- Introduction: A Top-Level Look at the Future of Federal Medicine
- Military Health System in Time of Transition as Conflicts End
- Army Medicine: Redefining Its Role in the Generation of a Ready and Resilient Force
- Air Force Medicine: Averting an Identity Crisis
- Moving Forward with Reforming the Indian Health Service
- The Clinical Pharmacy Specialist's Growing Provider Role in VA
- Public Health Service Pharmacy: Accelerating Transformation
- Military Pain Management’s Future: Less Invasive, More Data-Driven Techniques
- Navy Medicine: Strong, Agile and Ready
- Telemental Health in VA: A New Source of Support for Veterans
Medical Lessons Since 911 Impact Patient Care Aeromedical Evacuation Cont.
Maj. Travis Girlach, MD, installs a central line into a patients chest to relieve pressure from fluid at the Craig Joint Theater Hospital, Bagram Airfield, Afganistan. - U.S. Air Force photo by Sr. Airman Sheila deVera
Make no mistake; we have had lots of help getting to this point. We have partnered with medical schools, federal and private-sector facilities to leverage both our and their skilled work forces to help prepare us for the future. Among them are our Centers for the Sustainment of Trauma and Readiness in Baltimore, Cincinnati and St. Louis that provide our medics state-of-the-art training required to treat combat casualties. New relationships have been formed with Scottsdale and Tampa General Hospitals. We continuously work to incorporate these capabilities and lessons learned into the entire spectrum of care.
In our AE system, we want to improve the ability to move patients with blast-lung injuries. Till now, our ventilators have not been capable enough to move someone for the six hours required in flight, so they must remain in theater longer. Some of the new ventilators are much more capable of enabling us to move these patients sooner. We also have looked at different ways to do heart-lung machine support, such as utilizing oxygenation through the Novalung and through extracorporeal membrane oxygenation (ECMO). We want to see if we can miniaturize that equipment and make it available without having a special team to run it. These types of efforts are geared toward resuscitating patients more quickly in the field and bringing the sickest patients back home quickly and safely.
Our on-the-ground response has evolved with our new EMEDS Health Response Teams (HRT). These newly tested and proven packages enable us to arrive in a chaotic situation, set up and see the first patient for triage and early emergency care within 30 minutes of arrival and perform the first surgery within three to five hours. The HRT already has been used successfully in a humanitarian mission and will be our standard package in providing rapid battlefield medicine.
As we enter 2012, and during my final year as Air Force Surgeon General, I would like to see a lot of things completed that are now in motion. Foremost among them is modernizing our air-evacuation capabilities and EMEDS and completing training modules for these new capabilities. We also are continuing to make great strides in our Patient-Centered Medical Home concept to enhance quality of care.
The centerpiece of providing patient care and “Trusted Care Anywhere” is our Patient-Centered Medical Home. This program, which has more than 700,000 enrollees, allows better continuity of care for our patients. Previously, provider/patient continuity was about 40%; now, our patients are seeing the same provider 75 to 85% of the time. This patient/provider continuity makes a huge difference in terms of our ability to build a relationship of trust with our patients. We want to enhance this relationship even further over the next six months, when we roll out Secure Messaging, which will allow our patients to talk with their doctors by e-mail in a secure forum. Soon, our patients will be able to access a personal-health record. They will be able to view lab tests and X-rays on their home computers. It’s about making the patient a much more active participant in their healthcare.
Medical Homes are about building relationships between providers and patients, establishing trust and making the patient an active participant in their own healthcare. We have been working on this concept for almost 10 years. By this summer, we’ll have 1 million patients enrolled. We link patients and health teams to activate patients to be more involved in decisions regarding their health. This has huge possibility to change medicine.
An aeromedical evacuation crew carries wounded warriors aboard a C-17 Globemaster III aircraft at Ramstein Air Base, Germany, for a flight to Andrews Air Force Base, MD, to receive advanced-level care in the United States. (DoD photo/Donna Miles)
We are linking these capabilities to precision care. If you’re willing, we’ll take your genetic material and study it. Information from this genomic analysis that might pose a risk to your health will be shared with you. De-identified databases will allow us to advance research efforts. Research groups can determine associations or a specific area where they think there may be merit in terms of how we can change clinical practice. This type of research will likely change the way we think of disease.
Like you, I will never forget Sept. 11, 2001. I could not have foreseen the changes that would occur in combat medicine as a result of that day. As the nation rallied in support of the victims of the tragedies, so too did the men and women of the Air Force Medical Service. As I reflect on the past 10 years, I believe our medics epitomize the best of what America has to offer. They will continue to advance the art and science of medicine as they provide “Trusted Care Anywhere.”