research initiatives.
According to the American Red Cross, every two seconds, someone in America needs blood.
To improve the future of blood products, DoD, through the U.S. Army Medical Research and Materiel Command (USAMRMC), has established effective programs in the hopes of aiding both warfighters and civilians.
Approximately 44,000 blood donations are necessary each day to treat accident and burn victims, cancer patients, those having surgery, new mothers, premature babies, and many others. Donating blood is considered safe, and it takes less than an hour of time from the donor.
Once volunteers donate blood, it is processed to produce various blood products such as red blood cells, platelets, fresh frozen plasma, and cryoprecipitate, which is used to treat hemophilia.
Since the blood product to be used, as well as the blood type, depends on the individual patient’s need for blood replacement, maintaining a robust supply remains critical for meeting the needs of the general public. Having a limited shelf life, blood products must be replenished constantly.
Clearly it takes much more than a needle-stick to save a life.
USAMRMC research on improved blood products, under the broader Hemorrhage and Resuscitation Research and Development Program (HRRDP), supports six major strategic efforts, one of which is developing safer and more logistically supportable blood products for transfusion. The goals for the Improved Blood Products Strategic Effort are also to enhance the availability of blood products on the battlefield; improve the safety of those blood products; and examine selected issues related to the safety and efficacy of specific blood products.
Selected DoD product development and research in this area include: (1) dried plasma, to reduce logistical constraints associated with frozen plasma and to expand the availability of plasma in military operations; (2) cryopreserved platelets that can be stored frozen for years (DoD is also investigating other approaches to improving platelet shelf life); (3) an improved collection and storage system to increase battlefield shelf life and improve the metabolic quality of red blood cells; (4) a pathogen reduction system for whole blood; (5) clinical studies examining the effects of red cell storage age on outcomes following transfusion in critical patients; (6) evaluation of the use of frozen vs. liquid-stored red cells in a clinical trauma study; and (7) in vitro production of red blood cells that are universal donor and pathogen-free.
While these research efforts are intended primarily to help warfighters on the battlefield, the information gained will have applications in the civilian sector as well. These efforts, along with others, will help change the way blood products are collected, stored, processed, and ultimately transfused.
- REBECCA DUVE is the Assistant Portfolio Coordinator for Hemorrhage and Resuscitation Research at the Combat Casualty Care Research Program (CCCRP), U.S. Army Medical Research and Material Command (USAMRMC), Fort Detrick, MD. Duve holds a B.S. in clinical laboratory science, and an M.B.A. and an M.S. in management from the University of Maryland University College. She holds a Project Management Professional (PMP) certification, and is certified as a Medical Laboratory Scientist (MLS) with the American Society for Clinical Pathology (ASCP).
- DR. ANTHONY E. PUSATERI is the Coordinator for Hemorrhage and Resuscitation Research at USAMRMC’s CCCRP. He has focused on hemorrhage and resuscitation research for over 15 years. Pusateri has published work in more than 60 peer-reviewed scientific publications, primarily in the field of hemorrhage and resuscitation. He holds a B.S. in dairy science from the University of Illinois, an M.S. in reproductive physiology from Iowa State University, and a Ph.D. in physiology from Purdue University.
The adenovirus vaccine (officially known as the Adenovirus Type 4 and Type 7 Vaccine, Live, Oral) has been used since Oct. 24, 2011. It protects military trainees against febrile respiratory illness (FRI)—with fever plus symptoms such as coughing and sneezing—caused by adenovirus Types 4 and 7. The adenovirus vaccine goes into the mouth of every basic trainee of the Army, Navy, Air Force, Marine Corps, and Coast Guard.
It does not get there by accident.
The U.S. Army Medical Research and Materiel Command manages the development of adenovirus vaccine. The Pharmaceutical Systems Division of the U.S. Army Medical Materiel Development Activity (USAMMDA) houses the product manager and support staff. The Integrated Product Team (IPT), chaired by the product manager, developed the concept for deployment and distribution of adenovirus vaccine well before the U.S. Food and Drug Administration licensed the vaccine in March 2011. The Milestone Decision Authority approved the basic distribution concept—just-in-time deliveries directly from the manufacturer to the points of use—at Milestone B and C decision reviews.
When basic trainees become ill, the U.S. government expends resources by diagnosing and treating illness, paying trainees who are too ill to train, and making adjustments to the training schedule. The use of adenovirus vaccine is cost-effective when the cost of vaccine is less than the sum of the costs avoided. Under the low-rate initial production contract, the Army procures adenovirus vaccine at a cost lower than the threshold cost, defined as the highest cost at which procurement of vaccine is favorable, as assessed in a cost-benefit analysis.
Analysis of data collected by the Naval Health Research Center shows that the use of adenovirus vaccine has had a very favorable impact on the FRI rate. Disease caused by adenovirus Types 4 and 7 is no longer an issue during basic training.
The manufacturer supplies adenovirus vaccine in a package of two bottles. The IPT’s logistics working group, which includes the manufacturer, conducted a series of test shipments to ascertain the effectiveness of procedures to maintain the cold chain for the vaccine, which must be kept at a certain temperature during transportation and storage. Adenovirus vaccine reached all of the points of use, the nine basic training installations for the U.S. military services, within 48 hours after packing—the period within which the packed vaccine could reliably be kept within temperature limits.
The number of shipping containers sent by commercial carrier varies from month to month and by destination. The product manager develops a shipping plan from estimates of the number of recruits who will arrive at each site. The services need approximately 240,000 doses per year, a figure that includes a safety margin. Upon receiving the shipping plan, the manufacturer ships the number of doses of vaccine needed to immunize recruits in the following month. Since shipments began in October 2011, the manufacturer has shipped 100,800 doses to the training sites without incident.
The Adenovirus Vaccine Product Management Office has two links to the field, both represented on the IPT. The Distribution Operations Center of the U.S. Army Medical Materiel Agency (USAMMA) communicates with relevant logistics personnel at each of the receiving sites to call their attention to imminent deliveries, inquire about the condition of vaccine received, and respond to any questions or concerns relating to shipments.
After the receiving personnel evaluate basic information from the temperature monitors, they ship the monitors to USAMMA, where its personnel download a complete data set and then contact the manufacturer for information and advice on any questions regarding vaccine quality.
The Military Vaccine Agency, a component of the Office of the U.S. Army Surgeon General, is the IPT’s link to preventive medicine staff at each installation, and to senior public health officers of each of the services. With these links, the product manager and IPT are well-positioned to acquire, process, and disseminate information on a timely basis, which remains critical to the distribution of this important vaccine.
- CLIFFORD E. SNYDER JR. is the Product Manager for Adenovirus Vaccine in the Pharmaceutical Systems Division of USAMMDA. He holds a B.A. in natural sciences from Johns Hopkins University, a Ph.D. in biology from the University of Virginia, and a J.D. from George Washington University. He is a graduate of the U.S. Army Medical Service Corps Officers Basic Course. Snyder is Level III certified in program management, and is a member of the U.S. Army Acquisition Corps.