As our Army deals with current

Capt. (Dr.) Erik Schobitz, battalion surgeon for the 3-15 Infantry, treats a soldier wounded during the battle on Objective Curly during Operation Iraqi Freedom. Dennis Steele 18 ARMY June 2003

Fielding a Medical Force To Keep Soldiers Healthy As our Army deals with current challenges in Southwest and Cen - tral Asia, it is traveling some of the same ground it traversed in 1991. However, the Army of Operation Desert Storm was quite different from today s force. The Army Medical Department (AMEDD) is adapting doctrine and taking advantage of advanced technology to field a medical force that meets today s requirements. We are improving flexibility, scalability and deployability of the medical force through the Medical Reengineering Initiative (MRI). The MRI Combat Support Hospital incorporates 84-bed and 164-bed hospital companies. It is capable of breaking out a smaller package of up to 44 beds that is 100 percent mobile with organic transportation and more tailorable to the mission, thereby reducing its footprint on the battlefield. By Lt. Gen. James B. Peake June 2003 ARMY 19

Right, chemical biological protective shelter systems, like these two set up at Camp New York, are slated for issue soon to the 3rd Infantry Division (Mechanized) and the Marines. Below, Sgt. Hilda Lerma, Task Force- 44 medic, bandages the head of 1st Sgt. Leonard Houser, HHC, CJTF-180, after a gun-shot wound. The Forward Surgical Team (FST) is a new modular unit that can perform surgery far forward, in the area of a maneuver brigade or armored cavalry regiment. These small, flexible units can manage approximately 10 patients per day, providing initial surgery and postoperative care until patients are evacuated for more definitive care. FSTs have proven their value in saving lives and limbs in multiple deployments since they were first designed and deployed. Medics of the new mili - tary occupational specialty (MOS) 91W (Health Care Specialist) are trained to better treat casualties at the point of injury and for longer sustainment of patients during evacuation. More than 3,500 field medics have graduated from the 16-week 91W course at the AMEDD Center and School. All 91W soldiers will be qualified as emergency medical technicians. Former 91Bs and 91Cs are receiving additional training, with a goal of 35 percent of active component 91Ws and 25 percent of reserve component 91Ws fully qualified this fiscal year. The 507th Medical Company (Air Ambulance) and the LT. GEN. JAMES B. PEAKE, M.D., is the commanding general of the U.S. Army Medical Command and the Surgeon General of the Army. A graduate of the U.S. Military Academy and Cornell University Medical School, he is also a graduate of the U.S. Army War College. He is a member of the Association of Military Surgeons of the United States, the Society of Medical Consultants to the Armed Forces and the American College of Surgeons. 126th Medical Company (Air Ambulance) took our most advanced casualty evacuation helicopter, the HH-60L Black Hawk, to support operations in Southwest Asia and Afghanistan this spring. These aircraft allow for the more effective treatment of casualties during evacuation. Features include a digital cockpit, on-board oxygen generation system, external electric hoist, advanced communications, improved litter support system, medical suction and electrical power for medical equipment. We currently have nine HH-60Ls and expect nine more to be delivered in fiscal year 2004. In addition, Detachment 1, 146th Medical Company (AA) of the Tennessee Army National Guard has four UH-60Qs, which are UH-60A helicopters with the same medical equipment package as the HH-60L. The medical evacuation vehicle (MEV) variant of the Stryker will provide ground evacuation of casualties for U.S. Army/Sgt. W. Cullen James Army Medical Department 20 ARMY June 2003

This HH-60L Black Hawk helicopter is one of only 12 in the world. Bagram is the current home for two of these aircraft designed specifically for medical evacuation. Current plans will eventually give all paramedics a chance to put these choppers to the test. the Interim Force. The Stryker MEV can carry four litter patients or six ambulatory patients while its crew of three medics provides basic medical care. It can ride in a C-130 aircraft, has the speed and mobility to keep up with the fighting forces, and provides better communications and more room for equipment than the M-113 ambulance. The first of these vehicles was delivered to the brigade combat teams at Fort Lewis, Wash., in March. Developers at the U.S. Army Medical Materiel Development Activity and the AMEDD Center and School are designing lighter, more efficient shelters to house field hospitals, and the Telemedicine and Advanced Technology Research Center is examining lightweight portable equipment for use in deployments. When these are available, we will be able to get a hospital or FST to the battlefield with fewer C-130 flights and then set up and go into operation much more quickly. Some of our field hospitals now have equipment to produce medical-quality oxygen. A hospital can use about nine tons of oxygen cylinders per day, so the one-ton oxygen generator is a big reduction of our logistics footprint. Even lighter generators are being developed. U.S. Army/Pvt. 2 Terri Rorke, 11th PAD If an injured person receives advanced medical care within the first hour after injury, the chances of survival and recovery go up exponentially. Historically, 10 to 15 percent of wounded in action require surgical intervention to control hemorrhage and provide stabilization for evac uation. Highly mobile surgical teams deployed far forward near the fight ing allow this to happen. The forward surgical team: Provides versatility, expanda - bility and deployability. Deploys in the area of a ma - neu ver brigade or armored cavalry regiment. Typically includes 20 staff members organized into four func - tional areas: triage-trauma manage - ment, surgery, recovery and admin - istration/operations. Capt. Forrest Fernandez of the 948th Forward Surgical Team performs an ultrasound to check a patient for internal hemorrhages. Forward Surgical Teams Can provide initial surgery on two operating tables, and up to six hours of postoperative care for a maximum of eight patients at a time. Can treat major chest and abdominal wounds, continuing hemorrhage, severe shock, com prom - ised airway or respiratory distress, amputations, major organ fractures, crush injuries, and acutely deteriorating consciousness with closed head wounds. May be attached to a combat support hospital to provide additional surgical capability. Forward surgical teams maintain skills and learn teamwork by treating patients during rotations at the Army Trauma Training Center, work - ing in association with the Ryder Trauma Center at Jackson Memorial Hospital in Miami, Fla. This training is designed to provide military medical staff with the trauma experience that has been slowly disappearing from its ranks as Vietnam-era personnel retire. U.S. Army/Bill Geddes, Public Affairs, 88th Regional Support Command 22 ARMY June 2003

Chemical-Biological Protective Shelter Systems Special shelters enable Army medical personnel to care for patients in a clean, toxic-free, shirt-sleeve environment even when operating in areas contaminated by chemical and/or biological agents. There are two types of system: CHEMICAL-BIOLOGICAL PROTECTIVE SHELTER A highly mobile, chemically and biologically protected, environmentally controlled work area for forward deployed medical treatment units, the chemical-biological protective shelter (CBPS) allows the unit to continue patient care when the unit comes under chemical or biological attack. CBPS consists of a dedicated M1113 Humvee vehicle; a lightweight multipurpose shelter, a 3 0 0 - s q u a r e - f o o t semi-cylindrical airbeam-supported soft shelter, stored and mounted on the back of the Humvee for transporting; and a towed high-mobil - ity trailer with 10- The inflatable chemical biological protective kilowatt tactical quiet shelter can be transported by a single Humvee. generator for auxiliary power. Unit soldiers can configure multiple systems to provide a single chem-bio protected area. A single CBPS system can be inflated in four minutes and be fully operational in less than 20 minutes. All power is provided by the Humvee engine or from the auxiliary generator. A hydraulically powered environmental support system on the front of the shelter provides heating, cooling, airbeam inflation, chemical-biological filtration and ventilation air. Multiple systems can be complexed. CBPS is now being fielded to line-battalion treatment squads (aid stations), division/corps medical companies and forward surgical teams, including some units supporting Operation Iraqi Freedom. CHEMICALLY PROTECTED DEPLOYABLE MEDICAL SYSTEM This system provides environmentally controlled, collective protection for the core components of combat support hospitals using deployable medical system equipment. It is a joint Army-Air Force program, with the U.S. Army Soldier and Biological Chemical Command at Natick, Mass., the lead material developer for the Army. Each hospital consists of TEMPER tents, ISO shelters and connecting passageways. The chemically protected deployable medical system (CP DEPMEDS) is an integration effort to bring together the necessary components. Collective protection is provided by a chemical-biological protective liner system; nuclear-chemical-biological filters; an overpressurization system; low-pressure alarms; chemically hardened, field deployable environmental control units; airlocks for personnel, patients and resupply; CB-protected water distribution; and CB-protected latrines. CP DEPMEDS sets are being placed in Army prepositioned stocks for fielding to units deploying to high-threat areas. The Army is currently fielding CP DEPMEDS in support of Operation Iraqi Freedom. U.S.Army Medical Department Dentists now are testing the dental field treatment and operating system, which reduces weight for a dental unit by about 2,700 pounds and can operate off a Humvee battery. The threat of chemical or biological weapons is a constant consideration on the modern battlefield. We have developed and fielded new chemically and biologically protected shelters to secure our medical units in a contaminated environment and to allow efficient decontamination of casualties for treatment. The U.S. Army Medical Materiel Development Activity also has developed a multichamber autoinjector that allows a soldier to self-inject two nerve agent antidotes with one injection. It is smaller, easier to carry, easier to use and puts the drugs to work faster than the MARK I Nerve Agent Antidote Kit. We have integrated training for chemical, biological, radiological, nuclear and high-yield explosive (CBRNE) casualties into all specialty medical training and operations. The AMEDD Center and School also is disseminating exportable CBRNE training products to medical units. With a renewed supply of anthrax vaccine, the Department of Defense last year resumed its program to protect servicemembers against that disease. We also have begun vaccinating health-care providers and others at high risk against smallpox, another likely weapon of bioterrorism. Every precaution is being taken to provide safe and efficient vaccination programs. Among the first 100,000 to receive the smallpox vaccine, only four soldiers and one airman experienced serious reactions all were treated and recovered. Experts with the Medical Research and Materiel Com - mand (MRMC) are hard at work on new vaccines to protect against other dangerous diseases that may be used as weapons or to which our soldiers may be naturally exposed during deployments. Among the notable efforts: MRMC has an interagency agree- June 2003 ARMY 23

High-Tech Bandages Uncontrolled bleeding is a major cause of death in combat. About 50 percent of those who die on the battlefield bleed to death in minutes, before they can be evacuated to an aid station. New bloodclotting bandages will save lives on the battlefield. THE FIBRIN BANDAGE Contains fibrinogen and thrombin, clotting proteins in blood. Can reduce blood loss by 50 to 85 percent. Approved by the Food and Drug Administration for investigational use by special operations soldiers, with informed consent by the patient. Developed by the U.S. Army Medical Research and Materiel Command and the American Red Cross. Produced by CSL, Ltd. THE CHITOSAN BANDAGE Made of chitosan, a biodegradable carbohydrate found in the shells of shrimp, lobsters and other animals. Chitosan bonds with blood cells, forming a clot. In tests, effectively stanched a wound bleeding at a rate of 300 milliliters per 30 seconds. Approved by Food and Drug Administration in November 2002. No hazard to people allergic to shrimp. Developed by Oregon Medical Laser Center on a grant from the U.S. Army Medical Research and Materiel Command. Produced by HemCon, Inc. ment with the National Institutes of Health to develop a vaccine to boost immune response to human immunodeficiency virus (HIV), which causes Acquired Immune Deficiency Syndrome (AIDS). Phase One clinical studies are under way on a vaccine against dengue fever, which each year infects some 100 million people and kills approximately 35,000. Four vaccines against diarrhea being developed at the Walter Reed Army Institute of Research will provide protection against a condition that temporarily incapacitated 20 percent of the troops involved in Operations Desert Shield/Desert Storm. Wherever we send troops, we send preventive-medicine specialists to determine what environmental hazards might be present and how commanders can safeguard their soldiers health. After Desert Storm we formed the 520th Theater Army Medical Laboratory, which provides rapid, sophisticated analyses in the field, rather than sending samples back to the United States. Prompted by the unexplained health problems some Desert Storm veterans developed after returning home, we now survey deploying troops health before they leave and after they return, and keep extensive records on what they may be exposed to that could cause illness. A formal clinical practice guideline provides health-care providers with procedures to evaluate and document post-deployment illnesses. We are using computers to help monitor and manage health care in ways unimaginable in 1991. Since 1997, the Medical Protection System has captured medical readiness information on active and reserve component soldiers as well as DA civilians. It provides the unit commander an assessment of medical readiness in the unit. The system receives automatic data feeds from the Army Medical Surveillance Activity for HIV, Armed Forces Institute of Pathology for DNA, the AMEDD Corporate Dental Activity for dental readiness and the Total Army Personnel Data Base for personnel demographics. HEMCON The chitosan bandage bonds with blood cells, forming a clot. THE ONE-HANDED TOURNIQUET Allows an isolated soldier to stop bleeding in an arm or leg without assistance. Issued to special operations soldiers. Consists of loops of nylon webbing that tighten when pulled to shut off blood flow. Exempt from Food and Drug Administration approval. Developed by U.S. Army Medical Research and Mate riel Command. Produced by Canvas Specialties. The medical evacuation vehicle (MEV) variant of the Stryker. 24 ARMY June 2003

The Stryker MEV can carry four litter patients or six ambulatory patients. The Army Medical Surveillance Activity operates the Defense Medical Surveillance System, containing more than 250 million records on 7.4 million servicemembers who served on active duty since 1990. It receives data on all hospitalizations, outpatient visits, reportable diseases, HIV and immunizations, which are linked to individuals through their assignments and deployments. Disease summaries, trends and field reports are published in the Medical Surveillance Monthly Report. The Army is executive agent for the DoD Global Emerging Infections Surveillance and Response System (DoD- GEIS), which provides a centralized hub to help draw together information on emerging infectious disease threats, linking military disease surveillance resources with civilian and international efforts. When the Theater Medical Information Program software is fully developed and deployed, health-care providers in the field will have electronic access to patient records, disease and injury trends and chemical or biological attack alerts. It will also enhance our ability to manage logistics and make well-informed decisions on medical sustainability and supportability. Army Medical Department Dennis Steele Capt. (Dr.) Erik Schobitz stabilizes a wounded Iraqi civilian after his vehicle was fired upon at a checkpoint during Operation Iraqi Freedom. The most significant change in Army health care since Operation Desert Storm may be the enhanced awareness of the critical importance of force health protection issues throughout the whole chain of command. Our leadership has a keen appreciation of their responsibility, and increased knowledge of how to keep soldiers healthy and safe. The U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) has prepared Staying Healthy Guides for 15 countries and seven regions where troops may deploy. They are available at chppm-www.apgea. army.mil on the World Wide Web. USACHPPM also operates a health site at www.hooah4 health.com that helps individuals take charge of their health and wellness. Ultimately, it is far better to give soldiers the information they need to maintain their health than to try to repair preventable damage. The challenges we face have changed since 1991, and we have changed to match new requirements. The Army Medical Department is determined to remain forward-looking, to avoid the trap of fighting the last war, and to stay a step ahead of evolving threats of the future. B 26 ARMY June 2003