It is my privilege to lead more than 70,000 highly

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1 Army Strong AMEDD Strong NCO Strong By LTG Eric B. Schoomaker Commanding General, U.S. Army Medical Command and The Surgeon General of the Army It is my privilege to lead more than 70,000 highly trained, highly motivated professionals in a $10 billion international health promotion and healthcare delivery command. U.S. Army Medical Command (MEDCOM) protects our warriors from illness; treats and rehabilitates wounded, ill and injured soldiers on the battlefield and in garrison; trains, develops and equips medics to perform effectively across the full spectrum of operations; maintains the health of soldiers families; advances medical science through research and development; and cares for retired servicemembers and their families, all with responsible stewardship of taxpayer resources. In 2009, the Year of the Noncommissioned Officer, we take special notice of the contributions of our NCOs, who make up 18 percent of the Army Medical Depart- October 2009 ARMY 145

2 SPC Andrew Lee, a medic with the 325th Combat Support Hospital, applies a tourniquet to a wounded leg during the Army Reserve s Global Medic Exercise. ment (AMEDD) and play critical roles in every aspect of our support for the Army family. With a worldwide mission covering the entire range of health-care services from garrison to the battlefield and home again, we need a tool to synchronize and focus our efforts. We use the Balanced Scorecard, which keeps everyone working toward the same goals and avoids wasted effort. I d like to highlight some of the things AMEDD is doing to achieve the six strategic ends identified on our scorecard. Improved Healthy and Protected Families, Beneficiaries and Army Civilians We are dedicated to providing patients the right service at the right time in the right venue on the battlefield, in our garrison medical treatment facilities and through the TRI- CARE networks. We are determined to identify and remove barriers in access to care, realizing that some will have relatively simple solutions, while others will require more time. The MEDCOM AHLTA provider satisfaction initiative is smoothing some of the rough edges in DoD s electronic health record system (known as AHLTA), making it easier for providers to use. As a result, patients will see more effective and timely health care, better patient safety and improved record security. To better support our transforming Army, we are restructuring Medical Command from four regional medical commands in the continental United States to three regions aligned with supporting TRICARE regions. This will allow us to more effectively synchronize our efforts with our TRI- CARE managed care support contractors in order to better LTG Eric B. Schoomaker assumed command of U.S. Army Medical Command and became the Surgeon General of the Army in December LTG Schoomaker previously served as the commander of Walter Reed Army Medical Center and the North Atlantic Regional Medical Command. He has also commanded U.S. Army Medical Research and Materiel Command and Fort Detrick, Md.; Southeast Regional Medical Command and Dwight David Eisenhower Army Medical Center, Fort Gordon, Ga.; the 30th Medical Brigade headquartered in Heidelberg, Germany; and Evans Army Community Hospital at Fort Carson, Colo. He has also been chief of the Army Medical Corps. In 1979 he began his Army career as a research hematologist at Walter Reed Army Institute of Research. He has also served as assistant chief and program director of the Department of Medicine at Walter Reed Army Medical Center; medical consultant to the Headquarters of 7th Medical Command, Heidelberg, Germany; deputy commander for clinical services at Landstuhl Army Regional Medical Center, Landstuhl, Germany; chief and program director of the Department of Medicine and director of primary care at Madigan Army Medical Center, Tacoma, Wash.; director of medical education for the Office of the Surgeon General/Headquarters MEDCOM conducting a split operation between Washington, D.C., and Fort Sam Houston, Texas; director of clinical operations at MEDCOM Headquarters, Fort Sam Houston; and command surgeon for U.S. Army Forces Command, Fort McPherson, Ga. LTG Schoomaker received a BS from the University of Michigan at Ann Arbor and his medical degree from the University of Michigan Medical School. He completed his Ph.D. in human genetics in He is certified by the American Board of Internal Medicine in both internal medicine and hematology. He has completed the Combat Casualty Care Course, Medical Management of Chemical Casualty Care Course and AMEDD Officer Advanced Course, and has graduated from the Command and General Staff College and the U.S. Army War College. 146 ARMY October 2009

3 integrate private-sector care as well as support Army force generation and improve readiness. We also are combining elements of the Veterinary Command and the U.S. Army Center for Health Promotion and Preventive Medicine into a Public Health Command for unified control of publichealth assets and a synchronized effort toward protecting and advancing the health of our beneficiaries and communities. Whether ensuring safe and healthy food, controlling zoonotic diseases, identifying toxic materials that present a hazard or educating people about healthy lifestyles, our preventive medicine forces are truly on the front line of efforts to build and maintain a healthy Army family. Optimized Care and Transition Of Wounded, Ill and Injured Warriors As the Secretary of Defense has stated, aside from winning the war we have no higher priority than the care of our wounded, ill and injured warriors our warriors in transition (WTs). Having established an effective system of 36 distributed Warrior Transition Units (WTUs) at major installations and medical treatment facilities and nine community-based WTUs with the Army National Guard across the nation, this year we are focusing on individual WT plans for transition to the next phase of life and work. This year we launched the Comprehensive Transition Plan initiative for WTs. A team of physicians, case managers, specialtycare providers and rehabilitative therapists, together with the soldier and his or her family, develops an individually tailored goal to help that soldier return to duty, make the transition to civilian life, or continue rehabilitation through the Veterans Health Administration or civilian medicine. We recently activated the provisional Warrior Transition Command, led by BG Gary Cheek, a career Artillery officer, and his senior enlisted advisor, SGM Ly Lac. This command provides policy oversight to warrior transition units and coordinates programs that benefit wounded, ill and injured soldiers and their families. MEDCOM employs ombudsmen who operate independently, answering to MEDCOM and the Army for service to wounded warriors and their families, cutting through red tape. These ombudsmen, most of whom are former medical noncommissioned officers, know the system. They work with the triad of leadership hospital commander, installation commander and Warrior Transition Unit commander to ensure that the needs of soldiers are met. The MEDCOM Soldier Transfer and Regulating Tracking Center (STARTC) supports the Warrior Transition Command and Warrior Transition Units with the timely transfer of recovering warriors closer to home. The STARTC conducts global patient tracking and assists in redistribution of warriors to and between units. Improved Healthy and Protected Warriors In addition to the efforts previously mentioned in establishing a Public Health Command to ensure an injury and illness-free Army community, in 2009 MEDCOM continues to support the Army leadership s efforts to improve the mental health of the Army. We are making bold, sustained efforts to improve soldier and family resilience, reduce any stigma associated with seeking behavioral health care, and provide multidisciplinary care addressing specific behavioral-health needs promptly and expertly. Research initiatives, including the Walter Reed Army Institute of Research Land Combat Study and annual Mental Health Advisory Team missions to theater, guide efforts to provide behavioral-health support. A wide range of initia- William Kyle, physical evaluation board (PEB) liaison officer at Fort Hood, Texas, explains the PEB process to a soldier. October 2009 ARMY 147

4 SGT David Dasilma, Pacific Regional Medical Command, and SPC Jonathan Jordan, Great Plains Regional Medical Command, were named the winners of the 2009 U.S. Army Medical Command NCO and Soldier of the Year Best Warrior competition held at Madigan Army Medical Center and Fort Lewis, Wash. tives are under way to meet that need, including Battlemind Training, post-deployment health assessments and reassessments, combat stress control units, and the hiring of more behavioral health-care providers. Details are available at We are working with the Army Staff on initiatives to reform the Medical Evaluation Board and Physical Evaluation Board processes, to reduce the number of soldier suicides, and to introduce a comprehensive soldier fitness program that will improve all-around fitness the way we have traditionally maintained physical fitness. Veterinarian CPT Elizabeth Williams (left) and PFC Roderick Aldrich, both from the 218th Medical Detachment (Veterinary Service), prepare Kitti, an Air Force military working dog, for repair of a damaged tooth at an air base in Southwest Asia. 148 ARMY October 2009 Responsive Battlefield Medical Force War requires agility and adaptability, and so does the medical response to war. We used to talk about getting care to a patient in the golden hour, the first hour after injury. Now we are focused on the platinum 10 minutes when the combat medic provides immediate lifesaving care. The AMEDD Center and School gathers lessons learned from the battlefield and incorporates them into training so that our medics can be as prepared as possible for what they may face in combat. This training along with new technology such as tourniquets, bandages that promote lifesaving blood clotting, airway devices and a longer needle for decompression of chest injuries has saved many lives. Medical simulation training centers give our medics the benefit of the most advanced, realistic training to prepare for combat. In a recreated battle atmosphere, they treat wounds on mannequins that breathe, bleed and react and die if treatment is incorrect. New medical evacuation policies, supported by data collected by a special project of the Joint Theater Trauma System, are delivering soldiers to treatment facilities faster and in better medical condition, reinforcing our commitment to the best and most timely care. One development of the past year I must note is the awarding of Combat Medic Badges to members of air ambulance crews. Previously reserved for medics who served in combat with ground units, this award now also recognizes the heroism of medevac per-

5 U.S. Army Medical Command s SPC Daniel Farrier moves a casualty along before engaging targets during the Department of the Army Noncommissioned Officer and Soldier of the Year Best Warrior Competition. sonnel like SSG Matthew Kinney and SSG Peter Rohrs, both of whom received the Silver Star in the past year for rescuing wounded troops under fire in Afghanistan. Improved Patient and Customer Satisfaction Our performance-based adjustment model (PBAM) provides financial incentives for our medical treatment facilities to improve efficiency, patient satisfaction and quality. As a result, the Army is the only military service to achieve planned workload gains every year since Of equal importance in our incentives under PBAM are rewards for providing the right kind of care either care that complies with the most rigorously, scientifically proven care ( evidence-based practice ) or care that provides the best clinical outcome for the patient what we all want from encounters with practitioners in our system of health care. Congress has been extraordinarily generous with military medicine and the Army over the past year. We now have funding to build new hospitals at Fort Benning, Ga.; Fort Riley, Kan.; and Forts Hood and Bliss, Texas. Terrific new joint service facilities are being built in San Antonio, Texas, and the National Capital Region. This is the largest investment in modern hospitals in the past two decades. 150 ARMY October 2009 The quality of our facilities is a tangible demonstration of our commitment to military families and our medical staffs. As a result of such initiatives, a recent survey reported that more than 60 percent of TRICARE Prime enrollees rated their health plan at an eight or above on a scale of zero to 10, leading the nation in satisfaction with private and public managed care programs. Inspire Trust in Army Medicine Patients trust in our care and service is an essential part of our caring for them it is an irreplaceable element of any covenant between patients and caregivers. Our people are critical to the success of Army Medicine. They experience the rewards of performing the AMEDD mission, are privileged to provide care for the best patients in the world, see the quality of people with whom they work, and commonly conclude they can have no better career. Thus MEDCOM is one of the leading Army commands in retention. Most of our regional medical commands completed their fiscal year (FY) 2009 retention missions in March. Getting people into Army Medicine to begin with is a challenge, as there is great competition for people with the skills and dedication we require. Army Recruiting Command created a medical recruiting brigade last year, uniting the command structure for battalions that recruit for AMEDD. They recruited 108 percent of mission for health-care professionals during FY We also have a civilian human resources and recruitment branch within MEDCOM working on our equally hard-tofill civilian professional positions. Let me cite one example of the kind of warrior-medics we have. SSG Christopher Waiters received the Distinguished Service Cross for heroism when a Bradley fighting vehicle was hit by an improvised explosive device near Old Baqubah, Iraq. He ran through enemy fire and climbed into the burning vehicle four times. His clothes were charred, the bottom of his boots melted and 25 mm rounds were cooking off inside the vehicle, but he kept going back until he had retrieved two wounded soldiers for treatment and the body of another soldier who was killed. Such courageous, skilled, dedicated and devoted people are a constant inspiration to me and AMEDD is full of them. We are Army Strong, AMEDD Strong, NCO Strong working every day for our great warriors, their families and the retired soldiers who have given us so much. There is no nobler calling.