The medic who rushes to a war zone bombing … the ambulance speeding to a major car accident … the surgeons trying to save a shooting victim. Trauma care takes so many different forms that a national research strategy to improve it has yet to become a reality.
The deaths and serious injuries caused by trauma are taking a devastating toll on our Nation. According to the Army’s Combat Casualty Care Research Program, nearly half of those severely wounded in recent wars have not been able to return to duty. In addition, approximately 20 percent of all combat deaths are considered potentially survivable, had advanced, appropriate care been immediately available.
On the civilian side, trauma deaths have reached epidemic numbers. In the United States, according to the National Trauma Institute, someone dies from a traumatic injury every three minutes, and trauma is the leading cause of death of children.
Yet military doctors in the field have the same problems storing blood today that plagued doctors decades ago, and no one yet knows the best way to treat a head injury or whether drugs can stem internal bleeding. Unfortunately, the funds devoted to trauma research, which could find answers to such questions, are a small fraction of the country’s research dollars.
Recognizing the need to develop a national strategy, the U.S. Army Medical Research and Materiel Command’s (USAMRMC’s) Telemedicine and Advanced Technology Research Center (TATRC) gathered representatives of several key trauma organizations in January in San Antonio, TX. The panel discussed critical research needs in trauma and how they could leverage each organization’s strengths for a more effective approach.
TATRC Trauma Portfolio Manager retired COL Thomas Knuth, MD, who chaired the meeting, explained, “Over the decades, funding and public awareness of trauma needs have waxed and waned as wars come and go. We need to create an overarching strategy for exactly what to study and how to fund it, so we can continue building on the knowledge we’ve gained.”
According to the Army’s Combat Casualty Care Research Program, nearly half of those severely wounded in recent wars have not been able to return to duty. In addition, approximately 20 percent of all combat deaths are considered potentially survivable, had advanced, appropriate care been immediately available.
Much has been done to reduce death and disability from trauma injury. But gaps remain in areas varied as injury prevention, disaster preparedness, medical treatment, infection control, and the technology used for communication and medical monitoring.
Knuth pointed out that advances in military trauma care during the Vietnam War improved local and state civilian trauma systems. What has been learned during the wars in Iraq and Afghanistan is helping the country move toward a national trauma system, he said. A national system implies consistent quality care delivered seamlessly across all jurisdictional boundaries with equal access everywhere to pre-hospital, hospital, operating room, intensive care unit, rehab, and long-term care and sharing of resources through mutual aid agreements to maintain services in times of peak needs. A national trauma system implies nationwide consensus on standards, process improvement, research, and other system needs.
“The military actually has a global system now. It’s amazing how many NATO countries are communicating weekly across continents in the care of patients,” Knuth said. “We need to translate that to civilian and future military efforts. That’s a good example of where we could go through the collaborations that may come out of this national meeting.”
- TATRC, headquartered at Fort Detrick, MD, which manages approximately 800 research projects throughout the country. Its trauma portfolio includes 50 to 80 projects at any one time. TATRC explores models of high-risk and innovative research, and puts research findings into the hands of warfighters.
- The Combat Casualty Care Research Area Directorate, known as RAD II, a USAMRMC unit that collaborates closely with Navy and Air Force research efforts. RAD II conducts basic and applied research and advanced technology development to reduce the number of deaths on the battlefield, limit brain damage, improve en route care, and advance the acute care of battle injuries. It invests in related projects at other institutions, including universities, industry, and military medical organizations such as TATRC and the U.S. Army Institute of Surgical Research (USAISR).
- The USAISR, which is in a unique position to conduct both laboratory and clinical trauma research. Located at Fort Sam Houston in San Antonio, TX, USAISR adjoins Brooke Army Medical Center, a Level I trauma center. It operates the Nation’s only military burn center and is home to the Joint Theater Trauma Registry, which all branches of the military use to electronically compile combat trauma data for use in improving equipment and care. The institute takes the clinical problems identified on the battlefield for further investigation and solutions, and then validates those solutions in the clinical setting before they are returned to the battlefield.
- The National Trauma Institute (NTI), an aftermath of the collaboration between USAISR and civilian trauma centers in San Antonio. NTI, established in 2006, coordinates and funds trauma research nationally and applies it to benefit both the military and civilians. NTI is working to develop a national trauma clinical trials network to coordinate studies at multiple sites. A network is important because no single trauma center admits enough critically injured patients to provide substantiated support for improvements to medical care. NTI also holds an annual trauma symposium for military and civilian trauma researchers and providers, and is beginning a development program to raise private dollars for trauma research.
Hope for the Future
The meeting reaffirmed efforts by the participating organizations to increase coordination among military branches, other federal agencies, and civilian institutions. To-do items from the meeting include shaping a common vision, developing a priority list, and setting a strategy for funding.
TATRC Deputy Director COL Ron Poropatich said, “We are all ready to take it to the next level to meet the challenges and opportunities of today and the future.”
- BARB RUPPERT is a science and technology writer for USAMRMC’s TATRC. She holds a B.A. in English from the University of Virginia and an M.A. in education from Virginia Tech.
“Today is a blur for me,” said CW3 Terry Dover, fresh from temporary duty. “I walked into my office over there, and I said, ‘Where’s all my stuff? Did I get fired while I was gone?’ ” Fortunately, it was just another office move. Dover’s papers and belongings were boxed in a new office.
Dover is used to being on the go. He and colleagues on the U.S. Army Medical Materiel Agency (USAMMA) Technology Assessment and Requirements Analysis (TARA) team have experienced steady growth and inevitable changes over the past few years. Dover is the Project Manager for Clinical Technologies and the TARA Team Lead in the Integrated Clinical Systems Program Management Office.
A key component of the U.S. Army Medical Research and Materiel Command, USAMMA manages strategic-level medical logistics and provides medical equipment for Active Component, U.S. Army Reserve, and U.S. Army National Guard forces. Comprising a full-time team of 14 and drawing on a corps of expert consultants from the U.S. Army Office of the Surgeon General, the TARA team conducts thorough analyses of medical treatment facilities.
The team assesses clinical operations; workload requirements; technical operations; and equipment maintenance, use, and life cycle. The team then translates those findings into recommended process improvements and equipment replacement plans. Since 1995, the program has achieved a recognized cost savings of $231 million for the Army Medical Department in service and maintenance contracts, equipment purchases, group buys, and environmental hazard reduction.
Dover’s team charts an ambitious schedule; it is slated to assess seven Army medical centers and hospitals this year alone. By year’s end, the TARA team will have zigzagged across the country, working in Maryland, Kentucky, Texas, Georgia, Washington, Alaska, and California. In past years, the team has deployed to such far-flung locales as Korea, Kuwait, Afghanistan, Iraq, and Honduras.
Along the way, the team has made vital changes to outdated doctrine at medical treatment facilities worldwide. Dover cites the increased use of, and reliance on, computed tomography (CT) scans as a prime example.
Comprising a full-time team of 14 and drawing on a corps of expert consultants from the U.S. Army Office of the Surgeon General, the TARA team conducts thorough analyses of medical treatment facilities.
“We changed things dramatically when we went into the Gulf War,” said Dover. “The CT became essential [toward assessing] the types of trauma we are seeing now. With a CT, you can see everything to some degree, and you can perform a CT scan in a couple of minutes to know what is broken … where things may be bleeding. That becomes critical when you go into surgery.”
The CT’s benefits extend beyond the operating room, as the scans provide important feedback to field combat units. “If we see certain head injuries on a CT, we know the armor is not doing the job,” said Dover. “Or maybe it’s doing the job but missing this part of it. So people are going to go back and say, ‘Look, we know blast injuries are doing this. We are protecting the skull, but we have all these other problems.’ ”
CT is just one tool in TARA’s growing arsenal. Dover’s overriding mission is to assemble joint teams to better understand how different forces’ facilities might operate.
“The intent is to pool [experts] from different areas, so when we walk through the doors [of any] facility, that gives us instant credibility,” Dover said. “There are some nuances in how the Army does things, how the Air Force does things, and how the Navy does things, but ultimately, how they treat patients is really the same.”
A TARA assessment can also outline a facility’s capabilities, enabling incoming personnel to get up to speed quickly. During winter 2009, the team traveled to Soto Cano Air Base in Comayagua, Honduras, to evaluate the medical element at Joint Task Force-Bravo (JTF-B) before a new logistics chief arrived. What the team found was a facility in need of logistical guidance.
JTF-B is wholly dependent on generators for its power. The hot and humid climate, with rain half the year, is hard on equipment. Base personnel must send the equipment stateside for maintenance. If a crisis occurs, humanitarian or otherwise, staff must pull field equipment from the clinic.
The TARA team was able to assess the equipment and put together a replacement schedule, ensuring that critical medical equipment used in delivering health care to our deployed members is the best it can be and within safety and regulatory management controls.
In just one week, Dover and 10 team members combed through JTF-B, evaluating the facility’s nursing and operations, equipment and laboratory, diagnostic imaging, and image archive and transfer system. The resulting report included an inventory of more than 150 items, from operating tables to battery chargers, listing manufacturers, model numbers, and life expectancy for each piece of equipment. TARA also streamlined the equipment replacement process and made recommendations in other areas, from staffing to training to record-keeping, all with an eye to improving operations, safety, and quality of care.
U.S. Air Force Maj Andrea Ryan, the incoming JTF-B Logistics Chief, reported to the base four months after the assessment and praised what Dover’s team was able to achieve in its short time at the facility.
“Chief Dover has been nothing short of amazing,” said Ryan. “The TARA team was able to assess the equipment and put together a replacement schedule, ensuring that critical medical equipment used in delivering health care to our deployed members is the best it can be and within safety and regulatory management controls. [That] support for field operations is more than any medical logistics officer could ask for.”
For more information on the TARA program, visit http://www.usamma.army.mil/tara.cfm.
- JILL LAUTERBORN is a writer for the U.S. Army Medical Research and Materiel Command. She has nearly two decades of editing and writing experience.
Since Sept. 11, 2001, the number of Soldiers in the 160th Special Operations Aviation Regiment (Airborne) has increased by approximately 1,000. At the same time, the AH/MH-6M Little Bird, MH-47G Chinook, and MH-60M Black Hawk were or are being fielded. Simultaneously, the 160th is running its own schoolhouse. These multiple activities, all while the Army has been at war, have stressed the regiment—stress that the new U.S. Army Special Operations Command-Provisional (ARSOAC) hopes to alleviate.
ARSOAC was officially activated March 25. Its Commanding General is BG Kevin W. Mangum, former Deputy Commanding General-Center, U.S. Division-Center.
ARSOAC will manage the complex enterprise of aviation units and operations, institutional training, system integration and acquisition, and maintenance and sustainment functions, Mangum said. It will also provide oversight to ensure standardization and safety of rotary-wing and fixed-wing aircraft and unmanned aerial systems.
Mangum spoke about the mission, vision, and functions of the new command at the Association of the United States Army (AUSA) Institute of Land Warfare’s Army Aviation Symposium and Exposition Jan. 13, 2011, at National Harbor, MD.
ARSOAC is part of the U.S. Army Special Operations Command (USASOC), overseen by the U.S. Special Operations Command (USSOCOM), and has a dual role in Army special operations. It mans, trains, equips, and resources units to provide worldwide aviation support to Special Operations Forces (SOF) and serves as the USASOC Aviation Staff proponent, said Mangum.
As we build this headquarters, let’s get it right. Let’s not get it fast. The goal is to come out of the starting box with the right goals, missions, and functions.
“Taking the functions off the 160th—their own training battalion, their acquisition cell, and their programming—will free that commander to have a more relevant role for the battlefield. That is our goal and our hope,” he said.
Mangum said ARSOAC is “going to deal with all things aviation.” It will provide USASOC with a command and staff capability for USASOC aviation and will facilitate collaboration with the Army and USSOCOM on broader aviation issues.
“It’s a resourcing headquarters with a hiring role, both as a component command within USASOC as well as the staff proponent for aviation within USASOC,” he said. “Across the USASOC and aviation enterprise, we have a little bit of everything. We have fixed-wing, rotary-wing … We will be the single portal of entry for those issues for the entire aviation piece.”
ARSOAC is a provisional command for about a year, giving the command staff time to establish the conditions and resources for success. “As we build this headquarters, let’s get it right. Let’s not get it fast,” said Mangum. The goal is to “come out of the starting box with the right goals, missions, and functions.”
In the Army Force Generation cycle, the 160th Special Operations Aviation Regiment (Airborne) is divided into three rotations: maintenance, training, and modernization. These are three distinct pieces that compete with one another, Mangum said.
Army aviation and USASOC are collaborative, functionally relying on each other. Mangum said that more than half of the Combat Aviation Brigade effort supports SOF. Meanwhile, SOF relies on Army aviation to provide expert Soldiers to grow and sustain Army aviation and to generate combat power.
MG Anthony G. Crutchfield, Chief of the Army Aviation Branch and Commanding General of the U.S. Army Aviation Center of Excellence, Fort Rucker, AL, asked Mangum to join the Army Aviation Enterprise Executive Council. “It is an opportunity to collaborate, be transparent, and communicate better what our requirements are to the Army and also share with the Army what we’re doing and learn from Army aviation what it’s doing,” Mangum said. The goal is to have greater collaboration with the Army aviation enterprise, to have mutual support to achieve capabilities and readiness at best value.
Mangum’s presentation is available at http://www.crprogroup.com/2011%20AVIATION%20PRESENTATIONS/Thurs/PM/BG%20Kevin%20Mangum.pdf.
- KELLYN D. RITTER provides contract support to the U.S. Army Acquisition Support Center through BRTRC Strategy and Communications Group. She holds a B.A. in English from Dickinson College.
The 730th Transportation Company of the 311th Expeditionary Sustainment Command, U.S. Army Reserve (USAR), is the first unit to be equipped with the new Palletized Load System (PLS)-A1 truck, solidifying a significant shift in the distribution and allocation of equipment to Soldiers.
The 730th Transportation Company, one of the newest USAR units, is receiving the Army’s newest trucks. Since September 2010, the Soldiers have trained for the 60 new trucks, said COL John Smith, Chief of Staff of the 311th Expeditionary Support Command. In November, Product Manager Heavy Tactical Vehicles (PM HTV), under the leadership of Project Manager Tactical Vehicles, Program Executive Office Combat Support and Combat Service Support (PEO CS&CSS), obtained Full Materiel Release approval for the PLS-A1.
In a Feb. 4 ceremony, PEO CS&CSS formally recognized the new transportation company. “This is the second first unit equipped ceremony I’ve been privileged to attend, and it’s the second one for the Army Reserve,” said LTC Paul Shuler, PM HTV. “The PLS-A1 is the best we have.”
During the ceremony, COL David Bassett, Project Manager Tactical Vehicles, explained that the PLS-A1 is designed with a fully scalable and integrated cab armor protection package, meaning the vehicle comes off the production line equipped with “A-Kit” armor components and built-in mounting provisions for the “B-Kit.” The B-Kit can be installed on the vehicle, as missions dictate, to provide maximum 360-degree protection for the crew in a combat environment.
“These trucks are designed to get you there, get you back, and get you home safely,” said Bassett. “I’m gratified we can put equipment in the hands of Soldiers.”
Bassett noted that this second fielding of new equipment to a USAR unit recognizes the unique contribution that citizen Soldiers make to the Nation’s defense.
The PLS-A1 fielding will allow the Army to replace many of the older, aging PLS-series trucks currently in use. “What’s occurring here today represents much more than new trucks,” said Smith. “It represents our ability to supply and support the fighting force.”
Designed and manufactured by Oshkosh Defense Corp., the PLS-A1 incorporates a 600-horsepower Caterpillar C-15 engine and an Allison 4500 six-speed transmission, which meets on-road U.S. Environmental Protection Agency requirements, and an independent steel spring front suspension system. The truck also features improved heating and air conditioning, an electrical system capable of providing future support to diagnostic and prognostic maintenance systems, and an anti-lock brake system with traction control.
Many units can put a battalion into combat. The question becomes, how do you resupply? And the answer is a robust and versatile logistics system.
Mike Ivy, Vice President and General Manager of Army Programs for Oshkosh Defense, was on-site to deliver a commemorative plaque to the unit. “It’s an honor to see the first PLS-A1 fielded to the 730th Transportation Company,” said Ivy. “The PLS has become the backbone of the Army’s distribution and resupply system since it entered Army service in 1993. The PLS-A1 delivers performance and protection improvements that are important to America’s Soldiers, and we’re proud to provide it.”
“Many units can put a battalion into combat,” Smith said. “The question becomes, how do you resupply? And the answer is a robust and versatile logistics system.” This is where the Army Reserve comes in, Smith explained—to provide trained and ready Soldiers able to deploy at a fraction of the cost.
The PLS-A1 supports the Army’s need for local and long-distance line-haul supply operations. The first configuration, M1074A1, is equipped with a Material Handling Crane and is used primarily to support ammunition handling at local holding areas and transfer points. The M1075A1, which does not feature a crane, is used chiefly for long-distance line-haul missions. Both configurations feature the same payload and towing capacity.
- MAJ COREY SCHULTZ is a Media Officer for the Office of the Chief of the Army Reserve Public Affairs Office, specializing in media relations, crisis reaction, and planning. She holds a B.A. in English with a focus on literature and classical studies from Kalamazoo College.
- ASHLEY JOHN is a Strategic Communications Specialist for PEO CS&CSS. She holds a B.A. in marketing from Michigan State University.