Navy Medicine is undergoing significant changes

This 11 March, U.S. Navy Vice Admiral C. Forrest Faison, III, Surgeon General, Chief, Bureau of Medicine and Surgery responded to a wide range of questions from Halldale Group Editor Marty Kauchak. The Navy medical community leader’s insights are provided below.

US Navy Vice Admiral C. Forrest Faison, III, Surgeon General, Chief, Bureau of Medicine and Surgery
Source/credit: US Navy Navy/Mass Communication Specialist 1st Class John Paul Kotara II

MTM/MS&T: In your efforts to prepare Navy Medicine for the future fight, update us on how the community is optimizing learning (training and education).

Vice Admiral C. ForrestFaison (VAF):There are enormous possibilities for the future of military medicine. We havemaintained unprecedented survival rates during the conflicts in Iraq andAfghanistan. As we look ahead, our main focus will be to prepare for futureconflicts to sustain high combat survival while also keeping our forces healthyand on the job. This requires us to look at new ways of providing health care.

The last conflict was fought largely on land, where the United States had significant control over the battlefield and access to massive logistics support. In military medicine, that has translated to rapid recovery and evacuation of injured personnel during the golden hour, when trauma patients are stabilized and airlifted to the next level of care.

We will ensure our health care professionals have the skillsand mindset necessary to provide unparalleled combat care to our men and womenof the Navy and Marine Corps in what may be very different circumstances in thefuture.

Navy Medicine recently implementeda new trauma training curriculum to improve the knowledge, skills, abilitiesand utilization of hospital corpsmen in 2017 and 2018.

We established a new training partnershipbetween Navy Medicine, the Capt. James A. Lovell Federal Health Care Center(Lovell FHCC), and John H. Stroger Jr. Hospital of Cook County, a Level 1trauma center in Chicago, Illinois, referred to as “Cook County.”

We have completed three iterations of this training program, which have proven to be largely successful, and are exploring other partnerships around the country.

MTM/MS&T: A first follow up, highlight how learning for Navy medical health care providers may evolve in the next five or so years.

VAF: In the multi-domainbattle, patient survivability is highly dependent on minimizing the time frompoint of injury to receiving damage control resuscitation and damage controlsurgery (DCR/DCS). Analysis and real-world demand identified gaps in this capability,especially in the maritime domain.

The nextwarfighting environment may involve a near peer competitor in a maritime battlethat requires our corpsmen to stabilize and care for wounded Sailors forextended periods of time before medically evacuating them to a higher level of care.

Trauma injuries in a maritime environment will be different compared to what we have seen on the battlefield. Injury extent and severity, as well as the numbers of injured personnel in a short period of time will also be very different. For example, rapid medical evacuation may be challenged. We are taking this opportunity of unprecedented change to shift our focus back to readiness and fleet operational support.

As another example, the Role Two Light Maneuver concept is one of the solutions, along with en-route care and other capabilities being developed to mitigate identified gaps. Navy Medicine is proposing a formal program of record for these capabilities. New challenges require new concepts and Navy Medicine is working to implement new solutions to ensure the highest combat survival possible in the next conflict.

The next warfighting environment may involve a near peer competitor in a maritime battle that requires our corpsmen to stabilize and care for wounded Sailors for extended periods of time, as above, aboard the amphibious transport dock ship USS Green Bay (LPD 20) during a medical training evolution, before medically evacuating them to a higher level of care. 
Source/credit: US Navy/Mass Communication Specialist 2nd Class Anaid Banuelos Rodriguez

MTM/MS&T: Another follow up, tell us the role simulation and trainingtechnologies (simulations, serious games, simulators, others) will have in Navymedicine's learning programs.

VAF: Navy Medicine ismodernizing the way training is delivered as it shifts to prepare for a verydifferent future and different conflicts. Individual and team clinical skillsare introduced, solidified, refreshed and tested on medical simulators ofvarying styles and realism. Task-specific training devices allow practice ofprocedural skills from intravenous line insertion to robotic surgery.

Augmented and virtual-reality are being introduced into medical training to speed acquisition of knowledge and provide shipboard experiences to trainees on land. Computerized medical training is also available for procedural purposes and practicing small-team dynamics.

Traditionalcomputer-based training is moving into the hands of medical personnel on theirown mobile devices. In the near-term future, virtual medical exercises will bepossible with participants at different locations who can play their role inreal-time or asynchronously in a limitless variety of command, control andcoordination scenarios. Likewise, artificial intelligence engines have thepotential to personalize training to the task level. It also has the ability tooptimize the blend and frequency of training as individuals maintainproficiency with the knowledge, skills and abilities they need to save lives.

With the explosive growth in virtual and gaming technologies, training modalities unimagined just a few years ago are being evaluated and incorporated into Navy medical training in the coming years to deliver effective training to a new generation of Sailors in a way that is relevant to the manner in which they learn.

Individual and team clinical skills are introduced, solidified, refreshed and tested on medical simulators of varying styles and realism, including the above mock patient at Naval Expeditionary Medical Training Institute in Camp Pendleton, California. 
Source/credit: US Navy/Hospital Corpsman 1st Class Joseph Castro

MTM/MS&T: Your "help wanted" list: how can the simulation and trainingindustry and academia, address some of the learning requirements emerging onyour service's horizon.

VAF: Last year, I visited Case Western University and learned about technology that allows providers to manipulate a virtual cadaver. I found that incredibly interesting and innovative. Medical knowledge is doubling every couple of months. Keeping up with clinical practices and maintaining medical knowledge for every member of the Navy Medicine team will be a top priority when seeking new partnerships in industry and academia. Every Sailor, Marine, and their family for whom we are privileged to care is depending on us to ensure every member of our team is ready.

MTM/MS&T: Updateus on Navy medicine's efforts to improve patient safety and Access.

VAF: Patient safety andaccess are a priority for Navy Medicine.

Since September 2017, “Connected Corpsmenin the Community,” a Navy Medicine initiative, has allowed active duty servicemembers on an installation to be seen by their corpsmen, with remote guidancefrom a provider, outside of the hospital or clinic and beyond normal workinghours to assess the impact on convenience and access to care and with minimalimpact to their training or work schedule. This has been accomplished by havingcorpsmen work at the highest level of their training, appropriate for their operationalplatform.

The initiative also provides Navy corpsmen with additional training experience while assigned to shore-based facilities, keeping their skills proficient and ready for operational assignments. Corpsmen provide care for low-risk medical needs at an independent location with full tele-health connectivity and communication with a medical provider at all times.

In addition, I would argue that MHS Genesis is helping us maintain patient safety in that it helps us respond to an increasing demand for access, availability, entry and portability of health information across the spectrum of military operations while providing clinical guidance to standardize healthcare delivery to best practices worldwide.

MHS Genesis is a modernized andinteroperable electronic health record system that will be implemented acrossthe Military Health System.

Navy Medicine’s embedded mental health initiative is another example of care being brought to the service member. Navy Medicine has found that embedding mental health providers directly into Navy and Marine Corps operational units has had a powerful effect on decreasing stigma and making care more accessible to our Sailors and Marines. We currently have 25 percent of our mental health personnel embedded with the Fleet and Fleet Marine Force and are working to grow that number.

MTM/MS&T: Tell us how Navy medicine will expand its collaboration with U.S.private sector medical institutions in terms of training, preparation for masscasualties during natural and man-made disasters and other events.

VAF: This brings me back to our trauma training initiatives. As I mentioned before, we have tested a concept with our corpsmen and partnered with the Capt. James A. Lovell Federal Health Care Center (Lovell FHCC), and John H. Stroger Jr. Hospital of Cook County, a Level 1 trauma center in Chicago, Illinois. The corpsmen studied and practiced in-patient, out-patient clinic and trauma care during the proof-of-concept, which has proven to be mutually beneficial and subsequently an official program of record.

Afourth iteration at FHCC and Stroger is planned for April 2019. HM TraumaTraining is also in the planning phase of a partnership with the University ofFlorida Health Shands (UF

Health Shands). A pilot class started Jan. 28, 2019. We are also in exploratory talks for a similar program in Cleveland.

Furthermore,Naval Medical Center Camp Lejeune (NMCCL) has established a partnership withVidant Medical Center, a level one trauma center. This partnership will affordphysicians, nurses and corpsmen increased patient encounters and complexity ofcases to sustain clinical skillsets.

MTM/MS&T: On the topic of collaboration, preview how US military medicine willincreasingly become joint, in particular, in terms of training.

VAF: Military medicine by nature has to be a joint effort in order to be successful. The Medical Education & Training Campus (METC) is the primary entry point for Navy, Air Force and Army enlisted medical trainees. METC offers more than a dozen consolidated courses aimed at educating and training all three branches of medical trainees together. For example, the computer-based medical systems course, telemedicine systems course and ultrasound imaging systems course are all joint curriculums. METC courses and curriculums are expected to expand as the medical field advances.

MTM/MS&T: And finally, anything else to add?

VAF: Military medicine, including Navy Medicine, is undergoing some of the most significant changes we have seen in several decades. From changes mandated by Congress, to Department of Defense-directed reforms, we have an opportunity to successfully navigate these changes and create an improved Navy Medicine to support our Navy and Marine Corps. In doing so, our focus will be on three major areas: the next fight, a renewed emphasis on readiness and our new organization. In navigating these opportunities, we are ever-mindful of those for whom we are privileged to care for and who sacrifice and serve to defend us.