United States Army Medical Research Unit-Kenya

Transcription

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, our devices, our drugs and vaccines. We impact third world countries, disaster areas, and 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! First, like you, MRMC is a subordinate command to US Army Medical Command MEDCOM. It is just the way the Army runs. Like you, we get our funding taxed. Like you we get help form oversight groups like GAO and DCMA and, like you we get taskers. A full 80% of the taskers we handle inside HQ without external assistance.   We defend your money.  We defend your manpower.  Along with your leaders, we plan strategically and speak for the entire Command so that there is one voice, one mission, one vision.  We assimilate the differences, the diversity, the challenges into a cohesive force for the health and wellbeing of the Warfighting Family 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 Helps health care providers identify issues and provide medical care before 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 and quality of life. The CRMRP is the lead for program development and oversight of the Armed Forces Institute of Regenerative Medicine, or AFIRM, which is a multi-institutional, interdisciplinary network working to develop advanced treatment options for severely wounded 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 arm of each branch of the military to include forensic investigation of crime scenes. And upon request an AFME team consisting of a forensic pathologist, forensic anthropologist, investigator, and photographer can deploy to incident site for recovery, identification, re-association and return of fallen warriors to the families. With so many historic medical events occurring, it is critical that significant innovations in medicine be captured... The 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?