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From COVID-19 testing to MHS GENESIS support, lab techs do it all

Tue, 20 Apr 2021 00:00:00 Z

Even though April 18-24, 2021 is designated as Medical Laboratory Professional Week, for laboratory technicians like Navy Hospital Corpsman 1st Class KC Geisler, there's no slow down or reduction of service taking place during the week.

Geisler, assigned to Navy Medicine Readiness and Training Command Bremerton as the laboratory leading petty officer, readily affirms that his lab is central to all health-care provided at the command.

"As a laboratory professional we organically see almost every single patients either through getting their blood drawn or through their specimen(s) that are dropped off to the laboratory," said Geisler.

To describe what lab techs do, Geisler chose a famed fictional detective to illustrate their importance and provide context.

"Laboratorians are the Sherlock Holmes of the medical field. We help to identify cancers and disease through testing and have to ensure that the results that we put out are accurate. Providers depend heavily on the results that we give them so that they can better treat their patient," Geisler said. "To put it simply, providers cannot function without us. Without laboratory results it makes it that much harder to pinpoint that disease or affliction that a patient may have. Yes they could treat the symptoms but without that result to re-enforce their diagnosis, the patient wouldn't be able to get the right quality care that they need."

For 2020, there were approximately 699,500 tests conducted by the Core Lab, including hematology, urinalysis, coagulation, blood bank, point-of-care testing, microbiology and cytology/histology. There were another approximately 36,155 tests conducted at the NMRTC Bremerton Detachment Puget Sound Naval Shipyard lab, approximately 25,535 at the Navy Medicine Readiness and Training Unit Bangor lab and approximately17,750 at the NMRTU Everett lab. Three blood drives also collected 120 units.

Providing timely and direct support for COVID-19 testing has become the lab focal point over the past year, and has only added to the routine high operational-tempo of the staff.

"The laboratory became the gateway of all COVID-19 testing in our immediate region. The laboratory had to step up and tackle the pandemic head on with no reduction in schedules. When USS Nimitz was tasked to deploy last year, all of our staff came in over the weekend to order over 4,000 COVID-19 diagnostic tests, coordinate logistics, processing, shipping and DOD testing to support getting the carrier underway for deployment as scheduled," Geisler said.

Lab staff also took part in providing approximately 5,750 COVID swab tests for Marine Corps Security Force Battalion, Bangor; and approximately 4,250 COVID swab tests for Submarine Group Nine commands.

"When we receive the COVID samples we have to make sure that the sample is correct and acceptable for testing before tested or sent for reference studies," added Geisler. "Our microbiology bench received and validated four FDA approved infectious disease diagnostic analyzers to test COVID-19 and respiratory panels as well as another molecular testing system that can handle 400 COVID tests a day.

"With the implementation of those analyzers, the wait time for COVID-19 results went from three to seven days to mere hours. The efforts of the lab have helped to identify patients that have been infected with COVID-19, which has been instrumental in the care and further precautions to stop the spread of COVID-19," explained Geisler.

The lab team is comprised of two officers, two pathologists, 27 enlisted personnel and 11 civilians. The majority of young Sailors have arrived at NMRTC Bremerton for their first duty station. Their training and understanding of their chosen specialty, as well as work-ethic, has continually been put to the test during every conducted test.

"Our preparedness comes from rigorous training and the constant need to perform daily checks to ensure that everything runs smoothly in the laboratory," Geisler stated. "Most of the techs that we receive are straight from lab school. They have a huge responsibility on their shoulders as soon as they set foot in the laboratory, perhaps more so than any other department in the hospital. They all have done a phenomenal job. I am very proud of them!"

Along with all their in-house lab efforts, NMRTC Bremerton also sent two staff to assist with the collection and testing of COVID samples on Guam in response to fleet concentration outbreaks. Another lab officer was sent to augment U.S. Naval Hospital Yokosuka to assist with conducting PCR (polymerase chain reaction) COVID testing and facilitate management procedural changes there and at Branch Health Clinic Iwakuni.

The DOD's new electronic health record, MHS GENESIS, has been the second major focus for laboratory staff. The command supported the rollout of the new system along the west coast. Staff went on temporary assigned duty to provide subject matter expert assistance at Naval Health Clinic Lemoore, Branch Health Clinic Fallon, NMRTC 29 Palms and six clinics, Naval Branch Health Clinic Port Hueneme, and 13 small outlying clinics of NMRTC Pendleton.

NMRTC Bremerton's Laboratory has been fully accredited by the College of American Pathologists, American Society for Clinical Pathology and American Association of Blood Banks. It is also licensed and the Food and Drug Administration.

Keesler uses post-vaccine waiting period to identify routine care gaps

Tue, 20 Apr 2021 00:00:00 Z

Adaptation has been a common theme over the past year, especially within the medical community.

A perfect example is at Keesler Medical Center on Keesler Air Force Base in Biloxi, Mississippi. During the Centers for Disease Control and Prevention's recommended 15-minute waiting period after a COVID-19 vaccines is given, staff here have been talking to patients about making appointments for routine care that may have been missed due to increased focus on the virus.

Using CarePoint, the Defense Health Agency's information delivery portal, Keesler personnel look at the medical records of each patient who comes in for a vaccine and note whether they are behind on routine care. They then use the waiting period required after vaccination to speak with patients who are behind, make an appointment on the spot, or refer them to another clinic if they don't have appointments readily available.

The process was the brainchild of Air Force Col. (Dr.) Assy Yacoub, chief of medical staff for the 81st Medical Group, located at Keesler. It was facilitated by health care integrators Air Force Lt. Col. Wanda Stauffer and Air Force Lt. Col. Clementine Duke after discussions with DHA leadership regarding what could be done about COVID-19's impact on routine medical care across the enterprise.

"We had a need to improve our contact numbers with our patients, getting their overdue preventative screenings done, and this seemed like a prime opportunity," said Stauffer. "Our nurses were in place the very next day, and we've assisted more than 1,500 patients since the end of January."

Stauffer said the fact that vaccinations are done by appointment at Keesler allows them to review individuals' records before their arrival and address any issues with the beneficiaries on-site.

"We're then looking at the appointment list for the COVID vaccine line that we get from CarePoint, and it tells us what items people are overdue for," said Stauffer. "Out of 300 people that may be coming in on a given day, we sort that list into people who are overdue for items like breast, cervical and colon cancer screenings, and hemoglobin A1c tests for diabetics."

After vaccines are administered and the waiting period is over, patients are directed to a nurses' station where any outstanding issues are discussed, appointments are booked, or they are referred to their primary care manager.

"There have been several issues caught that wouldn't have been had we not been doing this," said Stauffer.

Additional benefits of this process are that personnel at Keesler have been able to both encourage individuals who are not primary patients of the medical center to resume their normal medical care, as well as to request information from patients who may have had appointments at outside facilities and update their records.

"Right now, we've had about 175 patients who have completed procedures that we didn't have records of," said Stauffer.

People have either been putting off other routine medical care out of fear of going to a medical facility during the pandemic or simply because there hasn't been enough personnel to perform that routine care.

Now that resources are becoming available, it is extremely important that military medical treatment facilities and the medical community at large, as well as individuals, begin to re-focus on things that have gone overlooked during the pandemic, Stauffer said.

"When COVID started, facilities didn't want people in the building that didn't need to be there due to risk of infection. A lot of care was put off by patients and medical facilities," said Stauffer. "This may be the first time a person has been in a medical facility since the pandemic started, so it's also the perfect opportunity to identify what may have been missed, especially now that the vaccine is relieving some of that fear."

The success of Keesler's process is in the numbers.

"We've had around 600 patients who have either had appointments scheduled or have been given instructions to make appointments, and we try to schedule as many in-person as we can," said Stauffer.

Keesler plans to continue this process throughout its vaccination effort.

Tanker medics from McConnell AFB are fighting COVID-19 in St. Paul

Tue, 20 Apr 2021 00:00:00 Z

Approximately 25 tanker medics from McConnell Air Force Base 22nd Medical Group help make life-saving vaccines readily available to the American people.

The medics departed Kansas on April 9, 2021, for St. Paul, Minnesota, in support of the Federal Emergency Management Agency COVID-19 response operations. They will join approximately 4,200 total-force personnel across the United States already in support of the federal vaccine effort. These personnel have already administered more than 1.9 million vaccine doses.

"Vaccination is our greatest weapon in the fight against the current pandemic," said Air Force Col. Lee Nenortas, 22d Medical Group commander. "As with almost anything in medicine, it's better to prevent than to try to cure. All of our potential vaccinators, including those of us remaining, have completed extensive training in every aspect of vaccine handling and administration."

The total-force team is supporting 39 Community Vaccination Centers in 19 states across the country, not including the site McConnell's tanker medics will staff in Minnesota.

Minnesota Gov. Tim Walz said in a news release that the vaccination site will receive 168,000 doses over the course of eight weeks, leading to more than 100,000 people being vaccinated.

The medics will be in Minnesota until further notice to help support FEMA and administer thousands of vaccines to Americans.

"It is an honor that we are able to [deploy]," said Air Force Maj. Helena Guerra, 22nd Medical Group commander of troops. "This is the first pandemic in 100 years, so to be able to help get people vaccinated and slow the spread is amazing."

COVID-19 has had a worldwide impact over the past year, making it crucial for vaccines to be widely available.

Tidewater set to become fifth Military Health System market

Mon, 19 Apr 2021 00:00:00 Z

The Defense Health Agency officially established the Tidewater Market in southeast Virginia on April 19. This is the fifth Military Health System market established to manage military medical treatment facilities as they transition to DHA.

Tidewater follows the National Capital Region, Central North Carolina, Jacksonville, and Coastal Mississippi markets, which were established in January 2020. It is the first transition since the COVID-19 national health emergency was declared.

A market is a group of MTFs in one geographic area working together with its TRICARE partners, Veterans Affairs hospitals, other federal health care organizations, private sector teaching hospitals and medical universities, as well as other health care partners. Markets operate as a system to support the sharing of patients, staff, budget, and other functions across facilities to improve readiness and the delivery and coordination of health services.

Although DOD decided early in the COVID-19 pandemic to pause transition, activities resumed in November, and a complete transition of management responsibilities for MTFs from the services to the DHA is scheduled to be completed by September 2021.

"The establishment of this market provides a true opportunity to optimize health care for our beneficiaries by focusing on outcomes and access across the Tidewater market," said Navy Rear Adm. Darin Via, Tidewater market manager. "It also allows us to work towards standardization of processes, creating an easier environment for our patients to navigate within.

Via said the ability of patients to schedule appointments across multiple facilities, and the ability of MTFs to appoint personnel and refer patients in order to meet specific demands are among the many advantages of a market model. He also said standardization of processes, policy, and monitoring efforts ultimately results in improved quality and safety.

Via foresees a smooth transition focused on mission readiness.

"Transition will have no immediate impact on patient care and will be seamless to beneficiaries," he said. "This transformation builds on our successes on the battlefield with an eye on emerging global challenges to ensure we are ready to fight tonight."

The Tidewater market includes the following military medical treatment facilities:

Navy

Naval Medical Center Portsmouth
Branch Health Clinic, Joint Expeditionary Base Little Creek (Boone Clinic)
BHC, Dam Neck Annex
BHC, Norfolk Naval Station (Sewells Point)
BHC, Norfolk Naval Shipyard
BHC, Chesapeake (Northwest Annex)
BHC, Naval Air Station Oceana
BHC, Yorktown (Naval Weapons Station)
TRICARE PrimeA managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime Clinic Virginia Beach
TRICARE Prime Clinic Chesapeake
TRICARE Prime Clinic Suffolk

Army

McDonald Army Health Center, Fort Eustis
Troop Medical Clinic 1 (TMC1)
Troop Medical Clinic 2 (TMC2)
Fort Story Army Health Clinic
Community-Based Medical Home Williamsburg

Air Force

USAF Hospital Langley Air Force Base (633 MDG)

"Establishment of the Tidewater market is a big step forward for the Military Health System, and for our patients," said Dr. Barclay Butler, DHA's assistant director for Management.

Butler reiterated that the pandemic has served to highlight the benefit of a market model, which ultimately results in higher quality care for MTF recipients.

"The market construct lets military medical treatment facilities coordinate locally to share patients, staff, and resources to improve care, patient access, and readiness activities," said Butler. "The global COVID-19 pandemic demonstrates the value of the market construct, giving our MTFs expanded flexibility and capability to adjust to local conditions in response to a crisis, while giving MHS patients a standard, high-quality experience across the whole enterprise."

The complete transition of MTFs to the DHA includes 19 direct reporting markets within the U.S., 18 small markets and many stand-alone MTFs across the country that will report to a Small Market and Stand Alone Organization, and two overseas Defense Health Regions.

The Military Health System remains committed to the congressionally-directed goal of transitioning all MTFs to DHA authority, direction, and control by Sept. 30, 2021.

Appenzeller emphasizes: Get COVID-19 vaccine, no matter where

Fri, 16 Apr 2021 00:00:00 Z

Army Major Gen. (Dr.) George "Ned" Appenzeller would love it if the military administered every COVID-19 vaccine to every service member.

But the assistant director for combat support at the Defense Health Agency told those in attendance at the third Military Health System and Military OneSource COVID-19 Town Hall that the "where" is not important.

"I would love to be the one to put the vaccine in everyone's arm, but if it's available to you in your local community, I suggest you go ahead and get it wherever you can get it first," he said during the event, held live on streaming platforms on April 14.

"What we do ask is if you get your vaccine outside of our DOD system ... bring us those records so we can get it documented in your medical records for all of your future encounters ... and that we can track you along with everyone else who is getting the vaccine within the system." He stressed that there is no pre-authorization needed for a vaccine taken outside the DOD - the DHA recently approved a blanket waiver removing that requirement.

Appenzeller, who is board certified in emergency medicine, was interviewed by Bruce Moody, public affairs specialist for the Department of Defense Office of Military Community and Family Policy. Appenzeller's team oversees the DOD COVID-19 Operational Planning Team, which built the DOD COVID-19 vaccination plan.

"We look at the overall allocations to the DOD, provide those allocations to the services, we give them guidance, and help them in the actual execution of the mission at all of the individual vaccination sites," Appenzeller said.

The vaccination efforts at 350-plus DoD sites across the world are paying off. To date, more 26 percent of all active duty, National Guard, and Reserves are now fully vaccinated, with a total of more than 2.4 million doses administered to service and family members, civilians, and contractors.

Appenzeller said that military installations around the country and the world were at different phases of the prescribed schema (who can get a shot, and when), but that on April 19 the DOD's "ultimate goal" will be to make COVID-19 vaccine appointments available to all who are authorized and eligible. Those individuals will be able to make an appointment by contacting their local military medical treatment facility directly or using those facilities' appointing processes. Appointments will be based on the local availability of vaccines. To find a DOD location offering COVID-19 vaccines in your area, check TRICARE.mil.

Leaving "as little on the shelf as possible"

April 19 "will coincide with [President Joe Biden's] guidance for the nation," he said. "Like all of the nation and the world, in fact, there's more demand than there is supply. We get our allocation from [the Department of Health and Human Services], just like ... all the other jurisdictions," weekly, and push them out as quickly as possible into as many arms as possible.

"Overall, we've been able to move everything out, every week, as much as they can give us, and we are averaging between 83% and 85% usage every single week."

For those having trouble booking appointments for a vaccine, Appenzeller said every hospital or clinic is different, and he urged people to contact their local DOD vaccination site directly.

Regarding acceptance of the voluntary vaccine, Appenzeller said military personnel reflect American society as a whole: a lot of interest and some reluctance, though recently he said there has been an "increasing rate of acceptance." Some service members still have a wait-and-see approach, particularly the younger population.

"Senior leaders are out there talking to people, giving them their experiences," he said, adding that outreach, along with sustained social media, daily talking points, and other methods are helping to get the message out that the vaccines are safe and effective. "It's a personal decision that people have to make."

Sexual assault awareness and prevention a DHA, DOD priority

Fri, 16 Apr 2021 00:00:00 Z

Sexual Assault Awareness Month has been commemorated every April since 2009, when President Barack Obama established it to raise public awareness and educate communities about preventing sexual violence.

This year, President Joe Biden proclaimed Sexual Assault Awareness and Prevention Month an opportunity for every person, employer, school, sports team, faith-based organization, and institution to come together and commit to being part of the solution.

"We must rededicate ourselves to creating a society where sexual violence — including sexual assault and sexual harassment — is not tolerated, where survivors are supported, and where all people have an opportunity to thrive without fear of abuse or assault," he said.

At the Department of Defense, "efforts to eliminate sexual assault in the ranks isn't limited to just a month — it'll be a full-time effort until the problem is gone," said John Kirby, assistant to the secretary of defense for public affairs and chief spokesperson for the Pentagon.

His statement echoed Biden's mandate that "it is the responsibility of each of us to stand up and speak out against it, not only to improve the laws and services available to survivors, but also to change the culture and attitudes that allow sexual assault to proliferate."

Striving to advance a military culture free from sexual assault, the Defense Health Agency prioritizes sexual assault awareness and prevention efforts. These are included in the agency's mission to ensure the DOD community is healthy and safe from potential health threats by supporting the medical readiness of the force.

This is particularly important considering sexual assault reports by service members in the DOD have risen steadily since fiscal 2015 and by 3% in fiscal 2019 over the prior year, according to the Department of Defense's fiscal 2019 annual report on sexual assault in the military.

And while the report, published in April 2020, also says DOD showed progress in reducing sexual assault and increasing help-seeking and reporting between 2006 and 2016, the number of service members who said they experienced a sexual assault increased for women, particularly those between the ages of 17-24, during fiscal 2018.

To address this, DOD's Sexual Assault Prevention and Response Office (SAPRO) initiated activities across all services for fiscal 2020, such as continuing education and training efforts, promoting an anonymous, confidential 24/7 DOD Safe Helpline and identifying ways it can support the needs of victims wanting to make reports of sexual assault, piloting workforce training sessions, and developing crosscutting prevention policy. The 2019-2021 campaign theme, "Protecting Our People Protects Our Mission" focuses on working together toward eliminating sexual assault from the armed forces.

"Consistent with DOD Instruction 6495.02, SAPRO enacts policies and creates programs to provide high-quality services and support to members of the DOD community who have been sexually assaulted," said Nathan Galbreath, deputy director of SAPRO, who has a doctorate in clinical psychology.

He explained SAPRO's policies and programs are intended to strengthen resiliency of sexual assault survivors and instill confidence and trust in the reporting process, whether they choose to file a restricted or unrestricted report. Each service executes the programs developed by SAPRO using sexual assault response coordinators (SARC), sexual assault prevention and response (SAPR) victim advocates, health care providers, and other members of the military response system, he added.

"This approach ensures that service members receive the protections to which they are entitled, and support through an integrated victim services network of care," said Galbreath.

Young cancer survivor rings bell signifying treatment end

Fri, 16 Apr 2021 00:00:00 Z

After a two-and-a-half-year battle with a rare childhood disease, one little girl has a big reason to celebrate.

Surrounded by her parents and a small group of medical staff, including Brooke Army Medical Center Commanding General Brig. Gen. Shan Bagby and Command Sgt. Maj. Thurman Reynolds, 7-year-old Sailor Parker recently rang the bell in the BAMC Pediatric Hematology/Oncology Clinic signifying she won her battle against Acute Lymphocytic Leukemia.

"Sailor we are so proud of you and how well you have done with your treatment," said Air Force Lt. Col. (Dr.) Della Howell, pediatric hematologist/oncologist assigned to the Joint Base San Antonio-Fort Sam Houston facility. "We couldn't have asked for a better patient."

According to the National Cancer Institute, childhood acute lymphoblastic leukemia, also called ALL or acute lymphocytic leukemia, is a cancer of the blood and bone marrow.

"This is the most common type of cancer in children and adolescents, but only happens at a rate of 34 per million in those who are under 20 years of age," explained Howell.

"In the past, before the advent of chemotherapy, this disease was almost always lethal. In the 1960s, the survival rate was less than 10 percent. Now the overall survival rate of the disease is about 90 percent."

Sailor's father, Air Force Tech. Sgt. Aaron Parker, was stationed at Goodfellow Air Force Base in San Angelo, Texas, when she became critically ill and was transported via life flight to Dell Children's Hospital in Austin, Texas.

"In less than an hour everything changed," Parker said. "Our entire world changed in so many ways."

Sailor's grandmother, Kim McSparren contacted an old childhood friend, Delores Hagen, who happens to be a critical care nurse in the Pediatric Sedation Unit at BAMC. Coincidentally, Hagen also had leukemia as a child.

"Forty years ago, Sailor's grandmother lived across the street from me. She was my best friend," Hagen said. "She asked me if I would please go talk to Sailor's parents."

After completing a couple months of treatments, Sailor was transferred to BAMC and her dad received a compassionate reassignment to nearby Randolph Air Force. Hagen was there to provide support every step of the way.

"Nurse Delores Hagen has been pretty incredible this entire time helping out above Sailor's treatment consisted of intravenous chemotherapy, oral chemotherapy and intrathecal chemotherapy, injected directly into the spinal fluid through lumbar punctures.

"By the time we received her as a patient, she was overall, doing quite well and was already in remission," Howell said. "The chemotherapy treatment course lasts about two and a half years for girls."

Sailor's parents were overjoyed that their daughter was finished with her treatment.

"There has been a lot of frustrating moments, a lot of painful moments, but now that it's all wrapped up and coming to an end, it's like a pinch yourself moment," Parker said.

COVID-19 made things even more difficult because Sailor's immune system was compromised.

"The COVID slump that everyone has been in; we were one level deeper," Parker said.

"Now we are actually getting to feel what normal COVID life is with everybody else," he laughed. "We don't know what to do because all these doors and possibilities have opened back up."

Megan Parker, Sailor's mother, agrees. "It's been a journey. It's kind of surreal that it's basically come to an end."

Sailor said she is looking forward to being able to go to grandma's house now that her treatment is finished. There may even be a trip to the beach and Jiu-Jitsu classes in her future.

"Sailor has done extremely well with her treatments and we hope that she is cured of her disease, but she will be watched very closely to make sure that there are no signs of the leukemia returning," Howell said.

Ektropy lunch sessions designed for end users

Thu, 15 Apr 2021 00:00:00 Z

A series of brown bag lunch trainings is being held from now until the end of June to assist users of Ektropy — an information technology tool used across the Defense Health Agency to support program and portfolio management.

Ektropy provides insight into personnel, programs, costs, and contracts across all activities. It improves the management of cross-program dependencies and the IT manpower footprint.

"Extropy is the basis for aligning organizational strategy, for the way we see where we want to go in a way that is visible and in a way that integrates all the different parts of the organization," said Pat Flanders, chief information officer of the information operations directorate of the DHA. "Ektropy allows the people executing the vision to align their personnel budgets to support the greater vision."

The lunch events are during the regularly scheduled Ektropy "Office Hour" sessions and are designed to assist end users with targeted Ektropy business and system processes that affect workflows for all Ektropy modules.

The first of four topics is for April and is designated "Navigating the Balance to Controls Report." This is a system-generated report available to users that will display the budget and validate it if it balances to zero. The report reflects the funds available to support spend plan line items that have been submitted.

The April speakers will be Drew Sims from the Ektropy team, and Air Force Lt. Col Beata Rosson, Ektropy military medical facility liaison for information operations at the DHA.

The May topic is "Positions Management." It is designed so that divisional points of contact, CIOs and resource managers have the availability to track and export reports of their respective positions data and to report any discrepancies through the chain of command.

Slated speakers for May will be Sahara Counts from Ektropy; Patricia Untermeyer, PRMD; and Ted Fariss, assistant director, health care administration at the DHA.

The June topics are "On-boarding and Off-boarding Personnel," including surge contractors, and "Contract Change/Update Requests." Each division/military medical treatment facility is responsible for creating and managing personnel records in Ektropy, including on-boarding users to a contract or position and ensuring the personnel data routinely stay current through their off-boarding.

Speaking on the June topics will be Ektropy's Sahara Counts and Wendy Thomas from the information operations directorate PRMD acquisition team.

Times for the sessions are:

April 15 for Europe at 8 a.m. EDT
April 20 for the Pacific at 7 p.m. EDT
April 21 for CONUS Ektropy users at 2 p.m. EDT
May 18 for the Pacific at 7 p.m. EDT
May 19 for the CONUS users at 2 p.m. EDT
May 20 for Europe at 8 a.m. EDT
June 15 for the Pacific at 7 p.m. EDT
June 16 for CONUs at 2 p.m. EDT
June 17 for European Ektropy users at 8 a.m. EDT

To participate in the Ektropy training events, dial into 646-749-3112, use the pass code 620234877, and log onto the Defense Collaboration Services meeting link for screen sharing at http://conference.apps.mil/webconf/EktropyTrain.

Projects test new approaches to improve health care quality, outcomes

Thu, 15 Apr 2021 00:00:00 Z

TRICARE has more than a half-dozen pilots and demonstration projects underway that offer new and innovative medical services, treatments, and approaches, and that have the potential to become part of its permanent health care coverage.

"Many of these pilots are value-based initiatives that seek to reward better health outcomes, enhance beneficiary care experiences, and reduce health care costs over time," said TRICARE Health Plan Deputy Director Curt Prichard. "These include projects for autism care, sexual trauma, and low back pain. These pilots and demonstrations are also looking to improve care through nurse navigators, a referral and appointing center and accountable care organization to make medical care easier for TRICARE beneficiaries."

Air Force Lt. Col. Donald "Del" Lofton, chief, TRICARE Optimization said: "The use of these pilots and demonstrations allows TRICARE to develop and test innovative approaches and services with the broader TRICARE beneficiary population as well as specific services to targeted groups. The goal is always to provide the most effective, high-quality, value-based health care while seeking to improve the overall health care experience for both beneficiaries and those who provide them care."

Here's a look at eight initiatives underway:

Comprehensive Autism Care Demonstration

The Department of Defense's Comprehensive Autism Care demonstration provides reimbursement from TRICARE for applied behavior analysis (ABA) services for beneficiaries diagnosed with autism-spectrum disorder.

Its major goals are to analyze, evaluate, and compare the quality, convenience, efficiency, and cost-effectiveness of ABA services that have not been shown to be proven medical care and are not covered by TRICARE. The pilot, which covers a wide range of TRICARE beneficiaries, began in July 2014 and is scheduled to conclude at the end of 2023.

Sexual Trauma Intensive Outpatient Program Pilot

The Intensive Outpatient Program pilot for sexual trauma aims to treat psychological behavioral health effects of that trauma in active-duty service members (ADSMs) through partnership with public, private, and non-profit organizations in seven locations in the United States.

The pilot is focused on treating ADSMs suffering from post-traumatic stress disorder and other psychological conditions associated with sexual trauma, and determining the feasibility and advisability of using such programs by measuring outcomes and sharing lessons learned. The pilot began last September and is slated to conclude Aug. 31.

TRICARE SelectStarting on January 1, 2018, TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider. Enrollment is required to participate. TRICARE Select Navigator Pilot

The TRICARE Select Navigator pilot is designed to assess whether providing eligible beneficiaries with one-on-one assistance from nurses identified as health care "navigators" improves health outcomes and the patient experience for those with complex medical conditions.

Those eligible for the pilot must be enrolled in TRICARE Select and have two or more medical conditions requiring coordination of specialties or at least $100,000 in claims per year.

This assistance could lead to reduced use of unnecessary emergency room or urgent care visits due to a beneficiary's lack of understanding of their options. The pilot also will determine the feasibility of incorporating nurse navigators in available support contracts. The pilot is expected to conclude March 31, 2023.

Tele-critical care will play increased COVID-19 response role in 2021

Thu, 15 Apr 2021 00:00:00 Z

The Military Health System's success in adapting and expanding tele-critical care programs for critically ill patients in 2020 during the COVID-19 pandemic will play an essential role in bringing the virus under control in 2021.

The Defense Health Agency's tele-critical care programs have cared for thousands of patients, leveraging information and communications technologies to dynamically allocate and extend critical care capacity to the point of need, anytime and anywhere, especially to community hospitals and smaller intensive care units in remote locations.

"The number of COVID-19 cases continues to underscore the need for proactive virtual health planning and implementation," said U.S. Navy Capt. (Dr.) Konrad Davis, MHS director of tele-critical care. “The recent, rapid maturation of virtual health capabilities have made it possible to not only respond to the COVID-19 pandemic but to also prepare for future disasters as well — both natural and human-made."

Tele-critical care and other virtual health programs help sustain care while keeping beneficiaries and health care teams at a safe distance, said Jamie L. Adler, lead of the Virtual Health Clinical Integration Office at the Defense Health Agency Connected Health Branch.

The effectiveness of the virtual health programs has made tele-critical care an ever more important enterprise capability, and its popularity with providers and patients alike has made it integral to health care going forward, he said.

Joint Tele-Critical Care Network

A notable DHA success in 2020 was the expansion of the Joint Tele-Critical Care Network, an important force multiplier that leverages virtual health resources to extend critical care expertise and treatment at a distance. Critical care physicians, also known as intensivists, and critical care nurses located at three hub sites treat patients located at a growing number of spoke sites worldwide.

Once fully deployed, the JTCCN will allow intensivists to monitor hundreds of intensive care unit beds simultaneously through a setup conceptually similar to how air traffic control systems ensure planes — and their passengers — safely reach their destinations, Davis said.

The system tracks and analyzes vital signs, lab results, progress notes, and other real-time data, which helps providers quickly identify patients at risk for deterioration and more effectively intervene to improve outcomes.

In response to the COVID-19 pandemic, the JTCCN added seven new spoke site hospitals during calendar year 2020, nearly doubling the number of participating locations. In all of 2020, the JTCCN provided over 2,200 days of ICU coverage to 432 unique patients in 109 ICU beds spread across 15 spoke site hospitals. The JTCCN plans to add one additional spoke site hospital in calendar year 2021.

National Emergency Tele-Critical Care Network

In addition to leveraging existing resources such as the JTCCN, the DHA is working with the Telehealth and Advanced Technology Research Center, leaders at the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, academia, and industry to develop a rapidly deployable, hardware-light TCC capability. Launched in March 2020, the National Emergency Tele-Critical Care Network seeks to expand capabilities and capacity by augmenting bedside personnel who may lack the knowledge and skills to care for critically ill patients.

One NETCCN prototype has already demonstrated its effectiveness at a civilian hospital in Guam, Davis said.

In late August 2020, COVID-19 case numbers there spiked to more than 200 percent their normal volume, outstripping local resources. Guam Memorial Hospital reached out to the Federal Emergency Management Agency, which coordinated with the Defense Security Cooperation Agency. Roughly 72 hours after receiving its official DSCA mission assignment, the DHA shared a NETCCN mobile technology solution enabling the JTCCN to provide cyber-secure and HIPAA-compliant on-demand consultative support and monitoring for critically ill civilian patients.

Intensivists and nurses at DHA tele-critical care hub sites in California, Texas, and Washington state provided real-time guidance to bedside staff providing hands-on care. The system - still in use - vastly improved the ability of Guam's civilian providers to treat patients and save lives. Over a one-month period at the peak of the surge, the JTCCN fielded 64 physician calls and supported the care of 473 patient-ICU days, including 14 events of cardiac arrest.

Partnerships Key to Success

The on-the-ground successes of the JTCCN, NETCCN, and tele-critical care would not have been possible without partnerships the Department of Defense is cultivating among its own components, between itself and other U.S. government agencies, and between DOD and commercial and non-governmental organizations, said Dr. Simon Pincus, chief of the DHA Connected Health Branch. These collaborations help ensure tele-critical care capabilities can seamlessly reach across organizations through compatible technology, training, and protocols.

To increase surge capacity and technologic resiliency, the DOD is also pursuing a partnership with the Department of Veterans Affairs to create a single federal tele-critical care network for all U.S. forces globally, Davis said.

This network would enable any DOD or VA hub site to provide tele-critical care to any of the 1,700 VA or 400 DOD ICU beds through real-time distribution of workload to locations with capacity. The resulting partnership will enhance technological resiliency while also improving surge capability in response to pandemics and other crises. The goal is to have completely interoperable systems between the two largest users of tele-critical care in the U.S. government.

A Month of Prevention and Intervention for a Lifetime

Wed, 14 Apr 2021 00:00:00 Z

There were one thousand, six hundred and ninety six 'justifications' Navy-wide in 2019 — 90 in the Pacific Northwest — why Sexual Assault Awareness and Prevention Month (SAAPM) is annually held in April.

That's nearly 1,700 allegations of sexual assaults, sexual trauma, sexual violence reported in the Navy for 2019.

The ongoing Department of Defense theme for SAAPM is "Protecting Our People Protects Our Mission." DOD is observing SAAPM by focusing on creating the appropriate culture to eliminate sexual assault and encouraging a personal commitment from every service member to do their part to create a healthy environment.

As part of the Defense Health Agency, Navy Medicine Readiness and Training Command (NMRTC) Bremerton is actively engaged in eliminating any type of sexual assault - and harassment - with ongoing education, insight and involvement. There is added emphasis on prevention and intervention.

"SAAPM is important to raise awareness about sexual assault and to promote the prevention of sexual violence. The April campaign was created to help spread information and facts about rape and other sex-related crimes. It is important not only in April, but at all times to spread this message and promote a zero tolerance for sexual assault," said Navy Chief Hospital Corpsman Jenny Singer, NMRTC Bremerton Sexual Assault Prevention and Response (SAPR) program coordinator.

The Navy is encouraging it sailors to engage in active intervention to help prevent sexual assault and other destructive behaviors. Prevention efforts are having an effect. The Department of the Navy policy is clear: sexual assault or harassment does not belong in the military.

There are intervention strategies Navy experts recommend that everyone can use to help someone who may be targeted for a sexual assault by a predator.

Direct intervention

Direct intervention involve speaking directly to those involved in the situation. By doing this, you can communicate that a particular behavior is not acceptable nor tolerated at your command, base or community.

Examples

Ask if everything is alright.
Address the concerning behavior and state that you think they could possibly cross a line.
Tell the aggressor to leave the potential target alone or step away from the situation.

Pull aside the potential target, let them know you are concerned, and /or ask if they would like any help getting home safely.

Enlist Others to Help

Enlisting other trusted people can take a variety of forms, in which you diffuse a potentially risky situation by indirect means.

Examples

Go find the friends of those involved and urge the friends to help remove them from the situation.
At bars and restaurants, tell a bartender, security staff or manager that you are concerned about a potentially risky situation.

Navy Pediatrician Rises from Humble Beginnings to Make History

Tue, 13 Apr 2021 00:00:00 Z

Navy captain and board-certified pediatrician Lynelle Boamah confidently stands with feet firmly planted atop two recent significant months: February's Black History Month and March's Women's History Month.

As the commanding officer of Navy Medical Readiness and Training Command Twentynine Palms in California and director of Naval Hospital Twentynine Palms, she defied the unwanted advice from friends and neighbors in the poor section of Baltimore where she was born, who told her: "Lynelle, you can never become a doctor."

She is now the first African American female Medical Corps commanding officer of a naval hospital.

Hers is the story of tenacity, drive, and the importance of mentors. Her mother, her biggest cheerleader, never discouraged her ambition.

"My mom got me the Playschool doctor's kit, with the medical bag and stethoscope," Boamah said. "I would practice on my sister who is 18 months younger than me, listening to her heart when we were little kids."

"From the earliest age (she said she thinks she was 4-years-old) she was impressed by the medical clinic a couple of blocks from where she lived with her sister and single mom in south Baltimore."

"The white sterile coats, their professionalism, the smell of antiseptic. I was excited to go to the doctor," she said.

Boamah attended Forest Park High School in Baltimore where she finished first in her class and delivered the valedictorian speech.

"I still have that speech on index cards," she said. "Now they remind me of my 1MC announcements."

After finishing college at the Notre Dame of Maryland University she took a year off and worked in a genetics laboratory at Johns Hopkins University where her immediate supervisor and program director were both female physicians.

"They were both great mentors," she said.

Both encouraged her to pursue her medical ambition. Also at that time, she met Medical Corps recruiter Navy Lt. Bill McCarthy, “who also turned out to be a great mentor," she said. Twenty years later, she met McCarthy again after he had become a Medical Corps officer and was assigned training at Naval Medical Center San Diego. "The roles were somewhat reversed," she said.

In 1995, Boamah was interning at Naval Medical Center Bethesda in Maryland and found the atmosphere challenging. She had the opportunity to transfer to Naval Medical Center Portsmouth, Virginia, where she was chief resident and deeply involved in department activities. It's also where she met her pharmacist husband, Charles.

"I found my battle rhythm and became the physician the nurses needed me to be," she said.

Following her residency, Boamah was assigned as a general pediatrician at Naval Hospital Twentynine Palms from 1998 to 2001. She then worked as a graduate medical educator at Naval Medical Center San Diego before entering the pediatric gastroenterology, hepatology, and nutrition graduate-studies course at the Cincinnati Children's Hospital Medical Center from 2004 to 2007. During fellowship training, she earned a master's degree in medical education and curriculum development from the University of Cincinnati in 2008, graduating magna cum laude.

Upon completion of fellowship, Boamah returned to Naval Medical Center San Diego in 2007, establishing a robust practice of pediatric gastroenterology. She served as associate pediatric residency program director from 2008-2011 and was selected as residency program director from 2011 until 2016.

During this time, she deployed as an individual augmentee to Palawan, Philippines, in a joint humanitarian assistance mission. She served as the director for medical services, of the USNS Mercy from 2015-2017, and as the Mercy's executive officer until 2019.

On Aug. 23, 2019, Boamah accepted command of Naval Hospital Twentynine Palms, the same military medical treatment facility where she had reported for her first assignment as a Navy lieutenant 21 years earlier.

Join Us!! Third COVID-19 Townhall Update with Major General George Appenzeller!

Tue, 13 Apr 2021 00:00:00 Z

Please join us for the Third COVID-19 Townhall!

April 14, 2021 at 1:00 p.m. ET

Major General George Appenzeller, Assistant Director for Combat Support at the Defense Health Agency, will be answering questions related to the COVID-19 vaccine, including where and when you can get it; the vaccine uptake increase; OCONUS Vaccinations; new CDC guidance, and other topics.

Do sports / energy drinks enhance individual performance?

Mon, 12 Apr 2021 00:00:00 Z

Sports drinks claim that they "increase performance," "rehydrate," and "refuel." What does this mean and should you include them as part of your work out?

What do sports drinks have in them?

Sports drinks contain electrolytes and carbohydrates (energy or fuel source). Carbohydrates replace the energy used to fuel your workout. Dextrose and high-fructose corn syrup are two commonly used energy sources.

Are all sports drinks the same?

Many energy sports drinks are available, however the energy source used for sports drinks varies. For example, some contain dextrose, a rapid source of fuel, while others use high-fructose corn syrup, which fuels muscles more slowly than dextrose. The cost of sports drinks can also vary with some being more expensive than others based on the cost of ingredients (high-fructose corn syrup is cheaper to produce than dextrose). Absorption rates of sports drinks is also different, dextrose has two glucose molecules, while high fructose corn syrup consists of glucose and fructose. Muscles absorb glucose more quickly than fructose. So if you are looking to fuel more quickly you will want to choose a beverage that is made primarily of dextrose.

Can sports drink increase your performance?

When it comes to "increased performance," there is no agreement on the definition. However, the use of sports drinks as fuel during exercise has been associated with performing an activity for a longer period of time.

When to include sports drinks...

Sports drinks aim to fuel the exercising muscle. However, not all exercise calls for drinking an energy-containing sports drink. You should critically analyze your exercise to ensure it meets the recommendations for adding energy containing sports drink. Different types of exercise require different amounts of energy replenishment. For example, intense exercise (an exercise level that makes it hard to carry on a conversation) lasting longer than one hour calls for ingesting, eating, or drinking 30-60 grams of carbohydrate per hour.

Additionally, endurance exercise (an exercise level of breathing hard but still being able to have a conversation) lasting greater than one hour also increases your need for energy replenishment. Exercise lasting less than one hour does not typically indicate a need for an energy-containing sports drink. Keep in mind that excess sports drink consumption can lead to weight gain.

Here are sports drink recommendations:

Exercise Time	Amount of Carbohydrate
Less than 1 hour	0 grams
Intense Exercise: 1 hour or longer	30 to 60 grams per hour
Endurance Exercise: 1-2 hours	30 grams per hour
Endurance Exercise: 2-3 hours	60 grams per hour

Sports drinks can aid in recovery after both intense or endurance exercise when used correctly. The next time you reach for a sports drink, make sure that drink is going to help you meet your performance goals; understand the amount and intensity of your exercise; read the sports drink label; identify the source of energy (dextrose versus corn syrup); identify how much energy (carbohydrates) it contains.

Making a smart choice will ensure you get the energy you need to enhance your performance.

For more information about diet and exercise, call your local military medical treatment facility's Nutrition Services Department.

Be proactive in looking for early signs of testicular cancer

Fri, 09 Apr 2021 00:00:00 Z

Testicular Cancer Week is an important time to remind service members to be proactive in their health.

According to Navy Lt. Cmdr. (Dr.) Dorota Hawksworth, a urologist at Walter Reed National Military Medical Center, testicular cancer is very rare, but is most common amongst males between 15 and 34 years of age, the age bracket of many military members.

Testicular cancer is a disease in which malignant cells form in the tissues of one or both testicles. While the diagnosis of cancer can be frightening, testicular cancer can usually be cured.

"Many men have no known risk factors," said Hawksworth, "the known risk factors [for testicular cancer] can't be changed."

These risk factors include a personal history of undescended testicle or prior testicular cancer, family history of testicular cancer, HIV infection, diagnosis of Klinefelter's disease, age, race, and ethnicity, Hawksworth noted. White males develop testicular cancer at a rate four times higher than that of Black males, according to cancer.gov.

Testicular cancer can be detected early through screenings both at home and by a doctor.

"Screening means looking for cancer before person has any symptoms. This process is performed differently, depending on the type of cancer," said Hawksworth.

Testicular cancer however has no standard routine or screening. According to Hawksworth, most testicular cancers are found by a man or his partner, either by chance or by a self-screening.

Self-exams should be performed monthly and in a warm environment such as a bath or shower to allow the scrotum to be more "relaxed," Hawksworth noted. Then each testis should be felt separately, using both hands to ensure that the contour is even and smooth with an egg-like shape with both testes about the same size.

If during a self-exam a patient finds a nodule or hard mass on or around the testicle, a size change, or difference in one or both testes, pain, or if the patient "thinks" he feels something and is unsure, he should seek medical attention urgently.

According to Hawksworth, most tumors present with a painless mass or swelling in one or sometimes both testes. Testicular pain only occurs in about 10% of men with testicular cancer. Men may have systemic, as opposed to localized, pain, "they may complain about breast swelling, back pain, or an abnormal pain or mass," said Hawksworth.

If caught early enough, many testicular cancers can be removed through surgery. According to cancer.gov, testicular cancer has a 95% five-year survival rate.

DOD surpasses 2 million COVID-19 vaccines worldwide

Fri, 09 Apr 2021 00:00:00 Z

The Department of Defense has now administered more than 2 million COVID-19 vaccinations to more than 1.3 million service members and beneficiaries, just a month after hitting the 1 million mark.

Army Lt. Gen. (Dr.) Ronald Place, director of the Defense Health Agency (DHA), said the 2 million milestone is an achievement to be proud of, and said the military must continue to focus on administering the vaccines that are received and communicating vaccine availability to those eligible.

"Reaching 2 million doses is a remarkable milestone," Place said. "More importantly, 24 percent of the military force is fully immunized - an achievement which directly improves our nation's health and our military readiness. Looking ahead, DHA will remain focused on the vaccine program to ensure we reach all of our eligible beneficiaries as quickly as possible."

As of April 8, the DoD has administered 2.3 million doses, with more than 900,000 fully vaccinated. About 83% of the vaccines received had been administered, which is above the U.S. national average of 77%.

Army Command Sgt. Maj. Michael Gragg, the senior enlisted leader of the DHA, said that along with an exceptional logistical chain, there has been widespread acceptance of the shots up and down the ranks.

"Through the education of our service members and our leadership, willing to step forward and accept the vaccine, it really allowed us to reach that mark so extremely fast," Gragg said. "The fact that these individuals, all of them, have volunteered to support and defend the Constitution against all enemies both foreign and domestic, it also comes to bear that they have realized and they understand that the enemy right now is COVID."

Still, the new milestone came as new cases of COVID-19 among all Americans have surged in large portions of the country, and deaths approached 550,000. But Gragg said that Military Health System professionals on the front lines, from medical augmentation teams to the vaccine shot teams mobilized to support civilian communities, have been doing nothing less than defending the nation. And that includes non-medical troops simply willing to walk into a tent and roll up their sleeve for a jab, he added.

"That is more of a testament to these individuals than people realize," Gragg said. "The fact that a generally younger and healthier population is stepping up and taking the vaccine when they aren't the ones being as adversely affected by the virus, itself further supports and highlights that they are stepping forward to not necessarily protect themselves, but to protect their fellow Americans. It is about protecting people you care about - your neighbor, grandparents, your friends, your community - that's what it is about."

According to Air Force Col. Jennifer Garrison, the DOD's operational planning team lead for its COVID-19 vaccination program, "The DOD is marching forward to administer vaccines we receive on a weekly basis. We are so grateful to our leaders, providers, and community partners for their efforts of getting shots into arms as quickly as possible."

Said Gragg: "I look forward to the day when we don't have this milestone to celebrate and our population is totally protected, and COVID is in our rear-view mirror or something that is controlled because we've all done the right thing."

Public health remains an integral part in the fight against COVID

Fri, 09 Apr 2021 00:00:00 Z

Although they may not be the ones putting needles in arms, public health personnel continue to play a crucial role in the ongoing battle against COVID-19. Often, this means keeping track of virus-related data, as well as facilitating the flow of information to both internal and external audiences.

"Public health's role in combatting COVID is very similar to our role in anything else related to communicable disease, which is a large portion of what we do," said Air Force Public Health Career Field Manager Chief Master Sgt. Sheryl Green. "We do a lot of risk communication — working with commanders and making sure we're messaging appropriately to our communities and vice versa, making sure those communities have access to those commanders."

This means ensuring information gets to its intended receivers. It also includes forming partnerships and coordinating with local health departments to make sure that efforts on installations better reflect what is happening in nearby communities.

"Communication is huge, not just on base but also within our civilian communities and civilian agencies," said Green.

The information that is being disseminated needs to be easily understood and easily acted on.

"Through outcomes from products such as surveillance, data modeling, and business analytics, we've been able to inform and assist the operational community with planning, logistics, tracking, forecasting and medical intelligence," said United States Public Health Service Capt. Kimberly Elenberg, chief of the Defense Health Agency's Total Force Fitness Division. "Further, a key role for public health professionals has been the interpretation of complex data into easily understood, actionable information."

Additionally, DHA's Immunization Healthcare Division has played a key role in providing critical information to beneficiaries through publishing articles explaining the vaccines, participating in social media events, conducting stakeholder briefings, and leading question-and-answer sessions at local events.

Since the beginning of the pandemic, Green said much of the focus has been on stopping the spread.

"Breaking the chain of infection" is a term that is near and dear to us, and that's where contact tracing comes into play," said Green. "A large focus of the COVID response has been contact tracing and trying to figure out who has been exposed and what that picture looks like for each community."

Within the Air Force, she said, public health is closely involved in tracking the number of positive cases, as well as the number of vaccinations being administered by its clinicians.

"In regard to surveillance and testing, our responsibility is to maintain close communication with the laboratory community and making sure we have visibility of all positive tests," said Green.

Public health's function is mirrored throughout the services.

"Our staff have worked tirelessly to make sure policies were synthesized and updated based on the latest research and Centers for Disease Control and Prevention guidance, interpreted in the unique context of Naval operations, and shared with operational decision-makers," said Navy Capt. (Dr.) Jesse Geibe, executive officer of operations at Navy and Marine Corps Public Health Center in Portsmouth, Virginia. "Whether we are advising on masking, testing and surveillance strategies, the impact of vaccination, or myriad other COVID-19 issues, we keep the health of our sailors and Marines and completion of the mission first and foremost."

Green said that, while public health professionals have become much more flexible and agile over the past year, the traditional role of public health hasn't necessarily changed.

"The scope has obviously gotten much larger, which has caused them to have to rework how they approach disease tracking and tracing from an overall perspective, and they've done an amazing job doing that," said Green.

MHS GENESIS has successful launch at Naval Medical Center San Diego

Thu, 08 Apr 2021 00:00:00 Z

MHS GENESIS launched at Naval Medical Center San Diego in February, but little did the team know a critical patient would arrive the very first weekend.

The NMCSD team delivered a severely ill 27-week-old newborn who required various medications and life support. A family medicine resident, Navy Lt. (Dr.) Hilary Hopkins, who trained on the new record for Wave Pendleton's Go-Live, was doing rounds in the neonatal intensive care unit and knew that MHS GENESIS was the right solution. Hopkins helped the team successfully document the delivery and care of the newborn via MHS GENESIS.

The successful outcome was the result of a long-term strategy in the deployment process. NMCSD was part of the most complex Wave deployed to date, involving more specialties than any previous deployment. Providers who trained in preparation for Wave Pendleton in October 2020 often work at NMCSD, which meant that NMCSD had a cadre of users who were familiar with the new record, ready and able to assist their colleagues. Hopkins knew how to use MHS GENESIS because she already had four months' experience with it.

"We knew a successful Go-Live at Camp Pendleton was going to drive a successful Go-Live at NMCSD. Providers at both MTFs share patients, specialists and residents all the time," said Navy Cmdr. (Dr.) Alexander Holston, chief medical informatics officer for the Department of Defense Healthcare Management System Modernization (DHMSM) program office and a fellow of the American Academy of Pediatrics. "In my experience, MHS GENESIS displays better patient information and orders compared with our existing systems. As a provider using MHS GENESIS, I am looking forward to using a modern (Electronic Heath Record system) that enables better clinical information support tools and better ways for providers to view information, including standard size order sets, and allowing for more intuitive ways to document patient care."

When Holston was practicing at another military medical treatment facility, a similar situation occurred with a 28-week-old newborn. At that MTF, the infant's delivery was documented using the other systems that will be replaced by MHS GENESIS. Holston said he noticed a significant difference between documentation processes in the new and existing health record systems. By documenting the patient's care in MHS GENESIS, providers can treat patients more effectively by using real-time imaging and clinical decision support tools. This ease of use improves the provider experience as well as patient outcomes.

Wave San Diego involved more system users and more health care specialties than any Wave to date; yet participants experienced a smoother transition than any facility of comparable size to date. Thanks in part to support from experienced users, the deployment team received zero patient safety notifications throughout the Go-Live period. The health care community also saw a faster return-to-normal than previous Waves.

DOD's next deployment, Wave Carson+, is slated to launch April 24. It will be the most geographically disparate, covering 11 states, and largest Wave to date with respect to the number of military treatment commands involved, 25 total.

Children’s well-being contributes immeasurably to force readiness

Tue, 06 Apr 2021 00:00:00 Z

Military service members are not the only ones serving their country. Their families – especially their children – do so as well, showing resilience, support, and strength.

In April, the Department of Defense celebrates military children for their essential role in the force's readiness – and the Defense Health Agency joins in that celebration with its "Celebrating the Mighty" campaign.

"Military kids are the cornerstone of military families worldwide," said Kelly Blasko, who has a doctorate in counseling psychology and is the DHA's Connected Health Branch lead for mobile health clinical integration. "Helping ensure their health and mental well-being enables military parents to focus on serving the country."

Patti Johnson has a doctorate in clinical psychology, specializing in pediatrics, and supports the DHA's Behavioral Health Clinical Management Team.

"Military children and youth show their resilience each day by making sacrifices small and large in support of the mission success of their service member parent," she said. "Their health and well-being contribute immeasurably to the readiness of the force."

Challenges: Glass half full

Military children face unique challenges, including psychological challenges related to military life, explained Blasko.

However, Johnson said, they also experience relatively unique events in comparison to their non-military peers that can positively impact their development and functioning.

"Military kids are more likely to move multiple times during their grade-school years and have a parent absent for long periods of time in potentially dangerous locations," said Blasko. "Unfortunately, they also may learn about difficult topics like injury or death at an early age, but they tend to also learn how to function well in stressful situations."

Though these factors may greatly stress military kids' mental health, their resiliency depends on the support they receive. Preparing for deployment as a family can help families handle the stress and changes of separation, noted Blasko.

Still, separations are not new for military kids. Because of continuous permanent changes of station or parental deployments, they know how to keep connected through letters, video chat, and other means, she added.

Additionally, living in geographically diverse locations - whether in the United States or other countries - exposes them to people who have different world views, perspectives, histories, and knowledge sets, added Johnson.

"This widens their opportunities to learn about different backgrounds, cultures, experiences, languages, and so on," she said. And "while moving frequently can provide some challenges, research suggests that as a result of military relocations, many military-connected children develop advantageous social skills needed to readily connect and engage with peers as well as adults."

Their experiences encourage many military-connected children to embrace positive military values such as patriotism, honesty, selflessness, and honor, said Johnson. "The adoption of positive core values likely contributes to enhanced self-worth and promotes healthy social and emotional development in many military youths."

This can result in kids with strong resilience skills that help them adjust and cope with military-related stressors, explained Johnson.

"These resilient kids adapt to new environments, put themselves out there to make new friends, and sometimes pick up more responsibilities at home," added Blasko.

Said Johnson: "Overall, the military lifestyle can be a very positive experience for many military-connected children. Military lifestyle experiences can instill a sense of responsibility, independence, tolerance, and maturity."

However, both experts agree that for some, it can prove stressful, and parents and other important adults should be aware of this possibility and provide support as needed to help all children adjust to this lifestyle.

Occupational Therapy Month highlights pros who give everyday help

Tue, 06 Apr 2021 00:00:00 Z

April is Occupational Therapy Month, a chance to highlight a profession that helps people to accomplish the everyday tasks they need to do through the therapeutic use of daily activities.

Occupational therapists often work with people with disabilities, injuries, and mental illnesses to help them get their lives back on track, working on tasks such as learning to walk and strength recovery.

Occupational therapy assistants (OTAs) help people who are struggling by providing treatment to improve motor skills, balance, and coordination. OTAs can help anyone at any stage of life and work in settings such as skilled nursing facilities, school systems, children's clinics, rehab facilities, and orthopedic clinics.

Occupational therapy (OT) dates to 100 B.C. when Greek and Roman physicians including Asclepiades and Celsus used it for the treatment of patients with emotional and mental disorders. Recommended therapy would include travel, therapeutic massages, exercise, conversation, and music to soothe the mind.

"OT month is a time when we can share the awesome work that we do and showcase that OT is here and we can help no matter the issue; from healing wounds and recovering strength, to finding new hobbies and new work interests," said Army Staff Sgt. William Cox, an instructor in the occupational therapy program at the Medical and Education Training Campus (METC) at Joint Base San Antonio-Fort Sam Houston.

"It is a time to not only let the community know who we are, but it also provides awareness to other health care providers by allowing them to offer another resource to their clinics that could help patients in their recovery," he added.

The METC OTA program trains Army and Navy students to become occupational therapy assistants.

The eight-month program is broken into two phases. In phase one, students are in the classroom learning general studies of occupational therapy and the required skills needed to be an occupational therapy assistant. Students also get to practice skills in practical labs.

In phase two, students work in two different clinical settings, putting their skills and knowledge to the test in local hospitals and clinics around the city and around the country.

After graduation, active duty Army students are assigned to a military medical treatment facility (MTF) or a holistic health and fitness unit, while National Guard and Reserve students go back to their hometowns and begin working as OTAs. Navy students are assigned to inpatient/outpatient MTFs. Navy OTAs are also stationed at overseas MTFs providing school-related services as part of the Education Developmental Intervention Services team.

"Our program is nationally accredited, and graduates of the program earn an associate degree from the Uniformed Services University as well the privilege to sit on the national board for certification as an OTA," said Cox.

Army Spc. Zachary Berdan, a student in the program, said that he was happy that he chose occupational therapy as a career.

"This field grabbed me because I wanted to help people recover," he said. "What I enjoy most about the training is that there hasn't been a block of instruction that I thought was boring or unnecessary."

Berdan added that all the instruction has intrigued him, even inspiring him to do more research in his free time.

"I have been learning how emotionally and spiritually rewarding occupational therapy can be," he said.

Dietetic interns train to better MHS beneficiaries nutrition, health

Mon, 05 Apr 2021 00:00:00 Z

Registered dietitians, exercise therapists and other team members in the Nutrition Services Department (NSD) at Walter Reed National Military Medical Center, assist patients and staff in making informed food choices and developing healthy eating and physical activity habits. Dietetic interns at WRNMMC also help Military Health System beneficiaries develop healthy eating and lifestyle habits.

The interns come to WRNMMC as part of the two-phase U.S. Military-Baylor Graduate Program in Nutrition (GPN). WRNMMC is one of the host sites for Phase 2 of the program, when interns continue their education and training with a goal of earning a master's degree in nutrition from Baylor University, as well as a Dietetic Internship Verification Statement, making them eligible to sit for the National Registration Examination for Dietitians.

Before entering the nutrition internship program, candidates must have completed a bachelor's degree in nutrition and/or dietetics and have a verification statement from the Accreditation Council for Education in Nutrition and Dietetics (ACEND), which accredits the internship.

"WRNMMC is one of four hospital-based Phase 2 sites," stated Shawntel Green, a registered and licensed dietitian nutritionist who serves as site coordinator for the U.S. Military Dietetic Internship Program at Walter Reed Bethesda. She explained the first phase of the program, the didactic portion, lasts approximately nine months at the Graduate School on Joint Base San Antonio-Fort Sam Houston, Texas. Phase 2, the internship and research portion, lasts a year.

In addition to WRNMMC, other locations for Phase 2 of the program are Brooke Army Medical Center at Joint Base San Antonio-Fort Sam Houston in San Antonio, Texas; Madigan Army Medical Center at Joint Base Lewis-McChord in Tacoma, Washington; and Womack Army Medical Center at Fort Bragg, North Carolina.

"Currently, there are about 15 interns per class, however, with our increased mission of H2F [Holistic Health and Fitness], the goal will be to grow to approximately 30 interns," Green explained. "Typically, this equates to around five [to seven] interns per site," she added.

MHS GENESIS Patient Portal expands new features

Mon, 05 Apr 2021 00:00:00 Z

MHS GENESIS' patient portal is rapidly increasing in size, capability, and usability.

Features gaining in popularity include a health library, provided by corporate partner Healthwise, said Air Force Lt. Col. John DaLomba, solution owner for the MHS GENESIS patient portal, at the Defense Health Agency (DHA) in Falls Church, Virginia.

"People can look up pretty much anything that they want" such as knee pain or diabetes, he said. "It's really quite good, and quite extensive."

But the portal's "best feature, in my opinion, is the secure messaging," said DaLomba, who is also an occupational therapist. "You can exchange secure information with your provider or provider's team, and all the communication takes place within the electronic health record program. You have exactly what was conveyed - there's no opportunity to misconstrue what was typed in."

Older MHS GENESIS communication systems were limited to a member's primary care physician. The new portal system allows communication with an empaneled provider or specialty clinic and their teams of professionals with authorized access. That last part is important so that communications go to a "message pool," and don't just sit unopened in an inbox if a provider is unavailable.

The tool allows communication with certain civilian health care professionals, too, and decreases the need to use a fax machine, DaLomba said. He added that there are more new features coming for the patient portal but couldn't give an exact timeline because of the need to work out licensing and acquisition periods.

Meanwhile there is an online scheduling capability for primary care physicians, and patients have the opportunity to view (and print) a lot of information from visit summaries and clinical notes, DaLomba said. Tests and measurements can also be viewed, though there is a built-in 36-hour delay for radiology and lab results, enabling doctors to view the results and prepare to communicate what they mean to the patient, particularly if there is an issue to discuss. For COVID-19 testing results, however, this delay has been removed.

DaLomba has used the MHS patient portal as a provider as recently as last year when he came to the DHA. And he had plenty of experience with the Military Heath System's legacy documentation efforts - two separate systems for inpatient and outpatient records. MHS GENESIS, which he started using at Travis Air Force Base in California in September 2019, incorporates both.

"It was a big change for everybody to get used to," he said. "Were there challenges? Of course there were. We were trained and there was plenty of support available. But it went well."

MHS GENESIS has been rolling out in waves around the military; eventually the entire MHS will transition from the legacy platforms. "It's a very complex deployment schedule, and it's mapped out through the next several years," DaLomba said. The first wave came in 2017, at sites in the Pacific Northwest.

Defense Health Agency celebrating the mighty military child in April

Fri, 02 Apr 2021 00:00:00 Z

The month of April is a mighty big deal for the Defense Health Agency.

The DHA launched the “Celebrating the Mighty” global campaign on April 1. This is the eighth year the DHA is participating in and celebrating the Month of the Military Child.

The “mighty” campaign will shine light on the virtual community that is available to military children on Military Kids Connect, as well as educating military children about the importance of building camaraderie as part of strengthening their mental health, well-being, and sense of belonging.

“Military kids provide creative and resourceful support to their families and communities, all while regularly adapting to new environments and making sacrifices alongside their parents,” said Kelly Blasko, counseling psychologist and lead for Military Kids Connect at the DHA Connected Health branch. “This year, the DHA is including the ‘Celebrating the Mighty’ campaign as part of our Month of the Military Child outreach so we can honor the strength, resiliency, and sheer might that military kids demonstrate every day.”

Blasko mentioned military children sometimes face unique psychological challenges that come with military life. For the nearly 1 million military kids, they may have a parent absent for long periods of time and move multiple times during their grade-school years. These factors alone may greatly stress military kids’ mental health.

“For military kids, sometimes it’s hard to relate to other kids when their parents aren’t in the military like yours are,” said Mackenzie Hale, a 16-year-old military kid living in Washington state. “I am lucky to have found a community of other kids and families who can support each other, and that has been very helpful when my dad has gone on deployments.”

Throughout April, Military Kids Connect is hosting virtual “Celebrating the Mighty” events and activities:

All month long, Military Kids Connect will share information for military kids on Instagram, Facebook, and Twitter, using #MonthOfTheMilitaryChild, #MOMC
Command Sgt. Maj. Michael Gragg celebrates the mighty with a video shout out to military kids.
On April 6, Military OneSource’s Daily COVID-19 Facebook Live will feature Military Kids Connect and the Celebrating the Mighty campaign.
On April 12, there will be a military kid “takeover” on the Military Kids Connect social media channels (see a preview video here).
April 15 marks Purple Up Day, when the DHA recognizes military kids everywhere by encouraging everyone to wear purple, the color representing all military branches, using #PurpleUp, #PurpleUpDay.
Military Kids Connect digital banners will be prominently displayed at large military installations in Germany, Korea, Hawaii, North Carolina, Texas, and Washington state.

The Department of Defense launched the Month of the Military Child campaign in 1986, and it has evolved to one of the most exciting campaigns of the year. Follow along and celebrate the mighty on the DHA’s Military Kid Connect Facebook, Instagram, and Twitter accounts.

Telemedicine advances put to the test during pandemic

Thu, 01 Apr 2021 00:00:00 Z

In the wake of the COVID-19 crisis, the Telemedicine and Advanced Technology Research Center continues to develop technology that increases medical capabilities and provides rapid, flexible critical care expertise at the point of need.

During a recent Medical Museum Science Café, held virtually by the National Museum of Health and Medicine in Silver Spring, Maryland, TATRC director Army Col. Jeremy Pamplin described the implementation of the National Emergency Tele-Critical Care Network (NETCCN) and how telemedicine can improve outcomes for disaster response.

COVID-19 has led to the need for physical distancing and has overwhelmed the capacities of health systems, compelling many to adopt telehealth solutions. Clinicians discovered how telemedicine can enhance communication efforts, reduce exposure and personal protective equipment consumption, improve efficiency and quality of care, increase access to specialty services, and in some cases lower costs and optimize the use of resources.

However, as Pamplin mentioned, the findings fluctuated due to the complex nature of the U.S. health system, which is an intricate mix of local, state, and federal policies and diverse expectations, cultures, and belief systems. For example, the implementation of telehealth may improve outcomes for one organization, whereas the same implementation elsewhere may not.

Pamplin described how he and his colleagues studied the implementation of telemedicine in a military environment.

“Telemedicine in the military has consistently enabled military clinicians around the world to work beyond their typical scope of practice while deployed in austere, resource limited environments by providing reach-back capability to military experts working in referral centers across the globe,” he said.

Pamplin then looked at the potential use of a telecritical health system for large-scale military operations. According to Pamplin, telehealth technology could be adapted to a variety of care contexts including large-scale combat situations or natural disasters that rely on military aid.

Partnering with the civilian sector, Pamplin and his colleagues developed NETCCN, a telehealth system that could consolidate telehealth networks and manage a high patient capacity during an emergency or a national crisis.

When COVID-19 emerged, Pamplin and his team began the implementation of NETCCN to help respond to the current stressed health care system. According to Pamplin, the network brings remote critical care expertise to the point of care, providing e-consult support, remote home monitoring, relief coverage, tiered staffing, and specialty services.

“The NETCCN addresses the lack of critical care clinicians across our nation by shifting these resources where and when needed,” Pamplin said. “In a dynamic, flexible fashion, NETCC links remote expertise to frontline providers, often working beyond their scope of training, using secure, HIPAA compliant applications on mobile devices, thus bypassing the lengthy process of purchasing and installing expensive hardware packages.

Said Andrea Schierkolk, NMHM’s public programs manager: “TATRC’s efforts to address the benefits and challenges of telemedicine were put to the test during the COVID-19 pandemic, and documenting these innovations in military medicine contributes to NMHM’s mission to share the value of the nation’s investment in programs like those of TATRC.”

For more information on TATRC and its initiatives, please visit at www.tatrc.org

Virtual program helps diabetic patients better manage their insulin

Thu, 01 Apr 2021 00:00:00 Z

The Diabetes Remote Electronic Assisted Monitoring, or DREAM, program focuses on teaching patients how to measure and adjust their insulin independently based on their provider’s instructions.

A team from the Military Health System Virtual Medical Center coordinated with the Diabetes Center of Excellence at Wilford Hall Ambulatory Surgical Center located at Joint Base San Antonio-Fort Sam Houston in Texas – to develop a program to help augment a patient’s diabetes treatment plan, providing support to the patient between provider appointments. The program is available for patients and providers across the San Antonio Military Healthcare System.

“The main idea was that patients are often told to titrate (go up or down) on their basal insulin based on a pattern of fasting glucoses,” explained Air Force Maj. Darrick Beckman, endocrinologist and Diabetes Center of Excellence medical director. “However, it is not uncommon for patients to be overwhelmed at appointments. And, even with having written handouts on how to titrate their insulin, when they return in three months, there have been no adjustments made to their insulin and their diabetes is not better controlled.”

The DREAM program offers patients help from a registered nurse to review their blood sugars and to help them identify patterns related to lifestyle that may impact their blood glucose levels. Patients also learn how to titrate their basal insulin according to the appropriate protocol as ordered by their provider.

After a provider refers a patient to the DREAM program, a registered nurse will contact them by phone to make sure they are suitable for the program and willing to participate.

“From there we set up an orientation to walk them through the program plan, including diabetes education,” said Nichole Carreon, one of the two DREAM registered nurses.

“Each week we have remote encounters by telephone to go through their weekly glucose readings and help them with their basal insulin through a titration protocol. The goal is to get patients into their prescribed target range for four weeks or titrating independently on their own for six weeks before we consider graduation from the program.”

Beckman said they worked hard to develop the algorithm(s) and the overall referral process to ensure the appropriate information is transmitted from start to finish — from provider referral and monthly reports to graduation from the program.

“We beta tested products and reports with primary care managers to get feedback about what data they would desire and even how often they would want reports,” he said. “We had to ensure continuity of care for transitioning providers. Once the patient was referred, we wanted there to be clarity to the providers about how the patient was doing and the ability to notify of acute concerns from nursing, in as little time as possible.”

Once the patient is appropriately educated and feels comfortable to titrate on their own, they no longer need the program, Beckman explained. “This titration capability is something the patient can use life-long.”

Since DREAM launched in February 2019, they have had more than 60 participants go through the program.

“It has taken on average about 5.1 months for participants to complete the program and we have seen an average A1C improvement of up to 2.5 points,” said Kim Wasmuth, DREAM RN. “Most patients reach their target goals before the end of the program and/or are able to titrate their basal insulin on their own. For those who do not reach their target goal, they leave with the tools needed to adjust their insulin on their own so that achievement of their goal is much more likely than without those tools.”

Beckman said from a provider perspective the DREAM program works well.

“I can make quicker adjustments in insulin, with little time spent on the overall process,” he said. “And, acute issues can be identified, such as hypoglycemia, and I can intervene quicker.”

“Patients tell me they enjoy having an accountability partner,” Beckman added. “They say that they’re more likely to remember to take their insulin doses because they know they need to report the numbers to the nurse.”

Providers interested in learning more about the DREAM program can email the Virtual Medical Center Remote Patient Monitoring Clinic at: dha.san-antonio-tx.healthcare-ops.list.vmc-fo-rhm-nursing-suppor@mail.mil.

BAMC Women's History Month honors women past and present

Wed, 31 Mar 2021 00:00:00 Z

Brooke Army Medical Center, located aboard Joint Base San Antonio-Fort Sam Houston in Texas, held a virtual Women’s History Month commemoration March 23 to honor women from the past and the present.

This year’s theme, “Valiant Women of the Vote: Refusing to be Silenced,” honored the brave women who fought to win suffrage rights for women, and the women who continue to fight for the voting rights of others.

Army Brig. Gen. Shan Bagby, BAMC commanding general, opened the event by highlighting the importance of women in the United States military.

“Women will always play a critical role within our military,” the general said. “The strength of our military and our nation comes from its diversity. Developing and maintaining qualified and demographically diverse leadership is critical for mission effectiveness.”

Today there are more than 230,000 women on active duty in the United States military, and 255,000 government civilians working within the Department of Defense.

The general talked about the significant roles women have taking within the military since the Revolutionary War.

“We know from history and experience that the contributions and achievements of women make our military stronger,” Bagby said. “Each day, there are countless examples of courageous and selfless service by military and civilian women throughout our ranks and within the halls of BAMC.

“I am overwhelmed by all of the women throughout history, or for the purposes of this conversation ‘HER-story’ who continue to serve as outstanding examples for us to follow,” said the event’s guest speaker Army Lt. Col. Alison Murray, BAMC chief medical information officer. Murray, has 18 years of military service, including five at BAMC; and currently serves as a nurse and information management officer.

Murray began by reflected on the women like Alice Paul, Lucretia Mott, Susan B. Anthony, Ida B. Wells, Anna Howard Shaw, Helen Keller and other suffragists who played significant roles in women obtaining the right to vote.

“Please keep in mind that even though the purpose was to fight for the right to vote, there were other participants that were fighting for a whole lot more,” she said, also mentioning the trailblazing efforts of 22 African-American women from Howard University who also participated in the 1913 Woman Suffrage Parade in Washington, D.C. as their first act of public service.

Murray encouraged everyone to think about how long it took to achieve voting right for everyone, which wasn’t until the passing of the Voting Rights Act in 1965.

“We have friends, family, staff members and patients old enough to remember when not everyone had a right that is essential to our standing as a functional democracy,” Murray said. “Needless to say, we are better for the efforts of all of these brave women who refused to remain silent on our nation’s path towards a more perfect union.”

Murray also highlighted the female leaders at BAMC, including Air Force Col. Heather Yun, deputy commander for medical services; Army Lt. Col. Jody Brown, deputy commander for inpatient services, and several others.

“Clearly, the women of the Armed Forces and Brooke Army Medical Center are not staying silent,” Murray said. “The late, great Shirley Chisholm once said ‘if they don’t give you a seat at the table, bring a folding chair.’ The women of Brooke Army Medical Center, don’t just bring chairs, they bring the entire table.

“We owe a debt of gratitude to all of those whom I have mentioned, in addition to the countless others that I did not,” she concluded. “We are better for their leadership and for their voices.” It is my hope that we inspire those currently in our ranks and those that are to come. We will not be silenced and most importantly, we remain steadfast in our commitment to demanding better for all people.”

DHA Centers of Excellence collaborate to improve TBI care

Wed, 31 Mar 2021 00:00:00 Z

When a rocket-propelled grenade struck her helicopter in Afghanistan in 2011, Army Staff Sgt. Beth King sustained a traumatic brain injury and was later diagnosed with post-traumatic stress disorder. Following the event, she experienced headaches, difficulty concentrating, and problems moving around.

King’s story in the A Head for the Future video series shares how she overcame balance issues and learned to pedal a recumbent bicycle and went on to win a gold medal in cycling at the 2019 Warrior Games.

King’s story illustrates the critical role collaboration plays among the Defense Health Agency’s centers of excellence in improving recovery from a traumatic brain injury (TBI).

“Patients often have comorbid conditions such as headache, vertigo, dizziness, and visual disturbances. The joint efforts of the TBI, Psychological Health, Vision, and Hearing Centers of Excellence allow us to cover all aspects of care and management with these unique cases,” said Gary McKinney, chief of clinical practice and clinical recommendations at the Traumatic Brain Injury Center of Excellence (TBICoE) in Silver Spring, Maryland. The centers of excellence are divisions of the Defense Health Agency Research and Development Directorate.

DHA preparing to complete treatment facility transition by Fall 2021

Wed, 31 Mar 2021 00:00:00 Z

The Defense Health Agency is planning and preparing to complete the Military Medical Treatment Facility transition by the mandated time at the close of this fiscal year, explained Dr. Brian Lein, DHA’s assistant director, Health Care Administration. Lein made these remarks to members of AMSUS, The Society of Federal Health Professionals,at a virtual talk on March 18.

“We are in the deep throes” of the integration and optimization of the MHS, said Lein.

Lein described the transition as “really a transfer of authority,” where the “rheostat shifts to the Defense Health Agency” and away from the Services controlling medical treatment facilities, dental treatment facilities, and all smaller hospitals and clinics.

In November 2020, the MHS transformation was restarted after the plans were put on hold in April 2020 because of the impact of COVID-19, Lein noted, updating remarks made by then-Assistant Secretary of Defense for Health Affairs Tom McCaffery at AMSUS’ December annual conference.

DOD warfighter brain health draft plan has six priorities

Wed, 31 Mar 2021 00:00:00 Z

Documenting how warfighters score on cognitive testing – from the beginning of their careers until after they leave military service – is one of six major concerns and priorities of service members being addressed in a plan for brain health that is in final draft form.

This change to looking at brain exposures and traumatic brain injury (TBI) across the warfighter’s entire career represents a “paradigm shift” in the Department of Defense’s approach, TBI specialist Kathy Lee told the Society of Trauma Nurses annual conference, held virtually March 26.

Lee, senior health policy analyst for DOD’s Health Affairs, discussed the comprehensive strategy and plan for warfighter brain health (WBH), which addresses brain health, brain exposures, including blast exposures, TBI, and long-term and late effects of exposures and/or TBI.

General physical and brain health assessments, scans, or tests “that occur on a more frequent basis over time across their military careers and beyond if deficits are identified” is one of the six concerns and priorities outlined by operational service members, according to Lee.

Dissemination of information on which “brain exposures are most damaging” and “outright disclosure if they are at increased risk of exposure or injury while performing a specific training activity” such as breaching walls or experiencing blast overpressure is another priority and concern for transparency.

There are “multiple, deleterious effects of exposures before traumatic brain injury actually occurs” as well as TBI itself, Lee said. Known and emerging brain exposures are: blast overpressure; blunt force/impact; projectiles; directed energy (high-powered microwave); chemical-biological toxins; and other environmental hazards, she explained.

WRNMMC’s kidney transplant program ranked as 5-star

Wed, 31 Mar 2021 00:00:00 Z

The Walter Reed National Military Medical Center in Bethesda, Maryland has the best organ transplant outcomes in the greater District, Maryland and Virginia region, according to the Scientific Registry of Transplant Recipients (SRTR), an agency that tracks transplant programs outcomes.

The SRTR provides statistical and other analytic support to the Organ Procurement and Transplantation Network (OPTN) for purposes including the formulation and evaluation of organ allocation and other OPTN policies.

“We provide kidney transplant for all TRICARE-eligible beneficiaries,” stated Sharriff McGee, a registered nurse and program director, WRNMMC Organ Transplant.

WRNMMC is not the only kidney transplant program in the Department of Defense’s Military Health System (MHS), but also highly-rated. “We perform approximately 50 kidney transplants yearly and we are considered a 5-STAR program according the newly released risk adjusted SRTR patient outcomes data,” continued McGee.

Additionally, we have a robust Living Donor Kidney program that participates in the National Kidney Registry (NKR) kidney exchange program which creates more transplant opportunities for our patients.

WRNMMC transplant program includes a multi-disciplinary approach and follows post-transplant patients progressively over their lifetime, and very closely for the first year, according to Army Lt. Col. (Dr.) Jason Hawksworth, transplant surgeon and chief of transplant at WRNMMC. Those participating in the program include physicians, nurses, transplant coordinators, pharmacists, psychologists, social workers and dietitians, who work together to address not only complex medical issues, but also psychosocial and emotional needs of patients and their families.

According to the SRTR report released in January 2021, WRNMMC’s patient and graft survival is 99% for estimated and expected probability of surviving with a functioning graft at one year. Additionally, the wait-time to receive kidney transplant at WRNMMC is shorter than the national average, McGee added.

In 2019, WRNMMC Organ Transplant Service performed the first fully robotic living donor nephrectomy surgery in the Washington, D.C./Baltimore region. The robotic technology enables a safer surgery for living donors, as well as faster recovery and return to work time frames, according to Hawksworth.

This month has served as National Kidney Month and according to the National Kidney Foundation, more than 100,000 people are waiting for a kidney transplant; approximately 660,000 people live with kidney failure; 37 million people have chronic kidney disease; and one in three Americans are at-risk for kidney disease. The median wait time for an individual’s first kidney transplant is about three-and-a-half years and can vary depending on health, compatibility and the availability of organs.

The kidneys serve as powerful chemical factories that perform various functions, including removing waste products from the body, balancing the body's fluids, releasing hormones that regulate blood pressure, producing an active form of vitamin D that promotes strong, healthy bones, and controlling the production of red blood cells. Kidney disease can affect one of both kidneys, and if the kidney’s ability to filter the blood is seriously damaged by disease, wastes and excess fluid may build up in the body.

Though many forms of kidney disease do not produce symptoms until late in the course of the disease, there are warning signs of kidney disease, including high blood pressure, puffiness around eyes, swelling of hands and feet, blood and/or protein in the urine, and more frequent urination, particularly at night, and difficult or painful urination.

Preventing chronic kidney disease (CKD) and its complications is possible by managing risk factors and treating the disease to slow its progression and reduce the risk of complications, according to the Centers for Disease Control and Prevention (CDC).

WRNMMC Organ Transplant department is eager and excited to offer kidney transplant services to our active duty, dependents, and veterans. To learn more, visit the WRNMMC’s Kidney Transplant Program’s website; or call 301-295-4331 to speak with a transplant coordinator.

For more information about kidney disease, visit the CDC website.

DOD healthcare leaders give COVID-19 update, praise DHA personnel

Tue, 30 Mar 2021 00:00:00 Z

Acting Assistant Secretary of Defense for Health Affairs Dr. Terry Adirim and Defense Health Agency Director Army Lt. Gen. (Dr.) Ronald Place praised the job done by members of the military medical community in fighting COVID-19 during a recent briefing at the Pentagon.

The Department of Defense "is playing a key role in supporting the whole of government approach to defeating COVID-19, particularly in support of vaccinations of our service members and other beneficiaries but also our fellow citizens through the Federal Emergency Management Administration mission," said Adirim.

Adirim explained that recent changes within the DOD included, a review of all COVID-19-related policies and updated Force Health Protection measures based on the Centers for Disease Control and Prevention guidance. She cited the incorporation of quarantine and testing guidance for vaccinated individuals as just one example. She also said DOD policies and guidance will continue to evolve in collaboration with the CDC.

"We will continue to update our guidance to ensure our DOD personnel are safe and can perform their missions," said Adirim. "In the meantime, we are vaccinating our service members and eligible beneficiaries as fast and as safely as possible."

In alignment with the President's announcement that all Americans will be eligible to be vaccinated in May, she said the DOD intends to open vaccination to all eligible beneficiaries by May 1.

She thanked service members, both those who have been vaccinated thus far, and those who have played an integral part in the vaccination effort.

"They are not only protecting themselves, but they're also contributing to the safety of their teammates, their families and their communities. I'm very proud of all of them," she said. "We've administered more than 1.8 million shots within the DOD, and more than 5 million shots have gone into arms by our military service members in support of the FEMA mission."

Adirim offered a message of hope and motivation to the DOD community: "The light at the end of the tunnel is near - I know you've heard that over and over again - but it's true. Vaccination is one critical part of getting our country back to normal, along with continued testing and adherence to public health measures like masking and social distancing. We just can't let up at this point."

Place delved into some of the specifics of both manning and administering such an effort.

"The Military Health System is administering COVID vaccines at 343 sites around the world," detailed Place. "At the same time, nearly 3,000 military personnel are currently deployed to support FEMA-led efforts at civilian vaccination sites around the United States, with more expected soon."

Place echoed Adirim's message for military medical personnel.

"A special thanks goes out to our superbly trained enlisted medical forces carrying out these responsibilities with compassion and with distinction," said Place. "We're thankful for those who have taken this step, protecting themselves, their teammates, their families and those most vulnerable."

Place explained that the DOD is balancing operational risks with vulnerability to infection. He said that almost all installations are vaccinating those who are deployed or preparing to deploy, those over 75 years old and front-line essential workers.

He noted that the unique demographics of the military, however, put over half of the population in the final tier of the DOD's vaccination priorities.

"It's important to note that about 60% of our military personnel are in that final tier of our vaccination priorities - that is, generally young without underlying health conditions and not currently required in an operational mission," said Place.

This, he noted, is similar to most civilian populations in jurisdictions within the U.S.

Place said that the DOD and DHA's efforts and messaging are fluid and based on input from military medical professionals from around the world.

"I speak with military medical commanders around the world every week and work through the issues they are confronting for vaccinations," said Place. "We exchange best practices and refine our communications efforts based on what our leaders on the front lines share with us."

As a physician, Place noted, he stands firmly behind the FDA-approved COVID-19 vaccines.

"These are safe, effective vaccines and are critical weapons in our fight against COVID-19," said Place. "All Americans who receive their care from the Department of Defense and would like to be vaccinated will have that opportunity over the next few months, whether abroad or here in the United States."

Five ways to keep your brain healthy

Tue, 30 Mar 2021 00:00:00 Z

Every March, the Department of Defense recognizes Brain Injury Awareness Month to raise awareness of the importance of improving brain health and identifying, caring for, and treating individuals affected by traumatic brain injury, or TBI.

Focusing on brain health is key to mission readiness, and there are several steps that the military community – service members and veterans, health care providers, researchers, educators, and families - can take to maintain a healthy brain.

Here are five ways to keep your brain healthy:

1. Get plenty of sleep

Getting restful sleep is one of the most important things you can do for brain health. Sleep also plays a pivotal role in recovery from TBI. You can improve your sleep regimen with these healthy sleep tips:

Aim for a minimum of seven hours of sleep on a regular basis
Avoid stimulants such as caffeine, nicotine, and energy drinks within six hours of your usual bedtime
Exercise regularly, preferably finishing two hours before bedtime
Avoid alcohol within two hours of your bedtime
Promote a sleep friendly environment; minimize noise and light and maintain a cool but comfortable room temperature
Avoid use of smartphones or reading devices that give off light for two or more hours before bedtime.

2. Protect your head

Service members can limit their risk of experiencing a TBI by wearing a helmet or other protective equipment when training, deployed, or recreating. Many activities that service members engage in regularly, such as military training and sports or recreational activities, are potentially dangerous and could result in a TBI.

When wearing a helmet while playing sports or riding a bike or motorcycle, always remember the following tips from A Head for the Future:

Never wear a cracked or broken helmet
Never alter a helmet yourself
Regardless of wear and tear, always replace a helmet five years past the manufacturer's date to be sure it has the latest safety features

3. Take care of your mental health

The brain affects how we think, feel, and act. Damage to the brain, including from TBI, can affect physical function, thinking ability, behavior, mental health, and more. Severe TBIs increase the risk for mental health conditions such as anxiety and depression, as well as sleeping problems. Remember to seek medical treatment if you have symptoms of depression, anxiety, or other mental health concerns, especially if you have recently experienced a TBI.

4. Build your social networks

The ability to engage in productive personal and professional relationships, and positively interact with unit and command networks, is important to overall well-being and brain health. When you experience a TBI, changes to your personal and professional relationships are common. Some TBI symptoms, like mood swings and personality changes, can stress relationships. Friends, families, and coworkers who notice these changes, and are aware of a possible head injury, should encourage medical attention. Seeking medical attention for a potential TBI is a sign of strength, not weakness.

5. Get regular exercise and eat a healthy diet

Physical exercise is very beneficial for maintaining brain health. You can make a major difference in terms of how your body is functioning and, as a result, how your brain is functioning, through regular exercise.

Good nutrition is also essential to everyone's good health and wellness, and to warfighter readiness. The right diet can improve physical and cognitive performance, positively impact your mental health, lower your risk of many chronic diseases, and even help with recovery from some injuries.

The Department of Defense is committed to protecting the brain health of our service members. For more resources, please visit the webpage for the Traumatic Brain Injury Center of Excellence.

Intrepid Spirit Centers promote healing from traumatic brain injury

Tue, 30 Mar 2021 00:00:00 Z

For service members or veterans with traumatic brain injury and associated health conditions, life can seem like a living hell.

However, the military is working hard to improve the quality of life for those experiencing traumatic brain injuries (TBIs). One way is through the Defense Intrepid Network for TBI and Brain Health. This network is made up of the National Intrepid Center of Excellence (NICoE) and 10 Intrepid Spirit Centers (ISCs), and provides interdisciplinary, comprehensive neurological, psychological, physical, and lifestyle programs to active duty service members with TBI and associated health conditions, including post-traumatic stress disorder (PTSD), anxiety, and depression.

According to the Defense Health Agency's Traumatic Brain Injury Center of Excellence, 430,720 service members have been diagnosed with a first-time TBI since 2000. The most common form of mild TBI in the military is concussion, but even that can create complications for service members on active duty.

The multi-disciplinary outpatient program for mild TBI at the ISC at Fort Hood, Texas, has 300 to 350 active patients. Each patient, based on their individual treatment plan, may have several appointments per week, and general outpatient treatment duration is approximately six months.

"Ours is a readiness platform to help service members get back into the fight," said Director Scot Engel.

"When the TBI occurs in theater, we conceptualize the injury as affecting the whole person," Engel said. "We then create an individualized and synchronized treatment plan that is delivered by a top-shelf transdisciplinary ISC team."

"Since the ISC is one integrated center, there is a plethora of services offered, such as medical, psychological, rehabilitative, and pain management subspecialties."

Fort Hood ISC also offers a six-week, 40-hour per week intensive outpatient program consisting of 75% group work and 25% individual specialty care. The group work includes adaptive physical therapy, stress management, mindfulness, sleep therapy, cognitive rehabilitation, PTS treatment, pain management, art, music, yoga, health and leisure, and nutrition.

"We provide everything over six weeks to help the service member to build a skill set to manage their symptoms," Engel said.

"We view the injury as a consequence of war," Engel said. Cognition, memory, sleep, hyperarousal, stress, and pain are all outcomes of the injury to the brain, he added.

"We integrate a model called 'The War Within'," he said. "The model is a theoretical framework to drive the care. The model provides a metaphor to conceptualize the enemy within and is attempting to isolate, marginalize, and stigmatize the soldier, and eventually drive them to take their own life.

Lovell FHCC staff steps up to create formidable COVID-19 team

Tue, 30 Mar 2021 00:00:00 Z

The COVID-19 vaccination effort at the Capt. James A. Lovell Federal Health Care Center has brought out the best in staff, many who volunteered to create a formidable team dedicated to one thing - getting shots in the arms of every staff member and as many of the FHCC's veteran, military, and military dependent patients as possible.

From the late December day the first Moderna vaccines were delivered with fanfare to the North Chicago, Illinois facility, it became apparent that what would typically be done through the Immunizations Clinic was too big of an operation for the limited clinical staff.

"We knew we had to stand up a group of people to basically volunteer to be vaccinators," said FHCC Assistant Director of Plans and Operations Kathleen Kennedy.

FHCC Gastroenterology Nurse Manager April Shaw was given the task of managing staff volunteers who would be running the staff vaccination clinic. This team dedicated six weeks to COVID-19 vaccinations for staff in the Family Practice Clinic. By the end of the seventh week, 73% of staff was vaccinated, including Department of Veterans Affairs and Department of Defense employees.

Chief of Pharmacy, Laurie Noschese, and Regional Immunizations Program Manager, Randy Tolbert, were tasked to deploy staff vaccines. They got support from the team of volunteers including nurses, pharmacy employees, and medical support assistants.

At first, some Navy staff at Lovell FHCC were unable to access the online appointment booking tool developed at another VA facility for staff to schedule their vaccinations. Once the clinic had enough doses on hand, walk-in appointments were opened for all staff, which mitigated the issue.

As the clinic became busier, more administrative staff volunteered to manage the flow of the clinic, checking people in, handing out paperwork, and scheduling second dose appointments. This allowed clinical staff to focus on their medical roles – vaccinating and observing those who had received the vaccine. Volunteers also helped schedule appointments over the phone. According to Kennedy, there was never a shortage of volunteers to help the vaccination effort.

"COVID-19 operations have the ability to unify everyone as a team," she said. "It's something we all live through at work and at home. People really understand the significance of what they're doing."

At one point during staff vaccinations, a roving team of vaccinators and other volunteers brought the COVID-19 vaccine to Lovell FHCC Branch Clinics at Recruit Training Command and Naval Station Great Lakes, allowing staff members the convenience of getting vaccinated near their work sites, rather than at the main hospital. The ability to offer this option displayed the flexibility of the vaccination team, Kennedy added.

Since the vaccine was made available to FHCC Community Living Center residents first and then to outpatients in mid-January, the team has made similar trips to vaccinate staff and patients at Lovell FHCC's Community Based Outpatient Clinics, which don't have the capacity to operate their own COVID-19 vaccination clinics.

The start of outpatient vaccinations drastically increased the clinic's operations, from an average of 100 daily immunizations to about 250 a day. With this change, the clinic began relying more on administrative volunteers to keep the area organized and facility management staff to ensure the area was safe.

Active duty corpsmen assigned to Navy Medical Readiness and Training Command Great Lakes were another group of Lovell FHCC employees who volunteered to man the greatly expanded vaccination effort. During the mass push of Moderna vaccine doses, Navy corpsmen and VA employees were not only running the clinic but transporting patients through the hospital tramways to overcome accessibility limitations.

"It's a great opportunity for corpsmen to use the clinical skills they may not be able to use on a daily basis, depending on where they're placed in the organization," Kennedy said.

Since established in 2010 as the nation's first fully integrated federal health care center in support of both the Department of Defense and the VA, Lovell FHCC's mission is best captured through the motto, “Readying Warriors, Caring for Heroes."

One year after the coronavirus pandemic was declared, Lovell FHCC staff is still adapting to the changes in responding to the novel disease.

"The (COVID-19 vaccination) team is so focused on the patients and getting us out of this pandemic," Kennedy said. "No matter what is thrown at them, when asked if they can do it, the answer is going to be yes."

Visual dysfunctions common in even mild TBI patients

Tue, 30 Mar 2021 00:00:00 Z

In 2008, the National Defense Authorization Act authorized the Secretary of Defense to "establish a Center of Excellence to address the full scope of vision care including prevention, diagnosis, mitigation, treatment, research and rehabilitation of military eye injuries and diseases..."

That year, the Vision Center of Excellence was established to address the full scope of vision care, including prevention, diagnosis, mitigation, treatment, research, and rehabilitation of military eye injuries and diseases including visual dysfunctions related to traumatic brain injury.

Although the Bethesda, Maryland-based center is not a treatment facility, it works to improve vision health, optimize readiness, and enhance quality of life for service members and veterans by promoting collaboration, facilitating integration, and serving as an advocate for vision across the departments of Defense's and Veterans Affairs' health care systems.

"We are an advocacy organization that drives consensus documentation to the provider communities out in the field that do deliver care," said Dr. Felix Barker VCE's director of rehabilitation and reintegration. "We engage large groups of multidisciplinary provider experts, who actively engage in the care delivery process for affected individuals."

Reporting to the Research and Development Directorate of the Defense Health Agency and the Office of Patient Care Services within the VA, VCE integrates DOD and VA-funded research related to vision health with a strong focus on ocular blast injury and traumatic brain injury (TBI) to improve operational readiness.

Service members can sustain TBI during day-to-day activities, such as sports or recreational events, as well as during military training and deployment. While the majority of TBIs sustained by U.S. service members are mild, also known as mTBI or concussion, they are also the most difficult to diagnose and the least well understood, according to a 2014 National Institutes of Health study on military-related TBI. Yet, in the first three quarters of 2020, 12,310 service members were diagnosed with TBI, most of them (85.7%) mild.

Concussion occurs when someone suffers a severe blow to the head or a violent jolting of the head and body, such as during a blast, explained Barker. Most service members who sustain mTBI return to full duty within 10 to 14 days through rest and a progressive return to activity, but further treatment is available when symptoms persist after the initial recovery period, he said.

"Military personnel who undergo blast exposure may be concussed by direct contact with a projectile or by being thrown against a rigid surface," said Barker. "Another unique feature of blast exposure is that some individuals have exhibited signs of TBI without direct concussive contact and are thought to have been affected by the direct effects of the blast wave itself."

However, vision-related problems associated with TBI are often overlooked during initial treatment of a brain injury, said Dr. Michael Pattison, VCE's program manager of readiness and operations optometry. "In some cases, symptoms may not be present until sometime following the injury - sometimes the eye itself is injured during the head injury or blast exposure and can result in conditions such as cataracts and retinal damage."

Additionally, "while vision is usually not affected by TBI unless there is a concurrent eye injury, patients with even with the most common mTBI have high rates of other visual dysfunctions which can dramatically affect job performance in terms of ability to read for extended periods, concentrate, and maintain clear and single vision," Barker explained.

"Other vision problems occur due to injuries in the brain," said Pattison. "Studies show that up to 90% of TBI patients suffer from some type of visual dysfunction."

These include blurred vision, sensitivity to light, reading difficulty, headaches with visual tasks, reduction or loss of visual field, and difficulties with eye movements. While many symptoms often go away over time, it is important service members don't ignore them, said Pattison.

"Any post-traumatic vision effect or visual symptom can be a result of concussion or TBI,” said Barker. "A TBI injury affecting visual acuity or visual field is indicative of a more serious brain injury and should be carefully evaluated as such by competent vision and neurology providers, who should engage as part of the rehabilitation team early in the process."

Additionally, he highlighted that the biggest issue with treating TBI is that each person must be treated individually because it is rare that all patients will have the same symptoms.

Women leaders say military health care offers limitless opportunities

Tue, 30 Mar 2021 00:00:00 Z

Formal mentoring programs exist for women in the military, but the need for ad hoc networking, personal communication, and informal mentoring still appear to be the strongest threads among female military health care professionals.

During National Women's Month, we highlight some of these leaders' opinions.

"There is more cognizance now for women early in their career to have that mentorship and sponsorship," said Acting Assistant Secretary of Defense for Health Affairs Dr. Terry Adirim. "As we get more senior, we develop other networks and relationships, so women won't have to struggle" as much as they did when she graduated from medical school 30 years ago.

"Surround yourself with people who will lift you up, not put you down," Adirim advised.

An emergency care pediatrician by training, Adirim now has a distinguished career in her field and in academia; and has been a senior Department of Defense official in different positions for several administrations.

Army Col. (Dr.) Dana Nguyen, chair of the Department of Family Medicine at the Hebert School of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, said women should seek out informal networks.

"Even though there are more formal mentorships and networks for women in military medicine, the best are the informal networks and opportunities to share stories, share feelings and reactions and help plan the way forward," and not just in military medicine, she said, but within their local communities as well. "There is more emphasis on whole-person well-being."

Air Force Lt. Col. (Dr.) Ruth Brenner, a preventive medicine physician and deputy chief of the Immunization Healthcare Division, Defense Health Agency Public Health Division, cited the "numerous women physician-leaders I have encountered along the way who serve as a collective guiding light for me as my career progresses. They proved to me that a successful work-life balance was attainable."

Discussing what advice to give young women in a military health care field, Air Force Brig. Gen. Anita Fligge, deputy assistant director, education and training, and chief nursing officer at the DHA, said: "To me, it's such a great opportunity; it has limitless opportunities to serve and grow professionally." She added: "Keeping an open mind and seeking out challenges, setting stretch goals, makes you grow as an officer, a health care professional and a person."

Fligge is responsible for 75 professional development and enlisted medical education programs across two institutes that train more than 308,000 DOD and international students annually.

Army Col. Audra Taylor, division chief, DHA Armed Service Blood Program, said young women and girls looking into health care careers in the military "should follow their passion and go for it. The ability to explore and research different careers and pathways is at their fingertips."

"I would advise that they do their homework, ask questions, and seek out a mentor in their desired career field and push forward."

Taylor has established herself with a strong record of leadership and experience within the blood banking community as well as with civilian counterparts, according to a June 2019 profile by AABB - formerly known as the American Association of Blood Banks - which is dedicated to advancing transfusion medicine and biotherapies.

Dover Air Force Base features ‘Park ‘N Pickup’ pharmacy

Fri, 26 Mar 2021 00:00:00 Z

COVID-19 has brought a slew of changes to the way military medical treatment pharmacies operate. One of the major changes, due to the increased need for patient safety, is that many pharmacy lobbies, including the one at Dover Air Force Base in Delaware, are closed.

To continue providing essential medications while incorporating COVID-19 precautions, the 436th Medical Group pharmacy at Dover has implemented a Park 'N Pickup process.

The process, implemented last November, allows patients to receive their medication without having to leave their personal vehicles. When arriving to pick up medication, patients park in a numbered spot within a designated area and text identifying information to the pharmacy.

Once the information is received, a pharmacy team member brings the prescription(s) to the vehicle. If a patient is unable to text, is dropping off prescriptions or needs further assistance, they turn on their hazard lights, and a pharmacy team member comes out to the car.

Patients can decrease their wait time by calling to alert pharmacy personnel that they intend to pick up their prescription.

When a patient's provider sends a prescription to the pharmacy, the patient can choose one of three methods to activate the prescription and alert the pharmacy.

First, patients can use TRICARE Online's Secure Messaging feature to directly message the pharmacy with their information and the prescriptions they wish to activate. An account must be set up before a patient is able to send messages, but once accomplished, this allows a patient to manage their appointments, refills, activations and more all from one screen. It also avoids length phone calls. Patients using this method can expect their medications to be ready in one duty day. Patients can find more information about secure messaging by visiting tricareonline.com.

At Dover AFB, patients can also call an activation line to speak with a pharmacy team member who will activate their prescriptions, but with high call volumes, that can lead to long waits.

Dover patients can also activate their prescriptions by using the Park ‘N Pickup process, but when they text their identifying information, they state how many prescriptions they wish to activate.

Paving the way for women in military medicine: Dr. Mary Edwards Walker

Fri, 26 Mar 2021 00:00:00 Z

Dr. Mary Edwards Walker was the first woman to be appointed as an assistant surgeon in the U.S. Army, she is also the only woman to date to have received the Medal of Honor, the U.S. government's highest and most prestigious military decoration.

Born in Oswego, New York, on Nov. 26, 1832, Walker graduated from Syracuse Medical College with honors in 1855. She subsequently married Albert Miller, and they started a medical practice in Rome, New York, shortly thereafter.

At the onset of the Civil War, Walker, then 23, traveled to Washington seeking a commission as an Army surgeon or a position as a contract surgeon. Both requests were denied as there was no policy in place for hiring female physicians. She then volunteered as a nurse, but continued to request a commission as an Army surgeon. After three years of persistence, she was hired as a contract surgeon and attached to the 52nd Ohio Infantry.

Walker served at the first Battle of Bull Run and the Battle of Fredericksburg, often near the Union front lines.

Army Maj. Gen. George Thomas and Maj. Gen. William Sherman, general of the Union Army, noted that Walker "...passed frequently beyond our lines far within those of the enemy and, at one time, gained information that led Gen. Sherman to modify his strategic operations as to save himself from a serious reverse and obtain success where defeat before seemed to be inevitable."

Walker's insistence on tending to injured civilians inside Confederate territory led to her being captured as a spy by Confederate forces near Chattanooga, Tennessee, in 1864 after helping a Confederate doctor perform an amputation. She was held in a prison in Richmond, Virginia, for four months and commissioned as an acting U.S. Army assistant surgeon following her release.

The difference between Celiac Disease & Non-celiac Gluten Sensitivity

Fri, 26 Mar 2021 00:00:00 Z

Eating gluten free has become very popular in recent years.

Many people who try it claim that it makes them feel healthier and have less gastrointestinal sensitivity, even when they do not have celiac disease --an autoimmune disease for which the only treatment is eating a gluten-free diet.

While eating a gluten-free diet is essential for those living with celiac disease, more and more people seem to claim that they are "gluten sensitive."

Contrary to popular belief, celiac disease is not a food allergy. It is an autoimmune disease that, when left untreated, can cause symptoms such as chronic or recurrent diarrhea, constipation, abdominal pain/distension, unintentional weight loss, vomiting, anorexia, dermatitis herpetiformis, dental enamel hypoplasia, anemia and hepatitis.

Celiac disease is diagnosed through a blood test with the presence of higher tissue transglutaminase enzymes; and a subsequent conformational intestinal biopsy. Currently the only treatment is eating a gluten-free diet.

Non-celiac Gluten Sensitivity (NCGS) is not an autoimmune disease and there is no single blood test for diagnosis. Symptoms can include abdominal pain, eczema and/or skin rash, headache, "foggy mind," fatigue, diarrhea, depression, anemia, numbness of legs/arms/fingers and joint pain. NCGS is a gluten reaction in which both allergic and autoimmune mechanisms have been ruled out. In other words, it is diagnosed by exclusion criteria including a negative immune-allergy test to wheat, a negative celiac disease blood test in which immunoglobulin, or IgA, deficiency has been ruled out, a negative intestinal biopsy, presence of biomarkers of gluten immune-reaction (AGA+), presence of clinical symptoms that can overlap with celiac disease or wheat allergy and resolution of the symptoms following a gluten-free diet.

If you are have been diagnosed with celiac disease or non-celiac gluten sensitivity and need help with your diet, a registered dietitian can help you implement a gluten-free eating plan. For more information, contact your local military medical treatment facility's dietitian or nutritionist.

Historic observance celebrates the achievements of women

Thu, 25 Mar 2021 00:00:00 Z

"If there's a first...then there can be a few and then many. A first is a signal that [anything] is possible!"

On March 17, Leslie Joseph, staff director for the deputy assistant secretary of the navy (civilian human resources) stated that we must celebrate when a woman becomes the first in history to occupy a position -- consider our current vice president, Kamala Harris, the first female voted into that position.

Joseph, along with Dr. Julie Cruz and Dr. Sharyn Potter participated in a panel discussion on women's history during the Defense Health Agency's virtual observance honoring Women's History Month.

They shared their experiences of serving in the nation's workforce and offered advice for women on finding success in life.

Women Are Connectors

As Director of the Technology Career Field in the Army's Civilian Career Management Activity, Cruz enhances civilian competencies, increases career satisfaction, maximizes employee engagement and retains talent for the Army's 15,000 IT/Cyber workforce.

In discussing her civil service career in the departments of the Army and the Air Force, she offered curiosity, positivity, and having the ability to connect with people as important characteristics of successful leaders.

"I choose to be positive and...to be a connector," said Cruz.

Cruz encourages women to support other people in their careers. "Make a decision on how you can uplift people...How do we try maximize people's strengths?"

Women Provide a Voice for the Voiceless

Dr. Sharyn Potter is a co-founder of and executive director of research at the Prevention Innovations Research Center: Ending Sexual and Relationship Violence and Stalking at the University of New Hampshire. Potter supports community efforts to reduce sexual violence throughout the nation.

When discussing her experience as a volunteer on a crisis hotline, Potter remarked, "The powerlessness described by the victims and their appreciation for having someone to listen to them...cemented my dedication to help end sexual violence."

"When talking about Women's History Month, we need to ensure that women can pursue their dreams and expand their opportunities for themselves and their families."

When we “Break Bread," we build social bonds

Thu, 25 Mar 2021 00:00:00 Z

Throughout history, people have bartered, decided the fates of nations, and built friendships all over meals. Within traditional military units there are key social times when meals have historically been shared: hails and farewells, promotions, and celebrating historical dates. Often these are labeled as "mandatory fun", but perhaps they play a bigger role. The sharing of meals has been shown to improve feelings of closeness, increase satisfaction with life, enhance team performance, and influence food choices.

Within the Total Force Fitness (TFF) framework, the 'Social Fitness' domain includes the ability to engage in healthy social networks and promotes overall well-being and for optimal unit performance. The global pandemic has forced physical distancing, closed indoor seating, minimized group size, and discouraged shared meals.

This, in turn, is discouraging the use of social meals in fostering social fitness. Countering any negative effects on social fitness, team cohesion, life satisfaction, and overall health among military members should be an important consideration.

A team is only as strong as its weakest link, and developing opportunities for social networking can promote team cohesion.

Unfortunately, per the Department of Defense Annual Suicide Report, suicide rates among military members was at an all-time high in 2019, with nearly 26 per 100,000 service members committing suicide. Concerns have already been voiced that the stress of the COVID-19 might drive these numbers even higher in 2020 and 2021.

Eating socially has been shown to influence happiness and life satisfaction; specifically participating in evening meals with more people, more laughter, reminiscing and alcohol consumption resulted in individuals feeling closer to those with whom they ate. It therefore makes sense for military leaders to find ways to promote social networking and team cohesion during a pandemic and adding a food element could help support those opportunities.

Social scientists have suggested that the phrase "you are what you eat" should be replaced with "you are what the people in your social circle eat". Eating habits and food choices seem to be influenced by the social circle that people belong to, so much so that "prior eating habits of friends have been shown to predict current eating patterns".

Perhaps, now is a time to capitalize on influencing food choices by creating virtual shared food experiences that can promote healthy eating habits and develop social connectedness.

Ways to Promote Social Connectedness and Fitness over Food during a Pandemic

Virtual happy hour - Pick a non-work topic and afford your team an opportunity for everyone to unwind with a beverage or snack of their choice and share in quality conversation.
Virtual networking event - Set up the event to include members of your team based on an interest or a team topic.
Virtual cooking classes - The class could include a specific recipe, with a list of ingredients for each person to pick up ahead of time, so that each participant cooks the recipe and the group eats the final product together. This would promote cooking skills while combining the opportunity for social conversation. Reach out to your local Military Treatment Facility to see if their nutrition professionals would be willing to provide a class, recipes, or both.
Virtual dinner party - Develop a menu, incorporating fresh foods. Send out the shopping list in advance with the recipe. Advise all participants to have their food plated and be seated in front of their electronic device at the start of the dinner party. The menu can be as elaborate or as simple as you'd like. Reach out to your local Military Treatment Facility to see if their nutrition professionals would be willing to provide recipes or suggestions for your menu.

Get creative, build your team, and incorporate healthy options to promote health and social connectedness.

To learn more, or get support - reach out to your military medical treatment facility nutrition professionals for assistance incorporating healthy options or seek out additional online resources by accessing the Human Performance Resources by the Consortium for Health and Military Performance (CHAMP).

DHA implements standard practices to improve maternal outcomes

Wed, 24 Mar 2021 00:00:00 Z

The Defense Health Agency's Women and Infant Clinical Community has recently implemented standardized practices to improve maternal outcomes in all its military medical treatment facilities around the world.

The new DHA-Procedural Instruction (DHA-PI) 6025.35, Guidance for Implementation of the Postpartum Hemorrhage (PPH) Bundle, provides instruction for implementation of the postpartum hemorrhage bundle at all MTFs providing obstetrical care.

Prior to issuing the DHA-PI in January 2021, the Military Health System had many different methodologies, but not an enterprise standard for the process to evaluate risk assessment and resources to promptly treat PPH to prevent maternal complications, said U.S. Public Health Service Capt. Anne McMillan, PPH Bundle Campaign co-lead and interim lead for the DHA Women's Health Clinical Management Team (WHCMT).

Considering PPH accounted for 10.7% of all maternal deaths in the United States between 2014 and 2017, according to the Center for Disease Control - Prevention's Pregnant Mortality Surveillance System, the effort is an important step in standardizing clinical practices and processes in obstetric care to reduce maternal morbidity and mortality across the MHS.

"The PPH campaign implements leading practices drawn from research and national and international organizations," said McMillan. "It provides a universal set of recommendations to standardize the clinical processes and resources that have been shown to help prevent and treat PPH."

The Navy Bureau of Medicine and Surgery adapted the hemorrhage safety bundle and implemented it across its medical facilities in 2016, according to McMillan. Building upon the lessons learned between 2017 and 2019, the Defense Health Agency conducted a PPH bundle pilot program at five military medical treatment facilities (MTFs). This pilot program further defines the standardized processes and develop a DHA PPH procedural instruction that would provide implementation guidance across the MHS, focusing on specific equipment, resources, and procedures required to enhance a system-level response.

As part of the bundle, each MTF must have a six-drawer purple cart with supplies, equipment, and medications specific to standard PPH treatment, allowing for immediate access to resources, explained McMillan. Additionally, each MTF must provide consistent assessments of a mother's risk factors throughout the course of perinatal care, before and after birth.

"Standardization of the review of a patient's risk factors or medical conditions is built into the medical record, with corresponding actions to support moderate and high-risk mothers," she said.

"The bundle components are designed to address specific steps to identify, prevent, and/or respond to a PPH event, and efforts are underway to update training, supplies, equipment, and resources and develop closer collaborations to decrease adverse outcomes for mothers and their families," explained McMillan. "Well prepared health care teams and informed patients comprise the best teams to prevent complications and improve outcomes for mothers and their families."

Additionally, the PPH bundle implementation campaign is one of DHA's strategic priorities for fiscal 2021. WICC started the implementation project in October 2020 in 12 MTFs with inpatient obstetrical units, focusing on readiness, recognition/prevention, response and reporting.

"Implementation of the PPH bundle is one of many clinical strategies being implemented to further support military readiness and quality of care for all beneficiaries and their families," said McMillan.

What is PPH?

PPH is a leading cause of maternal deaths globally, contributing to a quarter of deaths annually, according to a study published by the National Institutes of Health in 2016. It is one of a group of severe maternal morbidity (SMM) conditions that include unexpected outcomes from labor and delivery with significant consequences on a woman's health, explained Theresa Hart, senior nurse consultant, co-lead of the PPH Bundle Campaign, and WICC program manager.

According to the CDC, SMM has increased steadily in recent years, affecting more than 50,000 women in the United States in 2014, the last year for which this data is available. The report details that the cause of why SMM is on the rise is still not entirely clear. The report purports that changes in the overall health of the population of women giving birth - such as increases in maternal age, pre-pregnancy obesity, pre-existing chronic medical conditions, and cesarean delivery - may contribute to increases in complications.

Eight nations participate in West African virtual pandemic exercise

Wed, 24 Mar 2021 00:00:00 Z

Medical experts from six African nations, the United Kingdom and the United States, participated in a Virtual Pandemic Preparation and Response Engagement on March 16, in support of Obangame Express 2021, the largest multinational maritime exercise in Western Africa.

The virtual medical event served as an opportunity for partner nations to discuss infectious disease surveillance and virus outbreak response. Participants included medical leaders from Nigeria, Senegal, Côte D'Ivoire, Gabon, Liberia, and Ghana, along with medical professionals from the U.S. Navy and United Kingdom. These experts exchanged lessons learned from previous epidemics in their respective countries, as well as the unprecedented worldwide COVID-19 pandemic.

"The objective of the engagement, like Obangame Express 21, is to increase regional cooperation and interoperability. This event focused on how we can do that from a medical perspective." said U.S. Navy Lt. Amy Welkie, health security cooperation officer and the event's coordinator. "This allowed us to establish and build partnerships with our medical counterparts across the Gulf of Guinea."

Ghana Armed Forces Capt. Edward Nyarko, public health director at the 37th Military Hospital in Ghana, discussed the role Ghana Armed Forces' played in the national COVID-19 response. Nyarko credits his team's experience with previous outbreaks, such as the Ebola epidemic and prioritizing response workers' mental health for his team's many successes in saving lives in Ghana.

"All of us have one aim, and that is to ensure that we are prepared for any eventuality, especially for disease outbreaks," Nyarko said. "NAMRU-3 has been one of our biggest supporters as they are embedded in [the Noguchi Memorial Institute for Medical Research]."

Nyarko emphasized the importance of prior multinational partnerships with the U.S. Naval Medical Research Unit-No. 3 (NAMRU-3), U.S. Africa Command (AFRICOM) and others.

Through facilitated discussions, the event highlighted collaborations between militaries and local public health departments and the current goal of recovering previously infected military members.

Service members from the U.S. Navy and Royal Navy presented their experiences with outbreak responses in maritime environments.

"Outbreaks are the same whether you're in a maritime environment or a land environment," said U.S. Navy Cmdr. Brian Legendre, preventive medicine physician with the Navy Medical Corps. Legendre offered a number of strategies such as room ventilation, diagnostic testing, increased cleaning protocols, and isolation of sick patients as suggested tools for combating the spread of illnesses on ships.

Participants voiced their shared challenges during early pandemic response, which included shortages in personal protective equipment and limited accommodations for sick patients at the beginning of the COVID-19 pandemic in 2020. In cross-sharing the challenges and solutions, participants assisted each other in improving professional bio-surveillance methods, and refining other techniques learned throughout the pandemic.

"It's been fabulous interacting with everyone and seeing how people have sort of faced similar challenges and come up with similar solutions," said Lt. Col Dan Burns, British Army infectious diseases consultant. "It's been brilliant, and I feel like we've learned a lot from the dialogue."

Exercise Obangame Express 2021, sponsored by AFRICOM and conducted by U.S. Naval Forces Africa, is designed to improve regional cooperation, maritime domain awareness, information-sharing practices, and tactical interdiction expertise to enhance the collective capabilities of Gulf of Guinea and West African nations to counter sea-based illicit activity.

Army dietitian uses nutritional care to fight COVID-19

Tue, 23 Mar 2021 00:00:00 Z

Army Capt. Melissa Shaffer, a registered dietitian-nutritionist at Blanchfield Army Community Hospital at Fort Campbell in Kentucky, doesn't swab nasal cavities to test for COVID-19 or administer COVID-19 vaccines.

In the fight against COVID-19, her mission is to oversee the nutritional needs and special diets of all military healthcare beneficiaries admitted to the hospital - including those with COVID-19. As a certified nutrition support clinician, she was specifically trained to work with critically ill patients, and is part of the hospital treatment team for a critically ill COVID-19 patient.

Air Force retiree Gino Garcia can testify to the importance of her role at the hospital, as spent about two months in Blanchfield’s intensive care unit where a team of healthcare professionals worked together to help him recover from the deadly disease.

When he first arrived, his doctors noticed he wasn't able to oxygenate his blood so they decided he would benefit from being intubated and placed on a ventilator. A ventilator is a life-support machine that uses a tube inserted into the trachea through the mouth or nose that forces air into the lungs, artificially breathing for a patient who cannot adequately breathe on their own.

"The last thing I remember was that I had COVID and that I went through [the hospital] doors to be taken care of like any other patient. After that I don't have any other memories," said Garcia.

Now in recovery, Garcia referred to his time on the ventilator as "lights out" because he had no recollection of the month prior when the ventilator, his care team, his family's love and many prayers were at work to help him beat COVID-19.

Shaffer was responsible for the nutrition care needs of Garcia, which she coordinated with other medical specialists involved with his care.

"Nutrition plays an important role with the recovery of critically ill patients. Since Mister Garcia was ventilated and sedated he couldn't eat on his own," said Shaffer. "You have to feed critically ill patients who are ventilated with enteral tube-feeding and you have to consider the formula, the rate, and the type of feeding you are going to give them."

Shaffer used predictive equations to calculate his energy needs and started Garcia out on a continuous feed of a no fiber, high protein formula to meet all of his nutrition needs. She gave him additional protein supplements so he wouldn't lose a lot of lean body mass while he was hospitalized and also evaluated his medications.

"We screen all the patient's medication for nutrient/drug interactions. There are certain things you have to watch for if somebody is on tube feedings because certain drugs can deteriorate the tube," she said.

Garcia's case was extremely critical but after nearly a month on the ventilator he began to improve and became aware of his surroundings.

He was very weak from the toll the virus took on his body but ready to begin the recovery process with the help of his family and care team.

"After such a long time in that position I forgot about eating. I forgot the taste of food, color and aroma. So I had to kind of rearrange my brain...and go through the learning process like a baby learning to eat," Garcia said.

Shaffer explained that when a ventilator tube is removed some people may have issues with eating, and swallowing. Patients sometime have to relearn those skills and with ventilation they are not using their muscles so they may lose muscle strength.

Once he was able to breathe on his own Garcia's ventilator feeding tube was replaced with a thinner feeding tube through his nose. This tube would allow him to begin the process of learning to eat and feed himself again. Shaffer continued tube feeds to meet his energy needs until he was able to meet them through eating on his own.

The treatment team used a multi-disciplinary approach for Garcia's nutrition and self-feeding rehabilitation.

A speech pathologist performed a swallow evaluation to determine the texture of foods that Garcia could tolerate and provided the information to Shaffer so her team in nutrition care could create foods he could consume. Shaffer did daily calorie counts to assess how much Garcia was eating by mouth. As that improved she began taking him off tube feeds and protein supplements.

He started with thickened liquids and after his first swallow study he was able to have pureed foods and mechanically softened foods like applesauce, as well as puddings and gelatin.

"A lot of times a patient will want a specific food but you have to change the texture of it, so our patient food service team would blenderize or modify it to get it to the right texture," Shaffer said. Once Garcia progressed to scrambled eggs and grounded meat with gravy he no longer required tube feedings.

Meanwhile the hospital's occupational therapy and physical therapy personnel also played a large part in helping Garcia regain his self-feeding skills.

"Many times it was like turmoil because you would expect that I could [feed myself] very easy, but it wasn't. I didn't have the strength in my hands. I didn't have the balance in my hands," said Garcia.

After several weeks from coming off the ventilator, Garcia was healthy enough to transition to a rehabilitation facility where he continued his regain strength and the daily living skills he had before contracting COVID-19.

"Our whole team was rooting for him and his recovery. So it feels great to know he's improving and that we played a part in it," said Shaffer. "I am so incredibly proud of him."

In the Army, the field of nutrition is vast and Army registered dieticians can do a number of different jobs, from clinical to food production and humanitarian missions. Army dietitians also work closely with Army physical therapists through the Army's Holistic Health and Fitness Program to help educate Soldiers on performance nutrition to meet the physical demands of field training and combat.

Decide + Be Ready: supporting today’s modern service woman

Tue, 23 Mar 2021 00:00:00 Z

The average woman has a vast array of contraceptive options available to her and her partner.

However, for U.S. service women, who are often in unique military environments, contraceptive options may not feel as plentiful. Enter Decide + Be Ready, an evidence-based mobile app that was developed to educate and assist women with selecting the correct contraception for her and her unique needs.

To maintain operational readiness in an ever evolving world, today's modern service women require a variety of contraceptive. With the Decide + Be Ready app, women can answer a series of personal questions and instantly start comparing contraceptive options in a location that best suit her individual preferences.

"There are a lot of applications that help women record their cycles, when they're fertile and not fertile, and this app is different," said Catherine Witkop, a retired Air Force colonel; and professor of Preventive Medicine and Gynecologic Surgery & Obstetrics at the Uniformed Services University of Health Sciences (USU) in Bethesda, Maryland. "This app provides a lot of information about contraception and helps patients identify their own preferences and which, if any, contraception they're interested in using."

The app was developed as part of a collaborative partnership between the Defense Health Agency, USU, and the University of California San Francisco.

Decide + Be Ready includes valuable features such as:

Educational modules on birth control methods
Information on postpartum, breastfeeding, emergency contraception and fertility awareness
Capability to compare contraception methods based on medical history
Capability to record questions for a health care provider
Ability to email health care provider with the app's recommendations
A section addressing considerations for service women, such as impacts of future deployments and management of periods

While the app does answer many questions about different methods of birth controls, Decide + Be Ready works best when used as tool in conjunction with a health care provider. One of the many user friendly features includes a section to save any notes and questions one would have while comparing their options in the app. This allows for women to feel prepared to have an open discussion on the next steps for contraception and family planning.

The DHA Connected Health Branch Usability Lab assisted in the development of the app. Focused on empowering the user, the Usability Lab gathered feedback from health care providers, clinical communities, and service members to fine tune the app.

In addition to helping women make difficult decisions regarding their reproductive health and families, the Decide + Be Ready app is supporting the notion of health care moving into the digital era. The app can be updated the instant new medical information is available, and has an intuitive design that creates "pop-up" questions to think about when women are answering their initial life style questions. The app even allows the patient to email her health care provider with the app's recommendations so that provider can get a better understanding of their patient and her goals before she even steps into the office.

A recent positive review of the app noted that it was an "Excellent tool for service members, especially new members! Women's reproductive health is SO important, and as someone outside the medical field I have never known what to ask or what to consider."

Decide + Be Ready is available through multiple smart phone application stores.

Department of Defense revises several Force Health Protection measures

Tue, 23 Mar 2021 00:00:00 Z

In line with recent updates from the Centers for Disease Control and Prevention, the Department of Defense has revised several Force Health Protection measures. The measures include guidance on quarantine and testing for DOD personnel and close contacts who have been fully vaccinated against COVID-19, deployment and redeployment guidance, reaffirmation of DOD mask use, and additional updated guidance focusing on protecting all DOD personnel.

Dr. Terry Adirim, acting assistant secretary of defense for health affairs, said the changes to DOD/Military Health System policy not only align with the White House and CDC, but also serve as one more step back to normalcy.

"These Force Health Protection changes demonstrate our continued commitment to our 9.6 million beneficiaries, and to maintaining a medically ready force," said Adirim. "These FHPs demonstrate the DOD's continued effort in battling COVID-19, while ensuring our service members are prepared to defend the nation.

The measures are as follows:

Force Health Protection 15 - Focusing on testing, the biggest change in this guidance is related to quarantine and associated testing requirements for vaccinated close contacts who meet CDC criteria.

"When the close contact is an individual vaccinated with a Food and Drug Administration-authorized COVID-19 vaccine under emergency use authorization, quarantine and testing for close contacts is not required if the individual is fully vaccinated and up-to-date with the latest vaccine guidance, and has remained asymptomatic since the current COVID-19 exposure," explained Army Col. (Dr.) Jennifer Kishimori, director of chemical, biological, radiological, and nuclear medical countermeasures policy in the Office of the Assistant Secretary of Defense for Health Affairs.

FHP 16 - Focuses on deploying and redeploying personnel with an added exception for testing prior to air travel from the United States to a foreign country. The exception is based on previous full recovery from COVID-19 infection.

This measure also adds an assessment of prior COVID-19 infection and vaccination status to the DOD pre-travel screening process and clarifies that the head of an Office of the Secretary of Defense component or the secretary of the Military Department may, if host nation agreements allow, decrease restriction of movement.

There is also an added requirement for pre-travel testing prior to arrival in the United States for redeployment from a foreign country and added exceptions to pre-travel testing based on CDC allowance for travelers on military airlift and for those who have fully recovered from COVID-19.

FHP 17 - Reaffirms DOD mask use guidance consistent with CDC guidelines, including wearing masks on DOD transportation assets and at DOD hubs.

FHP 18 - Includes significant changes that focus on commanders and supervisors protecting personnel in workplaces including:

Improved guidance for providing safe workplaces and work schedules with a primary focus on maintaining safe distancing between personnel.
Clarification of the procedures for DOD personnel with COVID-19 symptoms and for personnel exposed to COVID-19 from “close contact” with individuals who have contracted COVID-19.
Updates to information collection requirements for COVID-19-positive personnel in the workplace.

"The Military Health System will continue to provide our service members and military commanders with appropriate force health protection guidance to ensure they have the most current information during this global pandemic," added Adirim. "The latest Force Health Protection guidance provides our service members and frontline commanders with the most current information during this global pandemic and will continue to evolve as more Americans receive the vaccine," she said.

Laser eye surgery: Provides clarity for active duty service members

Mon, 22 Mar 2021 00:00:00 Z

Annually, more than 4,000 graduates of the U.S. military academies begin their service to the nation. About 1,000 of these individuals will have laser vision correction eye surgery before they step into their leadership roles.

Just one generation ago, prior to the advent of laser vision correction technology, an academy member's dream to be an aviator, Special Forces leader, or other tip of the spear warfighter may have been derailed due to their dependence on glasses. There was nothing academy members could do to eliminate their need for vision correction, and many still had stellar careers, but in a second or third choice for their military career.

Dr. Joe Pasternak, a retired Navy captain, recalled that when he was a midshipman, it was crushing to his classmates to discover their dependency on glasses would eliminate their preferred career selection if it was in aviation, Seals, Special Forces, explosives ordinance and demolition, etc. "If you missed just one letter on the 20/20 eye chart, your naval aviation career was doomed because you needed glasses," Pasternak explained. "It was devastating news for myself and many of my classmates."

In fact, it was Pasternak's myopia that caused him to redirect his career interest to military medicine from his initial choice of naval aviation. He served over 20 years, as an ophthalmologist, helping pioneer and introduce laser eye surgery to U.S. Naval Academy midshipman in Annapolis, Maryland.

With the introduction and continual improvement of corneal refractive surgery technology, a third of the USNA third-year class comes to Walter Reed National Military Medical Center in Bethesda, Maryland to have their laser eye surgery, by Pasternak and his colleagues.

"It is amazing, today's midshipman can have LASIK or photo refractive technology (PRK) and three to six months later, qualify for his/her choice of service selection, including naval aviation," Pasternak said.

"This procedure is an operational boost to the human vision system, preparing these midshipman to enter their military careers and professions without the burden of dependence on glasses/contacts," Pasternak continued. Although about half the 400 midshipman who have laser surgery per year are seeking aviation as a career, every midshipman who has these surgeries augments their readiness.

LIVE Now!!! Second COVID-19 Townhall Update!

Mon, 22 Mar 2021 00:00:00 Z

Please join us for the Second COVID-19 Townhall!

The COVID-19 pandemic, one year later in the DOD

Mon, 22 Mar 2021 00:00:00 Z

The United States has spent more than one year in various states of physical distancing, mask-wearing, and quarantine as COVID-19 continues to spread around the world.

Since the beginning of the declaration of a national emergency one year ago this month — and even before — the Department of Defense and the Military Health System, and the Defense Health Agency have focused on the top priority of keeping our forces and families safe, providing the highest quality health care possible, maintaining operational readiness, and supporting the national effort to defeat the deadly disease.

The Defense Health Agency's DHA's mission of ensuring a Ready Medical Force/Medically Ready Force has never been more important.

Below is a timeline of how the pandemic has evolved this past year and key accomplishments impacting the DOD, the MHS, and the DHA:

2019

Dec. 8 - First person tests positive in Wuhan, China.

2020

Jan. 9 - World Health Organization announces mysterious coronavirus-related pneumonia in Wuhan.

Jan. 17 - Centers for Disease Control begins screenings at JFK International, San Francisco International, and Los Angeles International airports.

Jan. 18 - CDC begins testing for COVID-19 in the United States.

Jan. 21 - CDC confirms first U.S. coronavirus case, a resident of Washington state.

Jan. 29 - U.S. government establishes COVID-19 interagency task force.

Jan. 30 - Department of Defense issues initial Force Protection Guidance for COVID-19.

Feb. 2 - Global air travel is restricted.

Feb. 3 - United States declares public health emergency.

Feb. 6 - First U.S. death attributed to coronavirus occurs in San Francisco Bay area, Santa Clara County.

Feb. 9 - Vice chairman of the Joint Chiefs of Staff establishes COVID-19 Crisis Management Team.

Feb. 11 - WHO officially names the novel coronavirus disease COVID-19.

Feb. 28 - DOD establishes the DOD COVID-19 Task Force.

March 5 - Airmen from the California National Guard deliver virus testing kits to the Grand Princess cruise ship off the coast of California.

March 10 - 270 members of the New York National Guard are deployed to deliver school lunches and sanitize public buildings in a one-square mile containment zone in New Rochelle, New York.

March 11 - WHO declares COVID-19 a pandemic.

March 13 - President Donald J. Trump declares national emergency.

March 16 - Moderna begins phase 1 clinical trials of investigational vaccine for COVID-19.

March 17 - United States records 100th death from coronavirus. West Virginia is the last state to confirm a COVID-19 case. All 50 U.S. states have confirmed cases.

March 21 - First DOD death attributed to coronavirus, a contractor for the Defense Security Cooperation Agency in Arlington, Virginia.

March 27 - USNS Mercy arrives in Los Angeles to support the U.S. COVID-19 response efforts and serve as a referral hospital for non-COVID-19 patients admitted to shore-based hospitals in the greater Los Angeles area.

March 30 - USNS Comfort arrives in New York to support the front lines of the COVID-19 response.

May 4 - Pfizer initiates clinical trials of COVID-19 vaccine candidate in the United States.

May 27 - United States surpasses 100,000 deaths attributed to COVID-19.

July 27 - Moderna begins phase 3 clinical trials of vaccine for COVID-19.

Army Wounded Warrior perseveres despite COVID-19

Fri, 19 Mar 2021 00:00:00 Z

The COVID-19 pandemic introduced changes and challenges that continue to affect the way of life for everyone. Through perseverance, the Army is using innovative ways to deal with the "new normal."

One group in particular that are making the adjustment are wounded, ill, and injured service members in Soldier Recovery Units across the Army. The month of March typically finds some of them preparing to gather at Fort Bliss, Texas, to participate in the Army Trials. However, this year the Army Recovery Care Program, keeping safety paramount for participants and staff, executed the Trials virtually.

For soldiers like Army Staff Sgt. Gene Calantoc, the pandemic added an extra challenge to an already daunting one. Calantoc, assigned to the Brooke Army Medical Center SRU, is approaching the one-year anniversary of an accident that changed his life.

One of his hobbies is riding a motorcycle. "My accident happened on March 29, 2020 at Fort Leonard Wood, Missouri," said Calantoc. "I set up a group ride that day with my motorcycle organization.' Six of us went for a ride that day. I was the road captain and leading our group when we approached a route that had a very steep hill where I got hit by a truck." This led to an above-the-knee amputation of his left leg.

Born in the Philippines, his family moved to Hawaii and then to San Diego when he was 13 years old. Joining the Army was a life-long dream of his because of the influence of his uncle who served in the Philippine military.

"I've been in the Army for nine years as a 12N (Horizontal Heavy Equipment Operator)," said Calantoc. "I chose to be an engineer because that MOS (Military Occupational Specialty) interested me."

Calantoc said he likes staying busy, and he has proved that by participating in every event the Trials have to offer. "I heard about the Warrior Games at the CFI (Center for the Intrepid)," he explained. The CFI is where Calantoc was fitted for his prosthetic and is currently undergoing rehab. "I have always been an active person and I love to compete. My motivation to participate (in the Army Trials) was knowing that this is a good opportunity to get my foot in the competition."

Competing in the Army Trials is tough enough, but when you have to do it virtually, it adds a new dimension of change. Athletes do not physically meet with the other competitors and develop a "team camaraderie," which is an extreme motivating factor they use to push themselves to their limits.

For Calantoc, a first time Trials competitor, his focus has been on something different; something soldiers, particularly noncommissioned officers are used to. "The challenging aspect competing virtually is not receiving enough training before the trials," he explained.

The ARCP looks at their overall mission to help those assigned in SRUs to recover and overcome barriers, and aids them either back to their unit, or to transition into civilian life.

"Adaptive reconditioning and sports has helped me with overall rehab by physically and mentally keeping myself busy to prevent myself from feeling any pain," added Calantoc. "Participating in the Virtual Trials helps me overcome some of my pains during the day. My goal is to make it to the Army team."

There are countless examples of wounded, ill, and injured soldiers and veterans who have participated in the Army Trials who found themselves in a more positive place. Adaptive reconditioning and sports, to include these types of events, can be life changing. This can be priceless in times of an ongoing pandemic.

"What I would say to the person who might be considering adaptive reconditioning or participating in the Army Trials is to have fun and enjoy the opportunity to participate in the trials," he said.