Interview with Vice Admiral C. Forrest Faison, III

This, 11 March, US 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.

MedicalTraining Magazine: In your efforts to prepare Navy Medicine for the future fight, updateus on how the community is optimizing learning (training and education).

ViceAdmiral C. Forrest Faison (VAF): There are enormouspossibilities for the future of military medicine. We have maintainedunprecedented survival rates during the conflicts in Iraq and Afghanistan. Aswe look ahead, our main focus will be to prepare for future conflicts tosustain high combat survival while also keeping our forces healthy and on thejob. This requires us to look at new ways of providing health care.

The last conflict was fought largely onland, where the United States had significant control over the battlefield andaccess to massive logistics support. In military medicine, that has translatedto 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 careprofessionals have the skills and mindset necessary to provide unparalleledcombat care to our men and women of the Navy and Marine Corps in what may bevery different circumstances in the future.

Navy Medicine recently implemented a newtrauma training curriculum to improve the knowledge, skills, abilities andutilization 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 thistraining program, which have proven to be largely successful, and are exploringother partnerships around the country.

MTM:A firstfollow up, highlight how learning for Navy medical health care providers mayevolve in the next five or so years.

VAF: In the multi-domain battle, patient survivability is highlydependent on minimizing the time from point of injury to receiving damagecontrol resuscitation and damage control surgery (DCR/DCS). Analysis andreal-world demand identified gaps in this capability, especially in themaritime domain.

The next warfighting environment mayinvolve a near peer competitor in a maritime battle that requires our corpsmento stabilize and care for wounded Sailors for extended periods of time beforemedically evacuating them to a higher level of care.

Trauma injuries in a maritime environmentwill be different compared to what we have seen on the battlefield. Injuryextent and severity, as well as the numbers of injured personnel in a shortperiod of time will also be very different. For example, rapid medical evacuationmay be challenged. We are taking this opportunity of unprecedented change toshift our focus back to readiness and fleet operational support.

As another example, the Role Two LightManeuver concept is one of the solutions, along with en-route care and othercapabilities being developed to mitigate identified gaps. Navy Medicine isproposing a formal program of record for these capabilities. New challengesrequire new concepts and Navy Medicine is working to implement new solutions toensure the highest combat survival possible in the next conflict.

MTM:Anotherfollow up, tell us the role simulation and training technologies (simulations,serious games, simulators, others) will have in Navy medicine's learningprograms.

VAF: Navy Medicine is modernizing the way training is delivered as itshifts to prepare for a very different future and different conflicts.Individual and team clinical skills are introduced, solidified, refreshed andtested on medical simulators of varying styles and realism. Task-specifictraining devices allow practice of procedural skills from intravenous lineinsertion to robotic surgery.

Augmented and virtual-reality are beingintroduced into medical training to speed acquisition of knowledge and provideshipboard experiences to trainees on land. Computerized medical training isalso available for procedural purposes and practicing small-team dynamics.

Traditional computer-based training ismoving into the hands of medical personnel on their own mobile devices. In thenear-term future, virtual medical exercises will be possible with participantsat different locations who can play their role in real-time or asynchronouslyin a limitless variety of command, control and coordination scenarios.Likewise, artificial intelligence engines have the potential to personalizetraining to the task level. It also has the ability to optimize the blend andfrequency of training as individuals maintain proficiency with the knowledge,skills, and abilities they need to save lives.

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

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. Image credit: US Navy/Mass Communication Specialist 2nd Class Anaid Banuelos Rodriguezy.

MTM:Your"help wanted" list: how can the simulation and training industry andacademia, address some of the learning requirements emerging on your service'shorizon.

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

MTM: Update us on Navy medicine'sefforts to improve patient safety and Access.

VAF: Patient safety and access 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 theiroperational platform.

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. Corpsmenprovide care for low risk medical needs at an independent location with fulltele-health connectivity and communication with a medical provider at alltimes.

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 healthinitiative is another example of care being brought to the service member. NavyMedicine has found that embedding mental health providers directly into Navyand Marine Corps operational units has had a powerful effect on decreasingstigma and making care more accessible to our Sailors and Marines. We currentlyhave 25% of our mental health personnel embedded with the Fleet and FleetMarine Force and are working to grow that number.

MTM: Tell us how Navy medicinewill expand its collaboration with US private sector medical institutions interms of training, preparation for mass casualties during natural and man-madedisasters and other events.

VAF: This brings me back to our trauma training initiatives. As Imentioned before, we have tested a concept with our corpsmen and partnered withthe 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 andtrauma care during the proof-of-concept, which has proven to be mutuallybeneficial and subsequently an official program of record.

A fourth iteration at FHCC and Stroger isplanned for April 2019. HM Trauma Training is also in the planning phase of apartnership with the University of Florida Health Shands (UF Health Shands). Apilot class started Jan. 28, 2019. We are also in exploratory talks for asimilar program in Cleveland.

Furthermore, Naval Medical Center CampLejeune (NMCCL) has established a partnership with Vidant Medical Center, alevel one trauma center. This partnership will afford physicians, nurses andcorpsmen increased patient encounters and complexity of cases to sustainclinical skillsets.

MTM: On the topic ofcollaboration, preview how US military medicine will increasingly 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: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.

Originally published in  Issue 2, 2019 of MT Magazine.