Reports from 2010 MEDCOM Symposium 

6/15/2010 

Medic awarded Distinguished Service Cross at Medical Symposium 

By Jerry Harben
U.S. Army Medical Command


Sgt. Joseph Lollino receives the Distinguished Service Cross from
Lt. Gen. Eric Schoomaker, as family and friends observe at the
AUSA's MEDCOM/ Symposium in San Antonio, Texas.
Photo by Ed Dixon, Fort Sam Houston.

An Army medic’s heroism during a firefight in Afghanistan led to his recognition with the U.S. military’s second highest decoration for valor.

Sgt. Joseph L. Lollino received the Distinguished Service Cross and the Purple Heart from Lt. Gen. Eric Schoomaker, surgeon general of the Army, May 17 during the AUSA 2010 Army Medical Symposium cosponsored by U.S. Army Medical Command and the AUSA at San Antonio, Texas.

Lollino, 25, a native of Hoffman Estates, Ill., retrieved and treated five casualties when his convoy was ambushed June 20, 2008 in Paktika Province of Afghanistan. He was serving with 3rd Platoon, Company C, 1st Battalion (Airborne), 503rd Infantry Regiment, on his second deployment to Afghanistan.

“One vehicle was very badly disabled. The RPG blew up a fuel can in back starting a massive fire,” Lollino said.

“There were two mountainsides on both sides of the road, with a small dip on the left side of the road, so that makes it very difficult to maneuver around. It was very rocky with some trees,” he said.

Lollino drove his armored HUMVEE through enemy machine-gun and small-arms fire to reach the disabled vehicle, returned fire with his weapon, extracted the casualties from the vehicle and began treatment.

“As the (casualty collection point) started taking fire I returned fire,” he said. “I used a couple of magazines until the truck got behind us, then the .50 cal (machine gun) and the Mark 19 (grenade launcher) took over.”

“They shot RPGs at us, and I got down to cover one of the wounded who had very bad shrapnel wounds. I got wounded myself,” he added.

Despite shrapnel in his upper arm, Lollino treated four soldiers with shrapnel wounds to the neck, legs, arms and shoulder, plus a case of smoke inhalation. He loaded them into another vehicle and continued treatment as they escaped the four-kilometer long ambush.

“We got them out. I just wanted to make sure the guys were safe, they were good friends of mine,” he said. “I had a goal, I didn’t want anybody in my unit to die. We came back with casualties but nobody died.”

“They’re all doing good now, I get to talk to them every once in a while” Lollino said of the casualties. “One, Sergeant Matlock, got the Silver Star and he’s actually reported again to Afghanistan.”

Lollino now is assigned to Tripler Army Medical Center in Hawaii as a licensed practical nurse, working with patients recovering from anesthesia.

His wife, parents, siblings and several former comrades in the airborne unit attended the award ceremony.

“He’s a great guy, he always has your back. I have never had a more dependable friend,” commented Sgt. Cayleb Lee, who now has left active duty after serving with Lollino from basic training through assignment in Italy.

“I just wanted to do my job, fix the guys and make sure no one died,” Lollino said. “Everybody’s got a family we all want to get back to.”

 

Army medicine brings value and inspires trust

'We have been there when we were needed.'

Jerry Harben
U.S. Army Medical Command

Army medical personnel are making progress across a broad range of issues affecting health care for soldiers and their families, according to the Army’s top medical officer. 


Lt. Gen. Eric Schoomaker, Army
surgeon general,speaks to the
2,000 Army Medical Command personnel at the symposium.  

       Lt. Gen. Eric B. Schoomaker, the Army surgeon general, and commander of U.S. Army Medical Command, spoke May 17 to 1,900 military medical professionals attending the Army Medical Symposium sponsored by U.S. Army Medical Command and the Association of the United States Army in San Antonio, Texas.

      Schoomaker’s two themes were how Army medicine brings value and inspires trust, not only for patients and their families, but also
for Army leaders, government leaders and taxpayers.


            The warrior preparing for battle trusts that his or her medic will be there when the cry ‘medic’ goes up; the mother entering the delivery room trusts that her nurse midwife or (obstetrician) or that young 68WM6 (licensed practical nurse) has her interest and that of her baby in mind; the wounded, ill or injured warrior trusts that we as experts in healing, rehabilitation and reintegration are focused on getting them literally and figuratively back on their feet, back into the fight or on to productive lives; … the taxpayers, Department of Defense and national leaders expect that we are doing all we can do with an eye for high value,” he said.

            Schoomaker said the Army is shifting from a health care system that measures success by patients treated and procedures performed to a system of health that prevents patients from needing treatment, and treats them as effectively as possible when necessary.

            “We are not doing just more widgets of care but better quality of care,” he said.

            He promoted using evidence-based medicine to reduce unwarranted variation in care.

            “Why would you drive your car on the wrong side of the road,” he asked, “when all evidence suggests a better result for your Sunday drive if you just follow the rules?”

            He cited great progress in the past three years in care for wounded, ill or injured soldiers who must rehabilitate and transition either back to duty or to civilian life. Milestones include implementing an action plan for wounded warrior care, formation of a national Warrior Transition Command to coordinate such programs and local warrior transition units to provide support and supervision.

            More than 60,000 soldiers have successfully transitioned through this system.

            “They are hoping to change the culture of care for these warriors to one focused on ability instead of one focused on disability,” Schoomaker said.

            Other initiatives Schoomaker cited involve an automated system to collect information about combat casualties that has led to improved body armor and better protected vehicles, construction of more new hospitals in two to three years than in the past 20 years, improved access to primary-care clinics, improved skills for front-line medics, treatment of mild traumatic brain injuries close to the front lines and new measures to relieve pain without addictive medication.

            “I submit that we inspire trust through our track record of having been there when needed,” he said.


Medical personnel respond to the Fort Hood shooting spree

Braverman: ‘Medical care was never an issue’

  
Col. Steven Braverman, M.D., briefs
Army medical personnel on the operations at Fort Hood, Texas, following  the Nov. 5 shooting spree.
.              Calling the Nov. 5 tragedy at Fort Hood, Texas, a “mass casualty event that is a sensitive issue because of the on-going investigation,” Col. Steven E. Braverman, M.D., commander of the post’s Darnell Army Medical Center, briefed 2,000 Army Medical Command personnel and guests on the key role his people and their civilian counterparts played, as Army Secretary John McHugh said, in preventing a “bad situation from getting worse."

             On that day, Maj. Nidal Malik Hasan, a psychiatrist at Darnell allegedly shot and killed 12 soldiers and one Army civilian and wounded 30 others at the post deployment readiness center.

           Speaking at the Association of the United States Army Medical Symposium and Exposition in San Antonio, Texas, May 19, Braverman said, although there were problems, “what happened that day saved lives, but that’s not unusual. That’s what we are trained for, prepared for.”

           Reviewing the time line from the first minutes of the shootings, he said the challenges facing the medical community involved the emergency response, incident management, consequence management, community assessment and care, and communication.

            He emphasized, “It’s all about communication. Medical care [of the wounded] was never an issue.”

            After the 911 call was received, the first responders, to include the police, secured the site and within seven minutes ambulances were on the scene, local community air and ground evacuation assistance was arranged, a hospital emergency operations center was stood up at Darnall and off-post civilian hospitals were on call to accept casualties.

            Five minutes after the call, the first casualties were evacuated, some in private vehicles, to the hospital where initial hospital care had been established and was functioning.

            During the initial minutes and hours, the challenges became a reality.

            Because of the volume of casualties, “the multiple-trained combat lifesavers and medics who arrived on the scene went into a combat mode without planned onsite triage,” he said.

            “Our reaction saved lives,” Braverman said, “but this was not the typical triage that we plan for.”

            There was also inadequate tracking of patients at the time of evacuation from the scene.

            “We needed to do a better job of keeping track of who went where, who went with whom. This was a lesson learned. We need to have an observer and all he does is track casualties.”

            Adding, “We recognized that we needed external support from outside [Fort Hood], … but there was no ‘off-the-shelf crises response plan for external support.”        

            Hitting again on communication, Braverman said, “The information requirements were so intense, we needed a liaison, using layman’s language, to get the information out.”

            Internal and external information sharing is the key to successful communication.

            This situation was so intense, “that everybody was calling. We lacked the [amount of] radios we needed to communicate and some radios didn’t work in the hospital, so we had to use runners to keep the information flowing,” he said.

            Adding, “We now have radios that work in the hospital.”

            As always, in an event of this magnitude, there are early media reporting inaccuracies.

            Within hours after the shooting, the III Corps and Fort Hood commanding general, Lt. Gen.  Robert W. Cone, convened a briefing with his commanders and key personnel to ensure the correct facts were being disseminated, civilian authorities and off-post medical staffs in the surrounding communities were informed and press conferences were scheduled for the now nationwide media coverage.

            “On your initial medial engagement, you must get the correct information out to counter inaccurate information and innuendo,” he said.

            Because so many casualties needed immediate medical attention and care within the first 12 hours of the event, teams, made up of chaplains, Darnall Medical Center staff members, Resiliency Campus personnel, behavioral health specialists, family life consultants and caregivers were assembled to assist with the wounded and their families – and the families of the deceased.

            The Fort Hood Resiliency Campus is an innovate approach that deals with soldier and family stress,  focusing on emotional, social, physical, spiritual, and family issues. The campus staff works to build stronger soldiers and families by making them more adaptable, more resilient.

              At Darnall, “We had to take care of our hospital staff,” Braverman said. Because Hasan, the alleged shooter, was a member of the hospital team, “many of our staff felt they were the victims – they felt betrayed.”

            Adding, “Caregivers need care too.”

            Following the second day and beyond, medical personnel concentrated on a variety of ways to improve the operation to include organizing external assets, crisis response teams and traumatic event management.

            And, in the area of communication, how to establish a more comprehensive, information sharing communication “unity of effort” that will produce improved updates and assessments in a synchronized manner.

            “We must have a unity of effort,” Braverman said, “not separate stove pipes. One man is in charge, the commanding general, and all information must go through him and through the command structure.”

            Fort Hood has developed a Behavioral Health Campaign Plan as a direct result of the tragic shooting spree.

            The mission: “III Corps leads the team effort to provide comprehensive, long-term support services to meet the physical, emotional and spiritual needs of the entire Fort Hood community in order to reduce the impact and enhance recovery from the shooting incident, while maintaining mission capability.”

            As the Army chief of staff, Gen. George W. Casey Jr., said to the Fort Hood soldiers and families the day after the shootings, “We take care of our own. We will stand and grieve as a family. We will stay focused on our missions around the world.”


Soldiers adapt to situations with the right skills, values and attributes

Hertling: ‘Do less things better’

 
Lt. Gen. Mark Hurtling says
47,000 soldiers are in initial
military training right now.
        Taking on an Army Times front page story headlined “Basic Goes Soft – Why the Army has Lowered the Bar Again,” the deputy commanding general, initial military training, U.S. Army Training and Doctrine Command, told the 2,000 attendees at the Association of the United States Army’s Medical Symposium and Exposition that the service is employing a rigorous, comprehensive training program for its volunteers. 

              “We are stressing ‘Do Less Things Better’ with the over 47,000 soldiers in initial training right now – more than the Navy, Air Force and Marine Corps combined. We are reframing the fundamentals to train the civilian to [become] the soldier,” Lt. Gen. Mark Hertling said May 18 at the Henry B. Gonzales Convention Center in San Antonio, Texas.

            Adding, “We are instilling the right skills, values and attributes in the trainee so the soldier can successfully adapt to the situations soldiers finds themselves in. We stress the skills not the flash – the doer not the Hooah.”

            Training – termed “Warrior Tasks and Battle Drills” – formerly involved 32 tasks, 207 sub-tasks and 12 battle drills under the headings “shoot,” “communicate,”  “urban operations” and “move and fight.”

            “This was,” Hertling said, “task paralysis – we were training too much and some of the tasks were not relevant [in today’s fight].”

            Based on the lessons learned from commanders and noncommissioned officers serving in Iraq and Afghanistan, TRADOC has streamlined the list that now consists of 15 tasks, 76 sub-tasks and four battles drills – under the headings “shoot,” “move,” “communicate,” and “survive and adapt.”

            The underling training focuses on four essential elements:

  • Combat Life Saver – Medical training and more field training so soldiers can take care of soldiers on the battlefield.
  • Marksmanship – More than weapons’ qualification, train to be more comfortable with a weapon under battlefield conditions. This training allows the soldier to fire more rounds.    
  • Combatives – The emphasis is on fighting skills that directly relate to combat.
  • Pugil Stick Training – This is man versus man in a realistic combat situation.

            Under the new concept of relevancy, Hertling said, “We have done away with the Bayonet Assault Course. This course did not reflect the training our soldiers need today [in the current combat environment].” 

            A serious issue facing the Army in its efforts to accept volunteers is BMI – the body mass index that measures body fat based on height and weight in both men and woman.

            “Obesity has tripled in the last three years,” Hertling said, “and some of our youth don’t even have PT (physical training) until they get into the Army.”

            Adding, “54 percent of males arriving [for service in the Army] have a BMI above 25 and are classified as overweight. Of those individuals, 35 percent have  body fat above 20 percent, 15 percent were above 25 percent body fat.”

            Of the females arriving, 41 percent were classified as overweight, 61 percent of those had above 25 percent body fat, 37 percent above 30 percent. 

            The Army has now standardized its Army Physical Fitness Program beginning at soldiers’ initial military training that not only conditions them for better PT scores on their tests, but also prepares them for the physical challenges they will face during combat.

            PT, coupled with the Soldier Nutrition Program, is viewed by the Army and its trainers as a recipe for physical fitness success.

            “Go for Green – Eat like an athlete, train like a pro, perform like a champion” -- the program encourages the soldier to select “frequently” high performance foods that are fresh and flavorful and nutrient dense, Hertling said. 
         

Stress and strain on soldiers, civilians, families must be relieved

Quality of  life, quality of care are the key

 
Lt. Gen. Rick Lynch says there
is 'stress and strain' on soldiers, civilians and families.

 

      “The stress and strain on the Army is the stress and strain on the soldier and on the family – and it is our job to relieve that strain,” the commanding general of the Army’s Installation Management Command (IMCOM) who is also the assistant chief of staff for Installation Management, told a capacity audience attending the Association of the United States Army’s Medical Symposium and Exposition.

      Speaking May 20 at the Henry Gonzales Convention Center in San Antonio, Texas, Lt. Gen. Rick Lynch said his command’s primary responsibility is to oversee the quality of life and the quality of care on the Army’s 163 installations located around the world.

            Lynch added, not only must that stress and strain on soldiers and soldier families be released and relieved, but especially during this time of war, “we also have a responsibility toward the Army’s civilian workforce and its families.

            “We are neglecting,” Lynch said, “our civilians and their families. They have the same stress.”

            Implementing an ambitious IMCOM Campaign Plan, Lynch said the focus now is to support senior installation commanders who set the policies at their respective installations.

            The plan has six “lines of effort.”

They are:

  • Soldier, civilian and family readiness
  • Soldier, civilian and family well-being
  • Leader and workforce development
  • Installation readiness
  • Energy efficiency and security safety

            To convert these “lines of effort” into realities, Lynch co-chairs the Services and Infrastructure Core Enterprise, or SLICE, that formulates “big ideas” such as the “integration of service programs, the revitalization of the Army Community Covenant and BRAC (base realignment and closure) implementation,” that directly affect key stake holders to include the commanders of Training and Doctrine Command, Forces Command, Materiel Command, Installation Management Command, Army Reserve and Army National Guard, to name a few.

            Looking at human capital, materiel, readiness and services, and infrastructure, one of SLICE’s goals is to furnish trained and ready forces for the combatant commander.

            “We must always ask ourselves: ‘Are we doing the right thing?’ ‘What’s missing?’” Lynch said.

            The integration of service programs’ “big idea,” is essential according to Lynch.

            “There are at least 163 separate programs managed by numerous commands that have no central control or means to measure return on spending. And, commanders, soldiers and families are frustrated trying to determine which program will help them.” he said.

            To address this redundancy, the Army is developing methods of measuring program effectiveness and, in this age of constrained resources, “value” to determine how to provide quality support services at reduced costs.

            The Army Resiliency Campus Concept is tackling this issue by implementing a structure that will house the basic programs needed to strengthen soldiers, civilians and families whether under one roof, in one area or in one community.

            “The emphasis,” Lynch said, “is on body, mind, spirit – and the senior commander can tailor the services to meet the needs of the installation’s population.”

            With a campus made up of a spiritual center, physical center, social center and wellness center, the needs of the soldier, civilian and family members can be assessed to solve the problem or address the issue.

            At the present time, the Army has 19 wellness centers – 14 in the continental United States and five in Europe – that offer solutions through “core programs” to include metabolic testing, basic nutritional education, a human performance lab, tobacco cessation, and stress and weight management.

            Lynch said, “Our Wellness Centers create a holistic environment that addresses all aspects of health and wellness,” – physical, mental and spiritual.

            The center has the resources to administer health risk assessments, provide appropriate counseling and generate referrals as needed.

            Another tool is the Army’s Comprehensive Soldier Fitness Program, based on a 30-plus years’ scientific study that employs individual assessments, virtual training, classroom training and embedded resilience experts to provide the critical skills soldiers, family members and Army civilians need to cope with the stress and strain of deployments and separations.

            The Global Assessment Tool, an integral part of the program , determines the root causes of the problem – be it a broken relationship or financial issues – and provides an online survey-based assessment tool.

The results are confidential and are never reported to a commander or those in leadership positions.

            This initiative, that will, according to the Army chief of staff, Gen. George W. Casey Jr., “build the resilience and enhance the performance of every soldier, family member and DA civilian,” by identifying the problem in advance -- not allowing it to develop into a serious situation.

            “We must spend more time preventing the problem than on after action reviews,” Lynch said.

            In closing, Lynch said to the audience of U.S. Army Medical Command personnel, “What you are doing on a daily basis is magnificent.”

            The symposium and exposition is a professional development forum produced by the AUSA Institute of Land Warfare and the Association’s Industry Affaires Directorate in cooperation with the Army surgeon general and the U.S. Army Medical Command.