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This morning we are going to talk about a very unique and special Army Organization
- the U.S. ARMY MEDICAL RESEARCH & MATERIEL COMMAND. An organization that has about 7,000
employees. 17% are active duty; 41% are government civilians; and 42 % are contractors. But this
is not what makes USAMRMC unique. These employees come to work every day knowing they make a
difference -- They contribute to the wellbeing of all WARFIGHTERS --their families and other
beneficiaries. But this is not what makes USAMRMC unique. This organization is Army
thru and thru; but often looks tri-service. We work closely with Air Force and the Navy.
We collaborate with industry, such as the Bill and Melinda Gates Foundation, Chart SeQual
Technologies, ANP Technologies, Inc., and Biosentinel, Inc., academia, the University
of Penn for example and other government agencies like NIH. But this is not what makes USAMRMC
unique. So, what does make us so unique? Simple: We impact the Warfighter from the day he or
she becomes a recruit until, well sometimes, for their whole life span. But don't stop
there; we impact the family members. We impact civilians who benefit from our inventions,
we are a catalyst for our economy. This brief will depict one of our products, the adenovirus
vaccine, and show you how many of the organizations within MRMC contributed to it's success. Every
person at MRMC is Army Strong as we support the medic in combat the Warfighter, and the
Warfighter Family. We are the heartbeat of Army Medicine. We do the discovery. We are
out on the frontiers of science where innovation and breakthroughs are made. We do the advanced
development. We create unique partnerships built on trust. We do the logistics -- Supply
chain management. And - We do it better than anyone! You know what? We are not only Army
Strong; We are everywhere! Did you know that we are on every continent but one? Each and
every one of you, each person here, is part of a team that spans the globe. We have six
Army medical research laboratories.;three medical research detachments and four overseas
laboratories. Nothing works without acquisition and logistics:
U.S. Army Medical Materiel Development Activity U.S. Army Medical Materiel Agency
U.S. Army Medical Materiel Centers in Europe and Korea.
Not done yet: We have forward sites for the prepositioned
medical materiel and maintenance divisions to support:
Acquisition Fielding
Sustainment of medical equipment We have three Executive Agencies
The Armed Forces Medical Examiner System The National Museum of Health & Medicine
Defense Center of Excellence for TBI and Psych Health
All of this happens by design. This design begins with a mission and a vision. The mission
tells people what we do. Look at the words: We are responsive - (To the Warfighter -- They
need something -- we get it there) We are responsible -- (To taxpayers, to our
senior leaders, Congress -- Most importantly, we are responsible to the Warfighter)
And what do we deliver? Products, some materiel and some knowledge. The Vision looks to our
future: Trust (Partnerships work because we are trusted)
Leaders (We have leaders unlike other leaders.) Unrelenting service
Unsurpassed expertise Empathy
And the relentless pursuit of excellence Our leaders personify the ARMY VALUES
Innovation (Creative, inventive, resourceful) Global Health ( People and places are better
because we were there) Relationships & Perceptions
Before we go on to we should have a talk - much like the talks all of us have had as parents
with our sons and daughters. As youngsters we all go thru the same stages. I was always
on best terms with Mom and Dad whenever I needed cash or had to borrow the car. My parents
were the last ones to meet the latest girlfriend! I hated it when they were overseeing my homework
or housework! So I rebelled and joined the MILITARY! Talk about oversight! So, are we
much different when we refer to Headquarters when we are in the position of a Subordinate
Command? Let's talk about our relationships. I used to complain to my Dad: You treat me
like a child! He'd look at me and gave me "THE LOOK!" Of course I was 31 at the time
and may have actually deserved THE LOOK. Perception -- They treat us like a subordinate command.
If HQ would just leave us alone ...Way too much oversight -- Telling us how to do our
business. Like you, I spent many years in the field
anticipating the call from HQ with an urgent request -- a TASKER!
and the World. Diversity -- Let's talk about our people.
Like many large organizations, we have an incredible mix of people who have an endless
array of talent and skills, each able to fit into the huge complex called MRMC. Each day
we walk next to people who have made some of the great discoveries of medical science,
others have unique talents for sequencing, or repairing equipment. Others can write,
while others are remarkable teachers. Some of us love supply chain management, financial
analysis, acquisition, and contracting. Some are experts in quality assurance and quality
control. Some have developed procedures to make sure we have clean rooms when we need
them. Some of us know how to raise funds and create partnerships. And everyone contributes;
Each person matters; And we need each and every one of you.
Partnerships - One of our Great Strengths. Our partnerships fall into three general areas:
Government -- NIH, the VA, the Navy and Air Force; Academia -- Major universities who
are performing cutting edge research (Duke, Maryland, MIT, UCLA); and Industry -- The
partners who will commercialize our inventions, such as InBios, Intercell, and GenVec. They
want to partner with us. We do the heavy lifting. We take the chances and they are better off
because they partnered with MRMC! At the same time, we need these Partners in order to be
successful. And this works because we are: Responsive, Responsible, and Trusted.
Our Life Cycle Command requires Different Kinds of Work as well. The work is just as
diverse as the people who make up MRMC. We talked about the different people and the
diversity we see at MRMC. We require this because we are a full life cycle command.
We are a powerhouse of collaboration that spans the entire life cycle. Outreach programs
like GEMS - Gains in the Education of Mathematics and Sciences (GEMS) Program run by HQ.
MRMC is a threat-driven organization. Everything we do is centered on the Soldier and eliminating
medical threats. There are seven categories of threats that affect our Service Members.
The threats of today are not totally unique from the threats of earlier wars. Yet we have
had to adjust to the threats of today. Combat injuries -- They may look the same, but we know so much more today.
Yet they are different. Non-compressible hemorrhaging, pain management, loss of limbs and TBI. Operational
Stressors -- We had those in Vietnam as we do today, but we know so much more about the
effects of these stressors. We are addressing these and coming up with solutions. Endemic
diseases -- These have been around forever; and they change our focus with each battle
scenario. Addressing the threat is just the beginning.
From threats, we move to Requirements and the Joint Capabilities Integration & Development
System. Once the threat is identified, the Combat Developer - Identifies the capability
gaps we have and documents the requirement in three documents:
ICD -- Initial Capability Document -- Fairly broad
CDD -- Capability Development Document - More specific
CPD -- Capability Production Document -- Very specific
This whole process helps us prioritize our programs. It is a true test of how well we
respond to user needs. But the real test is in execution. We deliver. The Warfighter's wellbeing is worth every penny
that comes to this Command. We deliver both medical knowledge products and medical materiel
products. Next line -- We do this thru 3 integrated
programs that allow for transitions throughout the life cycle of development: Research & Development,
Development & Acquisition, and Acquisition & Logistics. These programs actually blend
one into the other. You are going to see this design again when
we address PPBE and the Decision Gate process. Complimenting these programs we have three
special programs: Congressional Special Interest -- with targeted outcomes, The Armed
Forces Medical Examiner -- Cause of Death, Identification of Remains, and the National
Museum of Health & Medicine - Captures the History of health and medicine, Provides lessons
from the past helping our understanding today, and Is a catalyst for future researchers and
practitioners. Not only are we a life-cycle Command, but
we impact the life of every Warfighter, from entry, thru deployment, post-deployment, and
retirement. We are going to look at the life of a Soldier and see some examples of where
we fin tin to make the Army STRONG. (COL Raymond Laurel) Good morning, I'll be
teaming up with Dr. Keith Vesely on "Training and Pre-Deployment." First, let's take you
to Basic Training so you can see firsthand who we support from the start.
Physical Training -- push-ups, sit-ups, 2-mile run, obstacle courses, immunizations -- are
all part of basic training and our Command has a shared mission to establish these standards
in building our Nation's force. The Army is the Nation's force for decisive action, both
at home and abroad, providing the Joint Force the ability to prevent conflict, shape the
environment, and if prevention fails, win decisively and dominantly. In order to meet
the needs of the Nation in a complex operating environment, our Army must remain agile and
responsive to provide forces that are flexible to operate across the range of military operations.
In support of the Army's mission to transform a civilian to a Warfighter, we team up with other Army
activities to produce training policy and guidelines that provide recommendations to
enhance Warfighter capabilities and reduce health risks. The objective of the medical
process in bringing in new recruits is to screen out applicants who are medically unfit
for service and for those fit to serve, enhance individual performance. We, in this Command,
continue this coordinated effort by product and knowledge improvement for clothing, equipment,
nutrition, pharmaceuticals, and other medical advances by providing design specifications
to improve individual Warfighter equipment, rations, and knowledge products.
"Keeping the Promise," "Fulfill their Trust," and "No one left behind" are several of many
mottos that refer to the efforts of the Department of Defense to recover those who became missing
while serving our Nation. During medical in-processing, blood is taken
from recruits to register their DNA. The DoD DNA registry is maintained by the Armed Forces
Medical Examiner System (AFMES), a relatively new component of our Command. This registry
enables the Casualty and Mortuary Affairs mission to provide compassionate, unwavering
support to the Families of our Warfighters who have paid the ultimate price of their
profession. This full accounting is in concert with upholding the Warrior Ethos in never
leaving a fallen comrade behind. Operation Iraqi Freedom is the first US Conflict in
which all personnel were accounted in large part of the ongoing science improvements at
AFMES. Medical in-processing is also a time to begin
the process of protecting Warfighters from the myriad of infectious diseases. Exposure
ranges from the training environment, some of which are a result of the stressful training
which they are about to begin... to the deployed environment on the execution of their mission
of serving as our Nation's interest across the Globe. Many of these products owe their
existence to the ideas and efforts of Army, Navy and Air Force researchers. As an example
of the impact of these efforts and the complexity of ultimately making one of these products
available to Warfighters, we'll illustrate the development path for the newest vaccine
in our armamentarium, the Adenovirus Types 4 and 7 Vaccines.
Adenoviruses, particularly serotype 4 and 7, are one of the primary causes of febrile
respiratory disease (FRD). Adenovirus-related FRD is uniquely relevant to military recruit
populations because it causes suffering, disrupts training, and consumes medical resources,
often resulting in recruit re-cycling and sometimes proving fatal. Eight deaths were
attributed to adenovirus infections in Warfighters from 1999 to 2010. Since the program restarted
last year, combined data from the training installations of the Army, Navy, Air Force,
Marines, and Coast Guard indicates that the vaccine has reduced the incidence of febrile
respiratory illness by over 75% and essentially eliminated the threat posed by adenovirus
types 4 and 7. So, how do we get a product to the Warfighter?
Like all product development efforts our Command, the Adenovirus program had to be managed in
accordance with not only regulations from the Food and Drug Administration (FDA), but
also those regulations, directives and processes of the DoD acquisition system. And also like
all USAMRMC development efforts, it could not be successful without the input of many
components of our Command. The Integrated Product Team (IPT) is a multidisciplinary
group of people who are collectively responsible for delivering a defined product or process.
The IPT for Adenovirus Vaccine brought together many elements of the Command including several
key offices in USAMRMC Headquarters in constant coordination with the Walter Reed Army Institute
of Research and the US Army Medical Materiel Development Activity. Each representative
brought a perspective to the team such that when combined they provide total expertise
required to navigate a product through the complicated development process through the
Food and Drug Administration (FDA) and DoD Acquisition System to s The Walter Reed Army
Institute of Research (WRAIR) located at Silver Spring, Maryland was instrumental in the development
of the Adenovirus vaccine. WRAIR conducts biomedical research that is responsive to
DoD and U.S. Army requirements and delivers lifesaving products including knowledge, technology,
and medical materiel that sustain the combat effectiveness of the Warfighter.
WRAIR focuses on research to advance prevention and treatment of Warfighters for the adverse
medical and operational consequences of combat stress, inadequate sleep, concussion, brain
injury, infectious disease, and more through its Centers of Infectious Disease Research
and Military Psychiatry and Neurosciences. Their Special Foreign Activities include:
USAMRU-Kenya USAMRU-Europe
AFRIMS - Thailand CPHRL-Georgia uccessful licensure and fielding.
The US Army Medical Materiel Development Activity (USAMMDA) located at Fort Detrick, Maryland
in close coordination with WRAIR was key in successfully navigating the Adnenovirus vaccine
into development. USAMMDA is the DoD's advanced medical materiel
development activity for products designed to protect and preserve the lives of Warfighters.
They develop new drugs, vaccines, and medical devices that enhance readiness, ensures the
provision of the highest quality medical care to the DoD, and maximizes survival of medical
casualties on the battlefield. The US Army Medical Research Acquisition Activity
(USAMRAA), as part of the Integrated Product Team for Adenovirus vaccine closed this product
development into a useful and effective combat multiplier for our Warfighters, so that they
can continue their development in becoming the Nation's finest military. USAMRAA, also
located at Fort Detrick, Maryland is the contracting element of our Command and provides support
to the Command headquarters and its worldwide network of laboratories and medical logistics
organizations. USAMRAA also supports DoD-wide projects sponsored by the Service Surgeons
General, the Office of the Secretary of Defense (Health Affairs), and numerous Congressionally
mandated programs. More importantly, USAMRAA is our command's vehicle for implementing
the command's acquisition strategic plan. The recruit's schedule includes: marksmanship
training, grenadier training, drill and ceremony, gas chamber orientation, radio and signal
communications, survival skill training, force road marches, combat and bayonet training,
combatant hand-to-hand training... The rapid pace of operations and the need for repeated
deployments have a profound effect on the physiological and psychological health and
performance of Warfighters. Our Command's physiological health research focuses on developing
medical standards, predictive models, and countermeasures to prevent or mitigate the
effects of physiological stressors on the performance and fitness of Warfighters. These
stressors may include inappropriate nutrition, poor physical fitness, sleep loss, sleep deprivation,
fatigue, and burnout. As you can see, the recruits' normal training
schedule can be described as chaotic. Our Command's Military Operational Medicine research
program (MOMRP) and the US Army Research Institute of Environmental Medicine (USARIEM) have been
at the forefront in providing information and input to training doctrine in an effort
to reduce injuries to recruits during training. For example, when training in extreme high
temperatures, Warfighters must learn to continually take-in fluids to prevention dehydration and
heat stroke. USARIEM has been instrumental in determining the appropriate regimens of
fluid intake for basic training recruits. Another method to reduce heat injury perfected
at USARIEM is the arm immersion kit as seen on the bottom-left photo. It looks like a
bathtub of water at 50 degrees Fahrenheit. Heat-stressed Warfighters immerse their arms
in the device up to their elbows for up to 3 minutes. This preventative measure cools
the Warfighter down. USARIEM and MOMRP have also conducted extensive studies on other
types of training injuries and are continually seeking to develop new and more effective
means of prevention for those injuries so that sound, healthy and well-trained Warfighters
join the fighting force. The U.S. Army Research Institute of Environmental
Medicine (USARIEM) located at Natick, Massachusetts conducts biomedical research to improve and
sustain Warfighter health and performance under all conditions.
USARIEM is internationally recognized as the DoD's premier laboratory for Warfighter health
and performance research and focuses on environmental medicine, physiology, physical and cognitive
performance, and nutrition research. Military guidance has been published for operations
in heat, cold and high-altitude environments and nutrition for health and performance.
Graduation Day -- the day that every basic training recruit eagerly anticipates. It's
a day to celebrate with visiting parents, brothers, sisters, boyfriends, girlfriends,
and Family. It is here they witness you become a Soldier, Sailor, Airmen, Marine, and Coast
Guardsmen. Thanks to you and your efforts as a member of our Command, these Warfighers
are now a well-trained member of an organization with a proud tradition of defending this country,
its citizens, and our Constitution. Because of you, they will also now be entering the
Warfighter's life cycle better trained and better fit to enter into more specialized
training with enhanced performance in preparation for deployments...deployments to new and far-reaching
areas...areas for operational, peacekeeping, and humanitarian missions...and because of
your efforts their period of post-deployment and reintegration back in to the Force are
better planned so that we can depend on their profession to continue to defend our Nation.
We'll see how our Command, the US Army Medical Research and Materiel Command is instrumental
in maintaining the Warfighter's health during all of these phases, preventing, diagnosing,
and treating disease and injury and rehabilitating those that are injured and ensuring these
medical products are strategically, operationally, and tactically distributed throughout our
global outreach. I will now be followed by the incomparable-friendly-neighborhood-veterinarian,
Dr. Keith Vesely, the Office of the Principal Assistant for Research and Technology.
The medical team is responsible for ensuring Force readiness, caring for the ill and injured
and enhancing the health of those entrusted to our care. To meet this mission, medical
personnel require training above and beyond what they received in basic training. This
slide shows some of the advanced training courses available. Several courses directly
supporting medical personnel are held at Institutes within MRMC to include USAMRICD and USAMRIID
which I will talked about shortly. Since time is of the essence for wounded warfighters
and medics can be very busy, the Combat Livesaver Course was developed to provide medical training
to non-medical soldiers so they can provide lifesaving measures as a secondary mission
to their primary mission. The course provides a bridge between the self-aid/buddy-aid training
given to all soldiers during basic training and the medical training given to the combat
medic Through their multiple medical logistics training
programs, the MRMC Logistics Commands contribute to the enterprise-wide initiative of educating
individuals and units on medical logistics procedures and medical logistics automation
A favorite course of many is the Medical Management of Chemical and Biological Casualties Course.
It is a six-day course held jointly at both ICD and RIID that provides familiarization
with the management of acute chem/bio warfare injuries in an operational environment. Part
of one day involves a field exercise where the students get to assess volunteer chem/bio
casualties positioned on stretchers. I was a volunteer casualty for several field exercises
during my time at ICD. Most fun was filling your mouth full of chicken noodle soup and
waiting for group of students in full MOPP gear to gather around you was you begin twitching
and retching. USAMRICD -- located at Aberdeen Proving Ground
(Edgewood Area). Nation's lead lab for medical chemical defense. USAMRICD discovers and develops
medical countermeasures to chemical warfare agents for U.S. military and U.S. citizens.
They train and educate personnel in the medical management of chemical casualties such as
course I already mentioned. Also, provides subject matter expertise in developing Defense
and National policy and in proper crisis management. USAMRICD is an active consultant role during
wars in Iraq and Afghanistan, questions such as what to do with dead birds they have found
to what is this rash on my hands? Under USAMRICD is the US Army Center for Environmental
Health Research (USACEHR). This organizational relationship is beneficial to both organizations,
because the missions are closely related. They plan, direct, and conduct research, development,
testing and validation for occupational and environmental health surveillance and environmental
health technology in support of Force Health Protection. Areas of research include Rapid
Analysis of Drinking Water for Microbial Contamination and Biomarker Discovery and Toxicogenomics.
Before renovations to the current building, back when it was called the BRDL Building
(Biomedical Research and Development Laboratory), could always tell they keep tropical fish
in the basement as part of their aquatic toxicology. USAMRIID -- located here at Fort Detrick.
DoD's lead lab for medical biological defense Research leads to medical solutions (therapeutics,
vaccines, diagnostics, and information) that benefit both military personnel and civilians
Since we cannot ethically or feasibly expose humans to chem/bio warfare agents to conduct
efficacy or effectiveness studies, the FDA Animal Rule allows us to test effectiveness
of a new countermeasure in animals rather than people
These "pivotal" animal studies must establish that the product is reasonably likely to produce
clinical benefit in humans In 2008,biosurety or the establishment of
systems and procedures to properly safeguard Biological Select Agents and Toxins (BSAT)
became important to RIID as well as the entire nation.
Examples of BSAT shown above USAMRIID as well as the Safety, Surety and
Environmental Office here at Fort Detrick constantly ensure all the BSAT material at
USAMRIID are handled in a safe, secure and reliable manner.
Nation's military forces may be called to serve anywhere in the world during times of
conflict or in peacetime. Among the threats our Forces face are injury from combat operations,
exposure to chemical or biological warfare agents, environmental extremes, and endemic
diseases not common in the United States. To provide Warfighters defenses against these
hazards and sustain their health is the goal of USAMRMC.
Examples of products currently in the hands of the warfighter include:
JBAIDS Ruggedized, portable system fielded to all
the Services Capable of rapidly identifying multiple biological
agents and other pathogens of operational concern
Anthrax, tularemia, plague and influenza detection systems are FDA cleared for diagnostic use
Being able to test for more common agents such as influenza allows operators to maintain
competency since we are not testing everyday for anthrax or plague
Unique collaborative effort between RIID and CBMS, the advanced developer of med chem/bio
product for DoD CBMS is located here at Fort Detrick
Soman Nerve Agent Pretreatment Pyridostigmine (SNAPP) or PB Tabs
FDA approved as prophylaxis against nerve agent soman
First drug approved under the Animal Rule I mentioned earlier
Collaborative effort between MRICD, and USAMMDA Antidote Treatment Nerve Agent Autoinjector
(ATNAA) Administered after onset of symptoms of nerve
agent toxicity Since affects CNS, I don't have to worry - no
target organ FDA-approved ATNAA is two-chambered autoinjector
for IM injection of nerve antidotes atropine and 2-PAM through same needle
Replaces the MARK I Nerve Agent Antidote Kit, same drugs but two autoinjectors
Development required collaboration between ICD and USAMMDA
Not all training is done through courses and not all of USAMRMC's products are materiel
development items or "widgets" USAMRMC has also been instrumental in the
development of medical knowledge products as shown here
These products exist on paper, or in the form of software, but are not "acquired" in the
usual sense of the DoD acquisition process which you will hear more about later
Nevertheless, they are important products that can be used to disseminate "best practices"
for DoD Examples include:
Red, blue and gold management of chem/bio casualties books which are designed to be
carried in the pocket of the ACUs Textbook of Military Medicine Series which
according to my count is up to 18 books. My favorite is shown here since I am co-author
is one of the chapters. Clinical Practice Guidelines MRMC was instrumental
in developing I believe our efforts to develop these products
not only moves military medicine forward but moves all of medicine forward
In addition to the courses I mentioned earlier, the Medical Training and Health Information
Sciences Research Program (or Joint Program Committee-1) and the Telemedicine and Advanced
Technology Research Center (TATRC) are working together to improve patient safety and quality
of care through modeling and simulation-based technologies/systems as shown in the initiatives
above Combat Casualty Training Initiative: Focus
of this initiative is to advance pre-hospital combat casualty training with an emphasis
on the combat medic Medical Practice Initiative: Focuses on maintenance
of military and medical skills over a medical provider's health care career
A tremendous benefit of Medical Simulation and Training is its ability to reduce our
reliance on live animal training. TATRC is located at Fort Detrick. It is the
lead DoD research center for electronic Health and mobile Health research initiatives.
eHealth research encompasses the use of information and communication technology, such as computers,
mobile phones, communications satellite, patient monitors, etc., for health services and information.
An example would be the electronic health record system.
mHealth is the delivery of healthcare services via mobile communication devices, such as
mobile phones, BlackBerries, and laptops. Also heavily involved in computational biology
or bioinformatics research. Come long way since I bought my Commodore Colt with "upgraded"
hard drive of 20MB and was told all the memory I would ever need.
TATRC also acts as S&T scouts for military medicine. Constantly looking to support innovative
and convergence science efforts to feed the R&D pipeline.
Surprisingly, usually do not require large investments, with ~$250-300K being the sweet
spot for finding new and innovative ideas. Prior to any deployment, the Warfighter must
be prepared at the unit level as well as an individual
Deployment Readiness requires completion of a set of basic elements for all the Services
to protect the health of our deploying Service members. This includes the basic things such
as updating your will and ensuring your bills will be paid while on deployment. In addition,
assessments such as the required Pre-Deployment Health Assessment are designed to provide
comprehensive health surveillance for Service members affected by deployments and make sure
overall Force Health Protection. Form designed to identify and address health
concerns, with specific emphasis on mental health
Allows military personnel to share any concerns they have prior to deployment
Medical Operational Medicine Research Program and WRAIR (which you heard about earlier)
served as consultants during the development of form
Other examples of products that USAMRMC was instrumental in developing and fielding and
now in the hands of the Warfighter about to deploy include:
Nerve agent autoinjector which I already mentioned Combat Application Tourniquet (CAT)
Life saving tool carried by each Solider to stop the bleeding quickly
Developed using funding from our Combat Casualty Care Research Program and operations and maintenance
(O&M) dollars Expeditiously selected and tested by the U.S.
Army Institute for Surgical Research, or ISR, and procured and delivered to each Soldier
by the U.S. Army Medical Materiel Agency USAISR is located at Fort Sam Houston in the
San Antonio Military Medical Center Army's lead lab for combat casualty care medical
solutions and products for injured Soldiers and works closely with the Combat Casualty
Care Research Program here at Fort Detrick When I think of ISR I think of their Burn
Center which serves as the sole facility caring for combat burn casualties, beneficiaries
and civilian emergencies within the entire Department of Defense
The Joint Trauma System (JTS) was established within the ISR to improve trauma care delivery
and patient outcomes across the entire continuum of care to include prevention, point of injury,
pre-hospital, patient movement, military treatment facility acute, subacute, chronic care and
life-long rehabilitation As part of the JTS, the Joint Theater Trauma
Registry (JTTR) is the data repository for trauma-related injuries and leads improved
care of wounded warriors through such things as new clinical practice guidelines I mentioned
earlier. I mentioned the great work that we do for
the Individual Warfighter during pre-deployment, now let's focus on how we support our Units
during pre-deployment. USAMRMC directly supports the readiness of the US Army through life-cycle
logistics to Army Units. Although you will hear more medical logistics details later,
I wanted to mention a key organization here at Fort Detrick that is a central focal point
for deployment readiness, the U.S. Army Medical Materiel Agency (USAMMA).
The U.S. Army Medical Materiel Agency (USAMMA) manages the fielding and technical inspection
of medical equipment and supplies. These fieldings bring modernized equipment
and materiel to our units prior to deployment to make sure they have the most state-of-the
art items to take care of injured or sick warfighters
USAMMA also manages multiple contingency stock programs to include Army Prepositioned Stock
around the world and those stocks linked to our national strategic emergency response
plans USAMMA also provides oversight/collaboration
on specific materiel projects that are linked to MRMC Acquisition and Planning, Programming,
Budgeting, and Execution (PPBE) processes (which you will hear more about later)
In summary, USAMMA provides strategic, operational, and even tactical level support to the warfighter.
For the deploying unit, USAMMA provides essential materiel fieldings and logistics solutions,
ensuring that they are ready! Next will be Dawn Rosarius who will talk to
you about deployment MRMC ensures Soldiers are prepared physically
and mentally for deployments All environment -- from desert heat to snowy
mountains to the rain forest From humanitarian assistance to combat
MRMC has been and continues to be heavily involved in ensuring our warfighters have
the protective equipment and supplies they need
The Military Infectious Disease Research Program the Walter Reed Army Institute of
Research, or WRAIR, and the U..S Army Medical Materiel Devel- opment Activity -- USAMMDA
-- develop bed nets used in areas with a heavy population of insects, to make sure our warfighters
are protected from disease Working with our Combat Developer, experts
from the US Army Institute of Surgical Research or ISR the US army Medical Materiel Development
Activity, and the US Army Medical Materiel Agency or USAMMA worked together to make sure
the best commercially available items were selected for the Individual First Aid Kit
which is now worn by each Soldier and has essential medical items, such as the CAT and
lifesaving bandages. The Military Operational Medicine Research
Program and Congressional Special Interest funds assist the U.S. Army Institute of Environmental
Medicine, or USARIEM, in conducting nutrition research to determine the impact and effects
of the types of food and calorie intake of a Solider.
And, we continue to be on the fore front of research in providing better protection with
the Combat Casualty Care and Military Operational Medicine Research Programs via the work at
the Walter Reed Institute of Research for Fatigue, sleep, and Traumatic Brain Injury
Like the protection to our individual Soldiers, MRMC also provides a safe working environment
for the staff. The Military Operational Medicine Research
Program with the U.S. Army Center for Environmental Health Research and U.S. Army Medical Materiel
Agency are developing the Coliform Analyzer -- a tool to make sure that the Soldier's
drinking water is safe from Coliform bacteria and E coli.
The MRMC has also been essential in developing and determining the best medical evacuation
and care solutions for both ground and air ambulances, at the U.S. Army Aeromedical Research
Lab, the U.S. Army Medical Materiel Agency, the U.S. Army Medical Materiel Development
Activity, and the Telemedicine and Advanced Technology Research Center.
Now how do YOU fit into this process and this great organization of MRMC?
From Research and Development, Development and Acquisition and Acquisition and Logistics
all important along the DoD LCM cycle. For example, vaccines can take 10-15 years and
devices can take about 5 years. : From Research and Technology, this is typically
research of knowledge or materiel solutions in the discovery through technology development
This area is led by Dr. Frazier Glenn, our Principal Assistant for Research and Technology
Funds managed by our Research programs noted from Military Infectious Disease Research
Program to out newest area the Medical Training and Health Information Sciences
Noted is RAD and JPC, a RAD or research Area Directorate manages the Army funds and typically
under the same manager the JPC or Joint Program Committee -- a multiservice team -- manages
the intramural Defense Health Program/DHP funding
Intramural programs are executed by our Laboratories noted there and Extramural programs are typically
managed by our Execution Management organizations who include the Clinical Directed Medical
Research Program -- CDMRP and the Telemedicine and Advanced Technology Research Center -- TATRC.
From Acquisition, this is typically for what DoD calls Programs of Record, from Milestone
B through production and deployment, ensuring products are properly FDA cleared, manufactured,
and prepared for the environment This area is led by Dr. Ken Bertram, our Principal
Assistant for Acquisition Execution is performed by our Project Managers
from the Pharmaceutical PM to the Helicopter MEDEVAC Mission Essential Package PMs who
work for USAMMA, USAMMDA, and WRAIR. Army dollars are managed by the PMs and DHP
dollars are managed by our Joint Program Chairs When products are ready for fielding, we then
hand this off to our logisticians. From logistics, we procure, assemble, field,
maintain and sustain our equipment and sets, kits, and outfits developed for our deploying
units. This area is led by Mr. David Williams, our
Deputy for Materiel Executed by our Log organizations of USAMMA,
U.S. Army Medical Materiel Center Europe/USAMMCE, USA Medical Materiel Center -- Korea/USAMMC-K,
and the 6th Medical Logistics Management Center. How Do we Make This Happened
As we mentioned -- it is You!! From your early ideas in basic research and
technology, through Advanced Development and Acquisition thru Logistics
Lastly, we NEED MONEY..... We all like money and we all need money to exist, as does MRMC.
We talked about the process of obtaining and spending our funding and making better decisions
using Integrated Product Teams This chart demonstrates how all these sources
of money we mentioned flows It all starts with Congress through the Office
of the Secretary of Defense and then, depending on the type of funds we receive, either through
the Defense Threat Reduction Agency if in support of research at ICD or RIID, Health
Affairs for our DHP RDT&E funding and in support of our logistics agencies, or via the Army
for our Army-funded programs; then through MEDCOM, and finally to us
This "funds flow and process" is what we call our CORE funding
We also receive special appropriations directly from Congress to do research in special areas
such as Breast Cancer and Traumatic Brain Injury -- these funds go around the entire
process and come directly from Congress. This is called Congressional Special Interest money
and is a large portion of our funds. Like you and Money, processes are important
to make us successful. One of those processes important for MRMC's research and development
is the Decision Gate Process This is not something MRMC developed to create
more oversight, it is the marriage of existing Federal and DoD regulations, laws and processes
from the DoD Acquisition system and the U.S. Food and Drug or Environmental Protection
agencies Decision Gate is a streamlined process to
support these many laws and regulations. Depending on the maturity of the product and it's intended
use, it can take several to many years. This demonstrates how from basic research
thru the Acquisition phases and Milestones, we get a product thru the process and in the
hands of the warfighter. One example of this is the Noise Immune Stethoscope,
which was taken thru the various research phase of Materiel Solution Analysis and Technology
Development by the US Army Aeromedical Research Lab/ USAARL
Then, at this triangle -- called a Milestone -- Milestone B, it was handed off to our Advanced
Development organization -- USAMMA who took the product thru Engineering and Manufacturing
Development -- ensuring the product was FDA approved, that it could be manufactured and
that is was supportable It is now being reviewed by the user community
and hopefully we will hand it off to our Logisticians to fully field and sustain it in the near
future. In addition, as part of our research and development
processes, like Decision Gate with our DoD and FDA regulations and laws, we have additional
laws and regulations that provide ethical and regulatory processes to help us be successful
with medical R&D. Our Office of Research Protections at HQ,
MRMC helps make sure that any research conducted on an animals or humans is ethical and done
in accordance with all regulatory requirements Our Division of Regulated Activities and Compliance/DRAC
at USAMMDA provides FDA regulatory support and is the single point of communication w/
the FDA-regulated products Both organizations are essential in our research
and development. As mentioned earlier, we are an unique organization
and a full lifecycle manager We have two lifecycles within the full lifecycle
- product development and product sustainment Both support the other and are essential for
us to develop, procure, and sustain products for our Soldiers
Not all of our products are developed from the early stages. 95% of products that go
to the field are COTS or commercial off of the shelf items.
(COL Dole) The Army Medical Department sustains the fighting force. The Army Medical Department
also inspires the American war-fighter: instilling confidence when they face dangers because
they know they will receive the best possible protection and care.
Media: Click to start the video Script continues: The medical materiel and
medical knowledge delivered by MRMC has been essential to the positive medical outcomes.
In Iraqi and Afghanistan, the military health system has achieved the highest rate of survival
with the lowest medical footprint of any conflict; 90% of total causalities have survived.
Follow the wounded Soldier in this scenario through the evacuation process.
Prior to the injury, the Soldier has received the best possible equipment and training,
efforts seeking to prevent or mitigate injury. Immediately upon injury, the Soldier receive
care from their battle-buddy, from the Soldiers in his squad trained in the Combat Life-Saver
program, and from medics integrated into the unit. You can imagine his buddy opening the
Improved First Aid Kit (IFAK) strapped to the Soldier's vest or, in a traumatic injury,
utilizing the Combat Application Tourniquet (CAT) to a severed limb.
At that moment, it is all reaction and hasty action. Adding to the Soldier's strength in
that moment are very deliberate and technical processes from MRMC's activities.
Illustrating this point, the Joint Trauma Analysis and Prevention of Injury in Combat
(JTAPIC) provides data, analysis, and recommendations to improve design to military equipment. JTAPIC
collects and analyzes intelligence and clinical injury data in order to provide actionable
information to the appropriate Program Executive Office. In this way, MRMC influences the proper
design and life-support systems for vehicles and equipment.
JTAPIC has impacted design changes to helmets, armor, vehicles, and clothing and changes
to Tactics, Techniques, and Procedures. The photos on this slide illustrate vehicle design
changes, a very relevant example to the video of the IED blast video.
The experience of the wounded Soldier continues as the '9-line' call for MEDEVAC brings in
medical evacuations. The medical materiel and medical knowledge
delivered by MRMC continue to be an essential element of the care. The Noise Immune Stethoscope,
MEDEVAC Telemedicine, and portable oxygen generation are illustrated in these photos.
The U.S. Army Aeromedical Research Laboratory (USAARL) located at Fort Rucker, Alabama,
the home of Army aviation, provided the research, testing, and knowledge products that made
those innovations possible. The USAARL's mission is to preserve and enhance
the health, safety, combat effectiveness, and survivability of the U.S. Army Aviator
and the Soldier. Their five main tasks are listed on this slide.
Ultimately, USAARL reduces the health hazards and improves human performance on Army aviation
platforms and vehicles. Their effort ensures the Soldier safety, health, and optimal human
performance is built into our systems. These are specialized examples of technology
solutions, consider that as the life-cycle-manager for all Class VIII Medical Materiel, MRMC
manages and delivers all medical products -- "Healthcare Starts with Medical Logistics"
The life-cycle management included three parts; Research & Technology, Acquisition, and Logistics.
It is in the logistics that MRMC provides direct support to the military units.
The medical logistics responsibilities (per the Joint Health Readiness CONOPS) includes
nine capabilities: Medical Supply, Equipment & Technology, Medical Maintenance, Optical
Fabrication, Medical Logistics Services, Blood Management, Medical Facilities, Medical Contract
Management, Assemblage Life Cycle Management. In 2009, the MRMC Commander was designated
by the Army Surgeon General as the senior leader champion for the Army Medical Logistics
Enterprise. This reinforced MRMC role as the life-cycle-manager for Class VIII materiel
and expanded MRMC's role and responsibility to influence the entire Army Medical Logistics
Enterprise. There are two elements, first, MRMC executes
medical logistics functions through organic Medical Logistics commands that provide robust
and unique capabilities. Second, MRMC develops and synchronizes medical logistics concept
of operations and strategic goals across all Army activities by leading a collaborative
approach with Medical Command, Forces Command, Defense Logistics Activity, and all other
stakeholders. MRMC has specific leadership responsibility
in supply, equipment, maintenance, and assemblage life cycle management -- as well as a significant
responsibilities in all nine MEDLOG capabilities -- especially through the logistics commands.
Provides medical logistics support to U.S. Forces Korea and organizations located in
the Korean theater. At USAMMC-K, a MRMC unit, partners with Korean
civilian employees, Republic of Korean (ROK) Army, and the U.S. Army 563rd Medical Logistics
Company to provide the full range of medical logistics support. Their vision includes "Fight
& Win Tonight!", as USAMMC-K is fully integrated into the Eighth Army contingency plans.
Provides medical logistics support to U.S. Forces Korea and organizations located in
the Korean theater. At USAMMC-K, a MRMC unit, partners with Korean
civilian employees, Republic of Korean (ROK) Army, and the U.S. Army 563rd Medical Logistics
Company to provide the full range of medical logistics support. Their vision includes "Fight
& Win Tonight!", as USAMMC-K is fully integrated into the Eighth Army contingency plans.
The 6th Medical Logistics Management Center (MLMC) is a deployable FORCES COMMAND unit
under the administrative control of MRMC. The 6th MLMC provides strategic medical logistics
resources -- to plan and execute expeditionary centralized medical materiel management. A
unique capability that has proven invaluable during expeditionary missions such as theater
openings, and disaster relief operations such as the relief mission in Haiti and Hurricane
Sandy. The 6th MLMC provides two deployable teams
-- these teams have been on constant deployed rotations to Camp As Sayliyah Qatar throughout
the Operation Iraqi Freedom and Operation Enduring Freedom, continuing today in Operation
New Dawn. In Qatar, the 6th MLMC provide leadership to the U.S. Army Medical Materiel Center -- Southwest
Asia (USAMMC-SWA) (Provisional), the TLAMM for Central Command providing direct logistics
support to hundreds of joint and interagency customers.
MRMC provides the full range of logistics support as part of the complete Life Cycle
Management of medical materiel; MRMC is the champion for the Medical Logistics enterprise;
and MRMC units and personnel provide direct support, including deployed logistics teams,
to all Army units and to Joint forces. I will be followed by (LTC Fobbs) as MRMC
continues to impact the Soldiers experience after deployment
(LTC Fobbs) Increasing numbers of Service members are surviving with extreme trauma
to the extremities and head due to advances in trauma care. VIDEO
The Clinical and Rehabilitative Medicine Research Program (CRMRP) seeks more effective
ways to treat wounded Soldiers. The program has multiple initiatives to
achieve its goals, including improving prosthetic function, enhancing rehabilitative care, repairing
damaged eyes, improving pain management, improving limb/organ transplant success, and creating
full functioning limbs/organs. The CRMRP focuses on definitive and rehabilitative
care innovations require to reset the nation's wounded warriors, in terms of duty performance
service members. The wounds of battle are often hidden. Close
calls and seeing buddies killed in action are traumatic. No one is immune.
The Military Operational Medicine Research Program supports the ongoing research and
development plan at Walter Reed Army Institute of Research for post traumatic stress and
other psychological health issues that impact our warriors.
Their goal is to develop better, standardized clinical practice guidelines that can be provided
to the Defense Centers of Excellence and implemented throughout our military treatment facilities.
Military Operational Medicine Research Program as well as WRAIR develops and manages resilience
training programs such as BattleMind that offer strength-based, positive psychology
tools to aid Soldiers, Leaders and Families who must face the daily challenges of military
life. The information provided within this training
is targeted to all phases of the Soldier deployment cycle, life cycle, and support system.
Here is an early example of a product used to assist warriors returning from deployment.
The Army places strong focus on cognitive assessment for its Service members.
As follow-on to the Pre-Deployment Health Assessment discussed earlier, the Army requires
deployed military and civilian personnel to complete a post-deployment health assessment
immediately after return to home station and post deployment health reassessment 90-180
days following return. The assessments are designed to identify
and address health concerns, with specific emphasis on mental health, that have emerged
over time since deployment. We have covered how MRMC takes care of the Warfighter in the
field, but also important is that MRMC supports the family in many ways. Of particular note
resilience training and suicide prevention training. Many programs are of interest to
Congress. As was mentioned earlier, Congressional Special Interest funding has assisting in
keeping Breast Cancer and prostate cancer research moving forward.
The Nation recognizes MRMC's capability to manage extremely high budget research programs.
Therefore, --- CDMRP manages Congressional Special Interest funded medical research programs
in areas directed by Congress. In the 20 years since MRMC received its
first breast cancer money, CDMRP has received over 100 different CSI appropriations for
other diseases to include ovarian and lung cancer, psychological health, traumatic brain
injury as well as orthopaedic and spinal cord injury.
In recent years, CDMRP has become an Execution Manager for the Joint Program Committees core
programs. Another of our organizations that has national
and international reach is... The Armed Forces Medical Examiner operates a system that provides
comprehensive services in forensic pathology, forensic toxicology, DNA technology and identification,
and mortality surveillance for the Department of Defense.
A Tri-service organization, the AFMES is the only Medical Examiner Operation at the
Federal Level and is an Executive Agency. They are responsible for determining cause
and manner of death in all cases of suspicious or unnatural death for US Service members
and persons of interest to the US government. They work closely with the investigative
National Museum of Health and Medicine has case studies and records about disease, injury
treatment and healthcare in the military since 1862. This includes vaccine research and trials,
brain surgery and artificial organs.
NMHM celebrated its 150th anniversary on May 21, 2012 (the exact date of its founding in
1862) with a formal ribbon-cutting and public open house, attended by more than 1000 people
from the across the entire Washington, D.C. metropolitan area.
The Museum's long history allows for a vast
collection of materials used for ongoing research and development. It also serves as a repository
for current products and technologies.
The Museum held its 25th annual Forensic Anthropology course in June 2012. The course was held at
the Office of the Chief Medical Examiner in Baltimore, Maryland, and drew participants
from national and international organizations of military and civilian professionals.
Each year during brain awareness week, the
museum educates nearly 1,000 local middle school students on TBI. The museum also provides
a welcoming and comfortable space for Soldiers and their families to discuss topics related
to Traumatic Brain Injury and post traumatic stress disorder.
The stress-free environment of the museum
reflects the care and concern shown for our warriors and the medical innovations developed
to care for our military. It enables family members to gain a sense of the medical community's
involvement in Soldiers' lives across a linear time spectrum. We all understand that health
for our warriors does not stop once the Soldier leaves active duty... The Department of Defense
and the Department of Veterans Affairs provide health care and benefits to the same population
at different times in their lives. For this reason it is critical that DoD
and VA share data, resources, and coordinate and collaborate on medical care and medical
research initiatives. MRMC works with the VA on many clinical
trials and consortia studies focusing on regenerative medicine (AFIRM), traumatic brain injury,
post traumatic stress, suicide, Alzheimer's, Gulf War Illness and the Millennium Cohort
Study, which examines the health-related effects of deployment on military personnel and Veterans.
This overview only scrapes the surface of the service, support and products MRMC develops
and distributes to make sure our warriors stay Army Strong, Aim High, and are always
faithful from initial entry to retirement
and beyond. Any questions or comments?