Army medicine’s Top 10 List 


Doctor and patient 
Dr. Richard Erff, chief of the Carl R. Darnall Army Medical Center Pain Clinic, Fort Hood, Texas, administers cervical epidural steroid injections to a soldier to treat back pain.  Army Surgeon General Lt. Gen. Eric B. Schoomaker has identified soldier medical readiness, a comprehensive behavioral health system of care and building a culture of trust among his top Initiatives for Army medicine.

The Army surgeon general, Lt. Gen. Eric B. Schoomaker, has announced his "Top 10 Initiatives for Army Medicine."

They are:

  1. Soldier medical readiness
  2. Comprehensive behavioral health system of care
  3. The Culture of Trust
  4. Implementation of mild TBI/concussive injury protocols
  5. Development of medical home implementation
  6. Pain Management Task Force/comprehensive pain management
  7. Implementation of the U.S. Medical Command/Office of the Surgeon General elements of health promotions and risk preventions
  8. Base realignment and closure (BRAC) completion and transition
  9. Physical Disability Evaluation System legislative initiatives for the Army chief of staff
  10. Army medicine’s role in enterprise transition.

When the 10 initiatives were announced, several were given special attention by Schoomaker.

Soldier medical readiness

Soldier medical readiness is spearheaded by Maj. Gen. Richard A. Stone, Army deputy surgeon general for mobilization.

This program ensure that all deploying soldiers are medically and psychologically fit, and returning soldiers receive quality assessments to identify any medical or psychological conditions and to provide evaluation and treatment services.

"There’s a substantial effort on the part of the Army to really move the physical disability evaluation system, which is also on the Top 10, on to the next level, and that is to get us, as a medical command, out of that process and really move us to a fitness-for-duty evaluation and pass on to the VA the physical disability adjudication," Stone said.

Comprehensive behavioral health

In the years since the U.S. became engaged in the war on terror, behavioral health care providers across the Army have developed innovative ideas and programs, Col. Rebecca Porter, chief of the Behavioral Health Division, Office of the Surgeon General, said.

In 2006, the Army established a readiness model, called Army Force Generation, which is designed to efficiently generate trained and ready forces for combatant commanders at sustainable levels, Porter said.

A year ago, the Army Medical Command (MEDCOM) established the Comprehensive Behavioral Health System of Care, or CBHSC, working group to standardize and coordinate care across the Army, she said. She added the objective was to optimize care and maximize limited resources to ensure the highest quality care to soldiers.

Currently, CBHSC is working to develop an integrated behavioral health information-technology system that will facilitate the use of standardized clinical data to optimize care, according to a chart Porter showed conference attendees.

It also showed that her organization is working to identify best practices, fully integrate all reserve and guard components, and fully synchronize tele-behavioral health support.

TBI/concussive injury protocols

Unlike a severe Traumatic Brain Injury, a concussion or mild TBI may not be readily identified, Col. Barbara Springer, director of the Rehabilitation and Reintegration Division, Office of the Surgeon General, said.

Recognizing the importance of early detection, the Department of Defense and Department of Veterans Affairs have established system-wide screening and assessment procedures to identify concussion/mTBI in service members and veterans, she said, at the soonest opportunity and through multiple points of care.

"The reason why this was put into place is because soldiers will not take themselves out of the fight, just like athletes won’t take themselves out of the game. So we had to put in policy to ensure that everybody is checked out," Springer said.

Currently in Afghanistan, there is a network of advanced concussion care resources, she said.

"For example, the Army stood up three Level II concussion-care restoration centers in Regional Command – East." The Army will stand up three more in Regional Command –South.

"And these restoration centers are really vital because they will keep soldiers in the fight," Springer explained. "They can come in and get the care they need for their initial symptoms, because most concussions will get better within hours or a couple of days.

"If they do need more care, then they can go to Level III Concussion Care Programs and that’s where advanced neuro-imaging and advanced special services are available."

Adding, "Also, there are neurologists, neuro-psychologists, occupational therapists and physical therapists who all work together to help keep our forces strong. These folks are also supported by TBI Tele-Health throughout the region."

The soldiers will be educated, she said, so that they know what TBI is, understand the symptoms, and know they will get better.

"We will be remembered in this war for many things," Schoomaker said.

"[We’ve had] many improvements on the battlefield, not the least of which is trauma improvements, and medevac and infectious diseases, but [also for] our ability in the field in what’s been called CPR for the brain so that a soldier or warrior in combat will receive prompt care, evaluation and rehabilitation as close to the point of injury as possible.

"I think [this] will have a dramatic effect on reducing long-term consequences, both physical and psychological, on 21st century warfare," Schoomaker said.

Comprehensive pain management

"Effective management of pain from the battlefield back, I think, is going to have implications that far go beyond the immediate relief of pain," Schoomaker said.

During the past nine years of conflict, and because soldiers have been arriving back home in pain, the Army community, with partners in the Air Force and the Navy, began a number of initiatives to deal with this problem Col. Chester Buckenmaier, Army regional anesthesia and pain management initiative director, said.

"We have a pain infusion system out on the battlefield for the first time in history," Buckenmaier said. He added Schoomaker realized that pain issues also had to be addressed at stateside facilities and even VA and civilian hospitals.

Pain continues to be the number-one reason people seek medical care in the United States.

"I chartered the Pain Management Task Force in August 2009 to provide recommendations for an Army Medical Command comprehensive pain-management strategy that is holistic, inter-disciplinary and multi-modal in its approach; uses state of the art/science modalities and technologies; and provides optimal quality of life for soldiers and other patients with acute and chronic pain," Schoomaker said in an article in "U.S. Medicine," a monthly publication serving health care professionals.

Since then, the Comprehensive Pain Management Campaign Plan was published last September, and a pain workshop was held at the Special Operations Medical Association Conference in December.

Regional medical centers will continue to standardize interdisciplinary pain management centers, a pain education curriculum will be implemented, and establish an integrative medicine consultant, Buckenmaier said.

The Culture of Trust

"Each of these programs reinforces our commitment to the needs of our patients and will be implemented based on the foundation of trust," Schoomaker said in the "U.S. Medicine" article.

A Culture of Trust, Schoomaker said, is a shared set of attitudes, values, and practices that distinguish Army medicine’s commitment to its beneficiaries to provide the highest quality and access to health services.

"It is based on confidence – confidence that we are competent, capable and committed; that we will tell the truth and keep our promises.

"Trust, along with transparency, creates the conditions in which our internal talent thrives, our patients receive the best care, and our stakeholders trust that we, Army medicine, deliver what we say we will deliver," he said.

The Culture of Trust is being implemented and the phased roll out will consist of on-site training, skill building and other training initiatives, Schoomaker said.

"The Culture of Trust supports our vision of bringing value and inspiring trust. Trust is the foundation of Army medicine, and I have charged Maj. Gen. Patricia Horoho, deputy surgeon general, to champion a Center of Excellence to execute a unified strategy, standardizing processes and improving customer-service processes, focusing on outcome measures, and strengthening our Culture of Trust," Schoomaker said. (Based on a story from ARNEWS.)