United States Army Medical Department Center and School: Supporting soldiers into the 21st century, The

Military Medicine, Sep 2003 by Kiley, Kevin C

Good afternoon. It is a real pleasure and honor to be here to speak about the AMEDD [Army Medical Department] Center and School and to review a few Army training initiatives. Fort Sam Houston is the home of Army medicine and at any one time we are training 3,000 to 4,000 soldiers to be medics of all kinds. They are a unique group of great young Americans.

I would like to run through a couple of things here for you and then open it up for questions. I'm very proud of what we have [been] doing at Fort Sam [Houston] and the [AMEDD] Center and School. It is probably the largest health training organization in the world, if you consider all of our different programs. And I think you'll see the importance of that when we talk a little bit about the combat medic, important at least to the Army.

The AMEDD is supporting not only our homeland defense and what's going on over in Afghanistan, among other places, but [is] still very heavily involved in beneficiary care. I think an interesting and fast-moving subject right now is our homeland defense CBRNE [chemical, biological, radiological, nuclear, and explosive devices] operations and consequence management. The Center School is doing some aggressive training, as well, not only at Fort Sam but across the rest of the Army medical department in our Table of Operations and Expenditures (TOE) and Table of Distribution and Allowances (TDA) units, ensuring that people are trained to manage CBRNE incidents on or off their posts. I think some of the traditional posse commitatus [limitations] which [prohibit] military [involvement] except when invited in under specific circumstances are blurring a little bit based after what happened on September 11, 2001.

You may not know a lot about the AMEDD. [We have nearly 3 million beneficiaries, and spend more than $18 million daily on health care.] Our TOE [generally referring to Army operational field units] units and TDA [referring to nontactical fixed facilities] facilities are fewer in number than [they] were 5 or 7 years ago. TRICARE certainly picked up the slack, and we now have TRICARE For Life [provides effective coverage for our older retirees.] There is a lot happening in the AMEDD in any one day, including, on average, 5,000 immunizations and 63 births. It is a busy organization. [In addition], the AMEDD is [the] executive agent for the anthrax vaccine program. We have all of the veterinarians in the Department of Defense. We have oversight for and assist the Board of Directors in the AFIP [Armed Forces Institute of Pathology] and the Armed Services Blood Program. There are 22 more activities for [which] we are Executive Agent. Our bottom line business is providing good medicine in bad places.

What I would like to [emphasize regarding] Army medicine is that it is not just a concept of logistics. It is a lot more. It starts with our combat soldier and from our perspective that is what we are all about. Combat soldiers will not go into combat without medics and medical support. Once someone is injured, be it disease, nonbattle injury or battle injury, it begins a fairly complex process.

[I will give you an example of] how complex this process is. A couple of years ago, at a conference here, I was asked to sit on a panel with General McDuffy, who was the J-4 at the time, along with several other service representatives. He talked about the Kosovo operations, [in which] one of the helicopters had lost a hydraulic pump, and they had had enough velocity logistics and asset visibility to get a replacement pump down from Europe. Once they had done all that and repaired the helicopter, they realized they could have gone right off the coast to a Marine Amphibious Unit [who] had extra pumps. [They] knew they would have to get better at that.

Well, I took his example and [related it from] a medical [perspective]. My view of combat medicine is that the helicopter has got a pump that's failing. It's sitting on a landing zone. It's still at idle, the crew is still on board, and you have 12 hours to get the pump there. [You must] replace the pump while the engine is still running and if you fail anywhere in that mission, all four crew members will die. It's a whole order of complexity more than the rest of the Combat Service Support Community is really accustomed to having to deal with, but it's hard to articulate that.

It has been interesting to see what has transpired in Afghanistan. We just brought a couple [an] FST [Forward Surgical Team] commanders and surgeons in, who had just come back from Afghanistan or Kuwait and performed an after-action review (AAR) with them. [This AAR] included the Joint Trauma Training Center at Ben Taub [General Hospital, Houston, TX], which is training FSTs and surgeons in the high-trauma, combat-like environment of the inner city. [The] Army is also training in Miami, while the Air Force uses Baltimore, and I think the Navy is going to be [in] Los Angeles.

Did the Joint Trauma Training Center have relevance as a training capability to what we were doing in Afghanistan? Frankly, I was a little surprised. I thought this would have fit nicely. You spend 4 to 6 weeks at Ben Taub, and [have the opportunity] to resuscitate seriously injured patients. [However,] the injuries the FST was seeing in Afghanistan were mostly explosive peripheral injuries with a lot of shrapnel and high-velocity weapon trauma because of the body armor and the types of munitions need. What we're seeing in Miami is lower-velocity thoracic and abdominal injuries [from] bullets, knives, and motor vehicle accidents. As a result, where I thought there would have been a very nice correlation, there still seems to be a potential disconnect. However, the ability to learn and take care of patients that are severely injured is still there as a benefit JTTC.