By Lt. Gen. Thomas W. Travis, Surgeon General, United States Air Force
U.S. military forces, now in the second decade of war, benefit from the vast achievements Army, Navy and Air Force medics have jointly made in deployed and enroute health care since 2001. With a 96% survival rate, we have never been better prepared to support our war-fighters. The great majority of our military medics have joined the military during this shooting war, and they have performed magnificently. War creates a readiness and training imperative and opportunity. The current war, now beginning to wane, has put military medicine center stage as an incredibly effective part of this nation’s operational capability. This is a hard-earned and well-documented “identity” for military medics. After this war, while we rightly focus hard on cutting the cost of healthcare as an increasing percentage of the DoD budget, we must not turn away from preparing for the next war, when our nation will expect us to be just as good as, if not better than, we were in this one.
With the end of the war in Iraq and the drawdown of forces in Afghanistan, our real-time, real-world, theater hospital training platform is diminishing. We rejoice that casualty patient movements have dropped significantly. But how do we sustain our position on the cutting edge of trauma care and aeromedical evacuation, ready for the next war, ready to provide “Trusted Care Anywhere?” What will we look like in the future? Averting this potential “identity crisis” depends on the answers to these questions.
Clearly, our post-war medical forces must stay ready through their roles in patient-centered, state-of-the-art, full-tempo health services that ensure competence, currency and satisfaction of practice, as well as foster innovation. Meeting these objectives requires sharp focus on readiness, better care, better health and best value.
Our most valuable readiness asset is our people — they must be and deserve to be in the best physical, psychological and emotional health to meet the challenges both at home station and in the AOR. As medics, it is our core competency to be current, trained, and equipped to provide full-spectrum care, no matter what or where the military operation — combat operations, stability operations, humanitarian assistance or disaster relief. To enhance our core competency on the ground and in the air, we’re pursuing major modernization initiatives.
In the past year, we’ve successfully tested and deployed our Expeditionary Medical Support Health Response Team (EMEDS-HRT), which replaces our former EMEDS Basic as the first element of EMEDS capability. The HRT provides initial operating capability within 15 minutes, emergency-room care within two hours, operating-room capability within four hours, critical care within six hours and full operating capability within 12 hours. The HRT allows us to tailor clinical care to the mission, adding specialty care and International Health Specialist components for humanitarian assistance or disaster relief missions. Ten HRTs are now postured for deployment.
Globally, almost 182,000 patients have been moved since 9/11, including more than 8,200 high-acuity patients moved with Critical Care Air Transport Teams (CCATTs). These teams provide intensive-care support in-flight to our high-risk patients and have proven to be a major contributor to the lowest died-of-wounds rate in our nation’s history.
Taking the next step toward raising the survival rate, the Air Force Medical Service (AFMS) has developed and deployed Tactical Critical Care Evacuation Teams (TCCETs) that provide emergency trauma care on rotary-wing aircraft beyond that provided by field and flight medical personnel. TCCETs represent the Air Force’s initiative to close the critical care gap and ensure continuous critical care en route from forward stabilization to definitive care. Two teams are deployed in theater, allowing even more expeditious movement of critical patients between Level II and Level III facilities.
To keep our trauma and CCATT providers current and ready for the next conflict, we will be relying even more upon the outstanding civilian partnering programs established at our Centers for the Sustainment of Readiness Skills (C-STARS) in Baltimore, Cincinnati and St. Louis, where exciting advances in training and research are taking place, such as the new TCCET course at C-STARS Cincinnati and expanded integration of medical simulation at all our sites. We also must meet the significant challenge of clinical and aviation exposure for our aeromedical evacuation crews.
As we prepare for the future, human performance and human systems integration will be even more critical factors in the evolving way we fight wars and must influence the evolution of medical support for operators. We must better support our “deployed in place” airmen who are staffing systems such as the distributed communication ground stations, space and cyber operations or remotely piloted aircraft (RPA), in addition to those who operate “outside the wire,” such as our Special Operations Forces or Explosive Ordnance Disposal (EOD) specialists. The types of injuries or stresses — both visible and invisible — to members and their families are evolving, too. We must provide medical support in different ways than we have in the past to address the expanding definition of “operators” and step up to our role as human performance practitioners, assuring airmen are able always to perform their missions effectively. We are engaging in many human performance research initiatives across the AFMS to further this goal as well as research in a broad spectrum of clinical, information/technology and operational projects to ensure the care we provide remains state of the art.
Achieving “Better Care” mandates that we provide reliable access to safe, quality care for everyone we serve, promoting positive patient experiences and outcomes. To do this, we must be consistent and reliable in ensuring our staff focuses on patient safety first and use evidence-based practices in the provision of quality care.
With more than 1 million patients enrolled, Air Force Patient-Centered Medical Home (PCMH) has made significant inroads into greater continuity of care and improved patient and provider satisfaction. To support PCMH, we implemented secure messaging, now deployed to one-third of our medical treatment facilities (MTFs), with the remainder coming on board this year. This technology gives us a secure online communication system that allows patients to contact their primary-care clinics for medical advice, appointments, prescription renewal and laboratory results. In 2013, we will give our patients access to personal health records via secure messaging, making our patients full partners in their health care.
“Better Health” requires us to encourage healthy behaviors through a culture of enhancing resilience and human performance, while reducing illness and injury. We are working hard with Air Force leadership to inculcate healthy behaviors in our airmen and help them to cope with the mental-health stressors they experience. Comprehensive Airman Fitness focuses on building strength across physical, mental, spiritual and social domains. Airman Resilience Training, for example, provides a standardized but flexible approach to pre- and post-exposure training for deploying airmen and reintegration education for redeploying airmen. The Deployment Transition Center (DTC) at Ramstein AB, Germany, has assisted almost 5,000 high exposure airmen (along with some Marines and coalition partners) since its doors opened more than two years ago. Research from DTC surveys have shown lower rates of post-traumatic stress, interpersonal conflict and alcohol use in attendees after returning home.
In conjunction with these resiliency efforts, we are implementing multiple initiatives to improve access to mental healthcare, including the Behavioral Health Optimization Program (BHOP), which embeds mental-health providers within the primary-care clinics of each MTF, and the Mental Health Integration Program, a demonstration project to evaluate placing full-service mental-health capability in PCMH at two of our MTFs. To support the unique “telewarrior” mission, we also are placing mental-health resources at our largest RPA/intel bases, attached to flight medicine.
Better Health also requires the AFMS to meet the health challenges of our returning wounded, ill and injured suffering from the apparent physical injuries to the invisible wounds such as traumatic brain injury and hearing loss. At the same time, we must be concerned with nationwide health issues that affect our airmen and their families just as in the civilian sector, such as the increasing rates of obesity and chronic illnesses. We continue to work with our service counterparts and civilian partners to address these issues, through research, education and best practices.
The Air Force is united with our Army, Navy and Defense Department colleagues in streamlining the Military Health System governance system. Implementation planning is under way to affect change beginning in 2013, to include consolidating and standardizing redundant processes and services. We are all committed to collaborating on shared services where it makes sense to lower healthcare costs and improve joint interoperability without abandoning our important service command structures and doctrinal role differences.
Even in austere fiscal times, readiness, better care and better health cannot be scoped solely on funding if we are to achieve and maintain a healthy, ready, fighting force. Best value means seeing a clear return on investments, which must be constantly measured, reported and adjusted. We are heavily engaged in identifying the best processes, optimizing existing services and pursuing continuous improvement to deliver the healthcare mission efficiently, effectively and safely, while maintaining the readiness edge. Building a solid, sustainable foundation for the way ahead, while recognizing there is a cost to maintain readiness, is a crucial next step as we prepare for an uncertain future while establishing ourselves as an agile, versatile and innovative medical force.