'PROVIDING THE WORLD'S VERY BEST MEDICAL CARE'

Like many Americans, I was moved while watching the HBO film "Baghdad ER" this spring. The one-hour documentary was a graphic look at the emergency room of the 86th Combat Support Hospital in Baghdad. The warrior ethos and soldier camaraderie resonate throughout the film. It is a testament to the courage and sacrifice of servicemembers wounded in combat and to the extraordinary compassion, skill and determination of the military medical personnel who care for them.

This film confirms what soldiers already know-that Army medical personnel are highly trained and well-equipped, providing the world's very best medical care under arduous conditions. As a result of their expertise and dedication, 90 percent of the U.S. personnul wounded in Iraq and Afghanistan between October 7, 2001, and March 24, 2006, have lived, and 53 percent of these were able to return to duty in three days or less.

Improvements in medical skills and resources have enhanced combat casualty care from point of injury through the rapid medical evacuation system to definitive care in the United States. It is not unusual for severely wounded soldiers to be transported to Landstuhl Regional Medical Center in Germany within a day and to a medical center in the U.S. within 96 hours after injury.

The leading edge of this system is the combat medic. More than 4,000 91W Army medics have deployed with advanced trauma skills and emergency medical technician training, while others have received this training in theater. Consequently, 243 combat medics deployed in support of Operations Iraqi Freedom and Enduring Freedom have received awards for heroism to date.

Training in tactical combat casualty care addresses the patterns of combat injury and how the environment of care on the battlefield differs from civilian experience. Soldiers receiving first-aid training and combat lifesavers learn skills necessary for battlefield resuscitation, while physicians, physician assistants and nurses learn these principles in the tactical combat medical care course. These skills help keep soldiers alive until they can be brought to a medical facility for surgical care.

An advance in individual training is the VIRGIL chest trauma training system, which uses a mannequin and computer-based graphic interface to help medics learn how to insert chest darts and chest tubes. The interactive system provides feedback to the user.

Forward surgical team members receive hands-on trauma training in the busy emergency room of Jackson Memorial Hospital in Miami, FIa. They observe and assist the experienced civilian shift, then take over and operate the facility, polishing both individual and team skills before deploying to the combat theater.

These well-trained warriors also have received new tools to help them save lives. Hemostatic bandages that improve clotting and self-applied tourniquets are helping to stop uncontrolled bleeding, the leading cause of death on the battlefield. The improved first aid kit for soldiers and the warrior aid and litter kit for vehicles contain the newly fielded dressings and tourniquets.

The golden hour container, developed by Walter Reed Army Institute of Research, can transport red blood cells to forward-deployed surgical teams without using batteries, ice or electricity. The container is reusable and maintains the contents at appropriate temperatures for more than 78 hours.

The battlefield medical information system-telemedicine (BMIS-T) is similar to a handheld computer. It can be used to record patient clinical encounters and transmit those records to a central repository. The system can hold servicemembers' medical records, including immunisations, dental and vision records and drug allergies. BMIS-T is also programmed with health-care reference manuals and can provide medical personnel with suggested diagnosis and treatment plans.

The electronic information carrier (HIC) is a wireless data-storage device the size of a clog tag that can store up to four gigabytes of information. Using the EIC, health-care providers can securely and wirelessly read and write data and store the data on medical devices up to 10 meters away.

Improved disease prevention and environmental surveillance have also reduced the rate of noncombat disease or injury in Iraq and Afghanistan to the lowest level of any U.S. conflict.

Scientists of the U.S. Army Medical Research and Materiel Command are developing products that show great promise for protecting soldiers.

* Researchers have three versions of a bioscavenger, a presentment drug that protects against nerve agents. They have demonstrated that large amounts of the enzyme butrylcholinesterase can interdict nerve agents when they enter the bloodstream. We hope to soon get Food and Drug Administration approval for the most mature version, made from human plasma.

* A new recombinant multivalent botulinum vaccine will protect against botulinum neurotoxins A and B. It will be easier to manufacture, require fewer doses and provoke immune response better than the current vaccine, now available under Investigational New Drug status.

* A development effort is under way to produce a more consistent and more easily manufactured smallpox vaccine using better defined and controllable cell culture production techniques. Only limited doses of the current smallpox vaccine are available, and there are significant reservations about mass inoculation because of known side effects.

* A vaccine to protect against Venezuelan equine encephalitis (VEE) will decrease the susceptibility of U.S. forces to biological warfare attacks. The genetically engineered VEE infectious clone vaccine will elicit an immune response within 30 days and provide 80 percent protection for one year.

* To protect troops against diseases spread by insects, our researchers have developed camouflage face paint containing the insect repellant DEET and an improved bednet.

* Soldiers eating MRE (meals, ready to eat) rations now gain protection from tooth decay through chewing gum containing xylitol, which blocks bacteria that cause cavities.

* Also being tested is a gum containing caffeine to help soldiers deal with sleep loss.

It is normal for soldiers to be disturbed by the experience of combat, but the vast majority of soldiers returning from Operations Iraqi Freedom and Enduring Freedom are mentally healthy and make the transition home successfully. Some 20 to 30 percent of soldiers who experience combat will report symptoms such as sleep disturbance, anxiety, irritability and increased alcohol use. These symptoms do not mean a soldier has a psychiatric disorder-often they are normal reactions that will improve over time. Some soldiers, however, will need help if symptoms persist or interfere with their work or occupational functioning. The Army is committed to ensuring that those soldiers who need behavioral health assistance receive the best care possible before, during and after deployment.

Combat stress control companies and detachments are deployed to bring behavioral health services to soldiers on the front lines. These teams contain psychologists, psychiatrists, psychiatric nurses, social workers and enlisted medical technicians, and take outreach and therapy to each forward operating base.

A post deployment health assessment screens redeploying soldiers for physical complaints, post traumatic stress disorder, major depression, concerns about family issues and concerns about drug and alcohol abuse. The primary care provider may refer soldiers to on-site counselors or to military medical treatment facilities as needed. Earlier this year a post deployment health reassessment was implemented to rescreen soldiers 90 to 180 days after redeployment.

As part of the reintegration process, soldiers are briefed on what stressors to expect on homecoming, the common symptoms of postdeployment hyperarousal and friction, ways to ameliorate these symptoms, how to recognize when further professional help is needed and how to access treatment services. Each demobilization site has care managers who manage the behavioral health aspect of care and ensure behavioral health referrals are made.

Soldiers and their family members can get help 24 hours a day, seven days a week, by calling Military OneSource at 1-800-342-9647. In addition to other assistance, callers can obtain referrals for six or more no-cost confidential counseling sessions. They can also contact their chaplains, behavioral health clinics, primary care providers and the TRICAKE network for assistance.

Even as we give great attention to the needs of U.S. soldiers in combat, Army medical personnel also support noncombat missions that bring humanitarian relief and perhaps help forestall military confrontations around the world. In the past year we have seen major deployments to the southeast United States after Hurricane Katrina and to I'akistan after a devastating earthquake. In locations such as Central America and the Horn of Africa, we routinely bring medical, dental and veterinary care to people who may have never had it available before. These missions are beneficial not only in humanitarian terms and for the experience gained by our personnel, but they often are truly the "tip of the spear" in 21st-century nonconventional conflicts.

Whether developing new equipment, doctrine and training, or forming modular medical units that provide the right mix of capabilities for evolving missions, or using base realignment and closure or integrated global presence and basing strategy initiatives to make the most effective and efficient use of our resources, the Army Medical Department is leading the way for the transforming U.S. military force. As we adapt and change to meet new requirements and defeat new threats, we will never forget our tradition and our vision: to be a world-class system of choice for quality health care in support of America's Army at home and abroad, accessible to the Army family and accountable to the American people.

© 2006 Association of the United States Army Provided by ProQuest LLC. All Rights Reserved.