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International Partnerships Foster Improvements in Military Health Care

Dr. Smith presenting at a podium U.S. Deputy Assistant Secretary of Defense for Health Readiness Policy and Oversight Dr. David Smith speaks at the International Committee of Military Medicine’s "Centennial Talks," a hybrid in-person and online event broadcast from Schelle, Belgium, Sept. 21 (Screenshot from official livestream of event taken by MHS Communications),

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In military medicine, innovation often springs from cooperation with partner nations, whether on the battlefield or in response to natural disasters, a top U.S. military health official told an international medical conference.

"Sharing experiences and knowledge helps us to build capacity for innovating and delivering great health outcomes," said Dr. David Smith, the U.S. deputy assistant secretary of defense for health readiness policy and oversight. Smith was speaking on Sept. 21 in Schelle, Belgium, to military and civilian health experts at a conference for the International Committee of Military Medicine, or ICMM.

Smith spoke about global health engagement and multinational interactions focusing on health and medicine. His remarks covered several unique aspects of military medicine and the importance of coordination with the United States' international partners to advance innovation, increase our partner nations' medical capabilities and, in turn, build capacity and interoperability.

The event – a hybrid in-person and online event – marked the 100th anniversary of the ICMM, an organization that fosters innovation, learning and cooperation among military medical services around the world to find solutions to military and civilian medicine's toughest challenges.

Smith pointed to the example of how hemorrhage control has advanced in the last century due to a better understanding of the problem.

"One hundred years ago, we knew we needed to stop major bleeding events, but we had limited tools and knowledge. I remember when a tourniquet was thought to be the tool of last resort – if you used it, you would most likely lose that limb," he said.

"But we have learned and re-learned over the course of the last 20 years that the appropriate use of tourniquets saves lives and does not further endanger the limb when properly used."

The Combat Action Tourniquet, he said, has likely saved more lives on the battlefield than any other invention since its introduction by the U.S. Army in 2005.

Smith said the ICMM has been one of the primary facilitators of global health engagement.

"After World War I, we really found ourselves needing a peace-driven outlet to communicate medical knowledge between the various armed services medical services of the world and, 100 years later, we're celebrating the intergovernmental support that followed," said Smith. "ICMM has been an important way that we've come together to cooperate, increase capacity and innovate in military medicine."

Collaboration to prevent, detect and respond to health problems leads to greater military and civilian healthcare capabilities, Smith said.

Smith also reminded his audience that security threats from health catastrophes are real and the spillover effects due to breakdowns in health systems have the potential to become harder to contain than the armed conflicts themselves.

"People don't immediately think about medicine or health factoring into their nation's defense, but we all know the critical importance of what we do to national and global security," he said.

Smith discussed an array of other topics including acute stress reaction, "far forward" surgery (i.e. surgery in a deployed or combat environment) and rehabilitation.

Smith highlighted several instances of interoperability including the Uniformed Services University of the Health Sciences in Bethesda, Maryland, working with the Sri Lankan military to develop a combat vascular trauma registry in order to improve combat casualty care.

He also said the U.S has worked with Estonia, Georgia, Ukraine, and other partners on injury management and rehabilitation to share lessons learned to improve rehabilitation and reintegration of injured service members.

Due to this partnership and their significant improvement in rehabilitation medicine, Estonia is now a regional leader in the field, he said.

Additionally, beginning with site visits to Walter Reed National Military Medical Center in Bethesda, Maryland, and San Antonio military medical centers, Ukrainian rehabilitation leaders were able to gain valuable insight into the full spectrum of modern rehabilitation medicine following significant casualties suffered in the conflict in their country in 2014.

Following the visit, "these leaders were better able to define goals for rehabilitative capabilities," Smith said. "American experts provided hands-on training to assist in achieving these goals. Ukraine has had impressive results with their patient outcomes. 20% of their amputee patients now return to active duty compared to 0% prior to 2014."

Collaboration is key, Smith said.

"When collaboration occurs, our militaries and nations can better handle natural and man-made disasters and bring them under control effectively and manage resources," he said. "And most importantly to save lives."

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