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Fort Sam Houston employs team effort to accomplish Army Medical Action Plan.

The United States Department of the Army implemented a five-phase Army Medical Action Plan (AMAP) this year to improve medical care, services, and transition for wounded Soldiers and their families. The Army achieved success in the first phase of the plan by establishing a list of 10 Quick Wins (See sidebar on page 92) and creating special Warrior Transition Units to care for Soldiers. Phase I was led by Brigadier General Michael Tucker, Deputy Commanding General of the North Atlantic Regional Medical Command and Walter Reed Army Medical Center. Fort Sam Houston is one example of many Army installations that are carrying out a successful AMAP.

"The Army Medical Action Plan at

Fort Sam Houston rocks!" That is the message delivered to the Brooke Army Medical Center (BAMC) and Fort Sam Houston community on a marquee located at the installation entrance at the BAMC exit, off I-35.

The message by Brigadier General (Brig. Gen.) James K. Gilman, Great Plains Regional Medical Command and BAMC commanding general is a pledge that Soldiers returning from fighting the battles of war will not have to fight a bureaucracy to obtain healthcare and other services during their recovery at BAMC and their transition afterward.

During a meeting on July 6, with Brig. Gen. Gilman, Colonel (Col.) Wendy Martinson, U.S. Army Garrison (USAG) Commander, and post Army Medical Action Plan (AMAP) planners, Fort Sam Houston's installation Commander Major General (Maj. Gen.) Russell J. Czerw explained the command's focus, stating, "Executing the Army Medical Action Plan is a team effort on Fort Sam Houston. We are working with the Installation Management Command and the Medical Command to provide installation resources and services to Warriors in Transition and their Families. We understand, and we are committed as a team with Brooke Army Medical Center, to a plan of action that provides each Soldier and Family member the care, dignity, compassion and respect they rightfully earned."

On May 15, Gen. Richard A. Cody, Army Vice Chief of Staff, approved the definition for Warrior in Transition as "An Active Component or Reserve Component Soldier who meets the qualifications of Medical Hold, Medical Holdover or Active Duty Medical Extension. It also includes Active Component Soldiers who require a Medical Evaluation Board or have complex medical needs requiring greater than 6 months of treatment. Warriors in Transition do not include Initial Entry Training, Advanced Individual Training, or One Station Unit Training Soldiers except in extraordinary circumstances. Exceptions to this definition must be approved by the local military treatment facility and unit commanders."

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Gen. Cody also decided two AMAP areas of responsibility:

* Army Medical Command (MEDCOM) will maintain Command and Control for all Medical Hold and Medical Holdover Soldiers.

* Army Installation Management Command (IMCOM) will maintain Command and Control for all Soldier and Family Assistance Centers except at Walter Reed Army Medical Center.

As part of its AMAP, the Army established 10 Quick Wins (See sidebar) for Phase I of five scheduled phases. The Quick Wins were defined as "any change in process or service in delivering healthcare to Warriors in Transition the Army can implement by June 15, 2007." When Phase I was complete (April 28-June 15), the Army had achieved its Phase I goals.

According to Col. (Dr.) Barry Sheridan, director of BAMC Healthcare Operations, "We have addressed the Quick Wins at BAMC. We have created a Warrior Transition Unit (WTU) at BAMC to incorporate all the Warriors in Transition. The manning of these WTUs will be filled with Army assets. We will incorporate the triad of squad leader, case managers, and Primary Care Managers."

Sheridan also noted that monthly Town Hall meetings are conducted to identify problems and areas of needed improvement for Warriors and their families. Commanders and staff from the Medical Treatment Facility (MTF), the WTU, and the Garrison attend. Escorts now meet families at the airport and bring them to the MTF to meet their Warrior.

Sheridan said that a Soldier and Family Assistance Center is being established to provide administrative and financial assistance; to aid with coordinating government entitlements, benefits, and services; and to provide information and assistance in obtaining nongovernmental benefits and services. BAMC already provides facilities in the hospital for Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA) liaisons.

In regard to the Army's AMAP Quick Wins, Col. David Baker, BAMC Troop Commander, noted that visitors inspecting BAMC commented that BAMC was already setting the standard. "BAMC was already picking up Soldiers at the airport and taking them to their rooms. Caseworkers were already assigned to the Wounded Warriors," he said. BAMC had accountability of the Soldiers through command formations, to get them out of bed, check profiles, and follow up on Soldiers who weren't getting out of bed, he indicated. "BAMC is at the tweaking stage of AMAP, because we already set the standard. BAMC is not coming up with new things to do; we are tweaking certain things to make them better for the Wounded Warriors," he said. Some of the adjustments Baker describes include keyless entries for the burn center patients, because they cannot open the doors; automatic flushers for the toilets; establishing a Family Readiness Group for the Wounded Warriors; continuing to evaluate patients negotiating one or more wheelchairs down a sidewalk; and adding 168 employees to the staff.

"Consolidating a Soldier and Family Assistance Center into a one-stop shop will make it easier for the Wounded Warrior to get around. Anything that the Wounded Warrior needs will be in this unit. AMAP is a good thing for BAMC and good for the Soldiers and their families. As General Gilman says, the key to success is to never stop listening," Baker emphasized.

MEDCOM has created the MyMEB (My Medical Evaluation Board) Web site on the Army Knowledge Online Web page, allowing Warriors to go online and access the status of their MEB. In addition, a physician dedicated to assisting Soldiers with the MEB process is being assigned for every 200 Soldiers involved in the process.

To further assist Soldiers in expediting the MEB process, MEDCOM is implementing new access to care standards for Warriors in Transition. MEDCOM has trained ombudsmen to permit the identification and resolution of problems at the earliest opportunity.

The Army leadership has directed the senior commanders on Army installations to make Warrior in Transition facilities and furnishings top priorities for repairs and improvements. Fort Sam Houston Garrison Commander Col. Martinson directed the re-opening of the BAMC ID Card office on July 10 in the basement of BAMC, specifically for Wounded Warriors and their families. The facility, which has an ID Rapid machine, will be open from 7:30 to 11 a.m. and 12:30 to 3:30 p.m., Monday through Friday. Additionally, the Okubu Barracks has been designated specifically to house Wounded Warriors assigned to the BAMC WTU. During the past few months, thirty-six rooms on the first floor of the barracks complex have been renovated and are in full ADA compliance. Recently, $1.5 million was provided by IMCOM to the Garrison to convert an additional twenty-eight rooms to ADA-compliant quarters. IMCOM also provided $4.83 million to add water softeners and anti-scalding devices for burn patients and for the installation of TV cables. Another project being planned is the installation of elevators in the Okubu Barracks to provide expansion of Soldiers quarters to the second floor, if required.

The Garrison staff is also investigating ways to support travel to administrative and medical appointments for the WTU by obtaining two additional ADA-compliant buses with wheelchair lifts that will be operated by the WTU in coordination with the Garrison.

Additional progress was made for Warriors in Transition during the Biennial AMEDD (Army Medical Department) Physical Evaluation Board Liaison Officer (PEBLO) Training Conference, held in May, in San Antonio, Texas. More than 200 PEBLOs, physicians, administrators, and other stakeholders from military installations around the world attended. The theme for the conference was "Maintain an Army Strong! Through Efficient and Compassionate PDES Processing."

Brig. Gen. Reuben D. Jones, the Adjutant General of the Army, in his role as Commander, United States Army Physical Disability Agency (USAPDA), provided the keynote address. During opening remarks, he stressed that overhauling the Physical Disability Evaluation System (PDES) is key to fixing the cumbersome, inconsistent, and confusing bureaucracy for wounded and ill Soldiers and family members. "If there is only one action taken, this is it," he said.

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Maj. Gen. Gale S. Pollock, Commander, U.S. Army MEDCOM, and acting Army Surgeon General, spoke during the closing workgroup session. She praised the quality of care that Army medical professionals provide, while recognizing that access to care is an issue of concern.

During the conference, PEBLOs and MEB physicians received certification on the new PDES Transformation Initiatives (TI), a system designed to improve and facilitate medical processing of over 15,000 injured Soldiers in the PDES.

The conference also included dedicated training tracks and updates on medical hold and medical holdover, MEB, the Army Wounded Warrior Program (WWP), retirement services, Social Security, and VA policies and procedures.

According to Maj. Gen. Pollock, the AMAP vision for Army Medicine, the Department of Veterans Affairs (VA), and other support agencies is the creation of a sustainable healthcare system open to all injured and ill Soldiers for medical treatment, vocational rehabilitation, and successful return to active duty, or transition back into civilian life with follow-up healthcare provided by the VA.

In the June 6, 2007 issue of MEDCOM Now, Pollock notes that AMEDD is providing the highest quality and most advanced medical care for Soldiers on the battlefield, and saving more lives of Soldiers wounded in combat than ever before.

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Yet Army leaders and medical professionals know that some wounds lie beneath the surface and are not always visible upon first assessment. According to Pollock, brain injury and psychological stress from combat deployments are a primary healthcare concern for the Army leadership.

In the weeks ahead, the Army will launch a chain teaching program (where a subject is taught to leaders, who then teach it to soldiers, continuing the sessions down through the Army's chain of command) to ensure that all Soldiers know how to identify symptoms of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). It will reach more than one million Soldiers and ensure early intervention. The goal is to educate all Soldiers and leaders to increase their awareness and understanding of these potentially debilitative health conditions. "As Soldiers deploy on multiple and extended tours to the combat zone, recognition, diagnosis, treatment, and prevention of PTSD and TBI are of utmost importance to our leadership, Soldiers and their Families," Pollock noted.

At BAMC, "We are standing up a special team of professionals to assist in the management of Traumatic Brain Injury," Col. (Dr.) Sheridan said.

BAMC's commitment to Soldiers and their families continues with implementation of the broad initiatives of the AMAP and its installation initiatives.

10 Quick Wins

Goals in Phase I of the Army Medical Action Plan

Approved by Army Chief of Staff General George Casey, Jr.

(The Army defined Quick Wins, included in Phase I of the AMAP, as "any change in process or service in delivering health care to Warriors in Transition the Army can implement by June 15, 2007." The Army met this deadline for achieving its Phase I goals.)

Establish Command and Control. Previously, wounded and ill Soldiers undergoing prolonged evaluation and treatment (termed Warriors in Transition) were segregated by Reserve or Active Component into separate companies that fell under different commands with varying leader to lead ratios, disparate resourcing, and often disparate billeting and support structures. The disparities favored Reserve Component Soldiers in some locations and Active Component Soldiers at others. The Army values the service of all Soldiers regardless of component. The Army Medical Command has new unified companies (Warrior Transition Units) providing leadership and support at a ratio of one squad leader to every 12 Warriors in Transition.

Institutionalize the Structure. Previously, the companies supporting Warriors in Transition were not formally manned. Each location was left to devise a method of manning these units by diverting personnel from other duties. In addition the baseline manning document of the medical treatment facility was not adjusted to account for increased workload with increasing numbers of Warriors in Transition. A formal manning document now exists that authorizes personnel to provide leadership, clinical oversight and coordination, and administrative and financial support at a strength based on the size of the population supported. At the heart of this structure is the triad of the squad leader, the primary care manager, and a nurse case manager to provide a synergistic level of support incorporating leadership, medical oversight, and medical coordination and management.

Prioritize Mission Support & Create Ownership. Army leadership has directed the senior commanders on Army installations to make Warrior in Transition facilities and furnishings top priorities for repairs and improvements. In addition they are to conduct monthly Town Hall meetings to identify problems and areas of needed improvement for Warriors and their Families. Commanders and staff from the medical treatment facility, Warrior Transition Unit, and Garrison must attend.

Flex Housing Policies. Policies now allow for single Soldier patient attendee support to receive military or guest house lodging in the same manner that family members of married Soldiers have been authorized. Warriors in Transition are now considered on par with key and essential personnel for military housing vacancies.

Focus on Family Support. Previously, Families arriving at Medical Treatment Facilities in support of a wounded or ill Warrior received varying levels of support. The Army recognizes the importance of supportive Families. Best Practices were institutionalized across the Army. Escorts now meet Families at airports and bring them to the Medical Treatment Facility to meet their Warrior. Soldier and Family Assistance Centers are being established to provide administrative and financial assistance; assist with coordinating government entitlements, benefits, and services; and provide information and assistance in obtaining non-governmental benefits and services. A Soldier and Family Hero Handbook will be distributed to all Soldiers and Families as a further aid. Formal Family Support Groups are being established With the support of a full-time Family Readiness Support Assistant. The Medical Command has trained ombudsmen to permit the identification and resolution of problems at the earliest opportunity. Consolidated policy is being developed to facilitate processes that support Warriors in Transition and their Families.

Develop Training & Doctrine. Previously cadre and staff in the companies supporting wounded and ill Soldiers received no formal training and no formalized standard operating procedures existed. The Army has developed standard operating procedures for the newly established Warrior Transition Units (WTUs), focusing on the mission of these units--to set the conditions to facilitate the Soldier's healing with the goal of returning the Warrior to duty, or to facilitate the transition to active citizenship. Orientation programs for new WTU commanders and cadre have been developed and the first formal course will be held June 25-26, 007. The Medical Command has increased its training programs in the identification and treatment of Post Traumatic Stress Disorder with special focus on Social Work personnel, WTU nurse case managers, and psychiatric nurse practitioners. The Army leadership has established a Post Traumatic Stress Disorder and Traumatic Brain Injury awareness chain teaching program for all commanders and Soldiers.

Create Full Patient Visibility. In previous wars, commanders often found it difficult to locate Soldiers after they were evacuated from the battlefield. The Medical Command has greatly improved the ability to provide feedback to commanders through the Joint Patient Tracking Application and is now further improving the reach-back with a letter directly to the Soldier's commander with instructions on how to contact the Soldier and how to submit awards and evaluation reports for battlefield service. The Medical Command has established policy for reception of Soldier-patients arriving by commercial or private transportation. The Army recognizes that Soldiers requiring evacuation may prefer to receive their care close to supportive Family and has developed a system to allow Soldiers to designate a preferred treatment location as part of the pre-deployment process.

Facilitate the Continuum of Care and Benefits. The communication between the DOD and VA continues to improve. As a pilot program, the Army Medical Command is co-locating Veterans Health Administration (VA) and Veterans Benefits Administration liaisons with the Walter Reed WTU nurse case managers to support the continuum of care and benefits, easing the transition for Warriors transitioning from the military to the VA. The Army has developed formal mechanisms to seek the Soldier's approval and electronically transmit the required medical and administrative documents between the Army and the VA to expedite the continuum of care process.

Improve the Medical Evaluation Board (MEB) Process. Previously Soldiers undergoing a MEB had to make an appointment with their nurse case manager to find out the status of their MEB. MEDCOM has created the MyMEB Web site on the Army Knowledge Online Web page, allowing Warriors to go online and access the status and progress of their MEB. In addition, a physician dedicated to assisting Soldiers with the MEB process is being assigned for every 200 Soldiers in the process. To further assist Soldiers in expediting the MEB process, the Medical Command is implementing new access to care standards for Warriors in Transition. Only Soldiers preparing to deploy will have priority over Warriors in Transition for non-emergency appointments.

Enhance Physical Evaluation Board (PEB) Representation. The Army called Reserve Component lawyers and paralegals to active duty to provide additional legal advocacy for Warriors undergoing the PEB process to act as legal advocates for these Warriors in Transition.

Phil Reidinger is Director of Public Affairs of the Army Medical Department Center and School and U.S. Army Garrison at Fort Sam Houston, Texas.
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Title Annotation:United States Military Section
Author:Reidinger, Phil
Publication:The Exceptional Parent
Geographic Code:1USA
Date:Sep 1, 2007
Words:2954
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