Joint Pathology Center to celebrate 100 years of helping military docs confirm diagnosesPamela Baker (left), 88th Diagnostics and Therapeutic Squadron cytology technician, prepares the staining of a patient's tissue sample, while Maj. Luisa Watts (right), 88 DTS pathologist shows 1st Lt. Jeffrey Davey (center) her findings on a screen that connects to the microscope inside the operating room at Wright-Patterson Air Force Base Medical Center, June 26, 2017. Watts examines the tissue sample under the microscope to make a diagnosis of the patient's condition. (U.S. Air Force photo by Michelle Gigante)Falls Church, Va. — As a young pathologist 40 years ago, Dr. Isabell Sesterhenn helped doctors diagnose disease. She was essentially “the lab” you hear about where a biopsy or tissue sample is studied to determine what the disease might be. But back then, the information she had within arm’s reach was limited.
“There were cases, for example, of testicular tumors,” said Sesterhenn. “As a general pathologist, you might see just 60 cases in a lifetime. But later when I came for training to the Armed Forces Institute of Pathology, the forerunner to today’s Joint Pathology Center, within one week, I looked at 500! So when I went back home, it was a piece of cake to diagnose a tumor.”
Sesterhenn is now a staff pathologist at the Joint Pathology Center located near the campus of Walter Reed National Military Medical Center in the suburban Washington, D.C., area. While doctors and local pathologists are the first ones who diagnose a disease, the center serves as the secondary consultative service for military and Department of Veterans Affairs pathologists, and other federal organizations. She said other pathologists and medical doctors in the Military Health System and researchers from the world of academia have a wealth of information to help draw conclusions.
“In the center, you see a lot of variation of specific tumor types,” said Sesterhenn. “With the new methodologies we have now, we learn very subtle differences we might have overlooked or didn’t understand before.”
To say the collection is big is an understatement. “We have the world’s largest collection of pathology specimens,” said Army Col. Clayton Simon, Joint Pathology Center director and a doctor himself. “We have more than 4 million cases, 55 million pathology slides. The next largest collection is, maybe, 800,000 slides.”
This expansive knowledge database gives doctors and pathologists a wide-ranging resource to make better diagnoses.
“Now we’re able to look at specific proteins and genetic changes in some cancers to refine the diagnosis and customize patient care,” said Sesterhenn. “That’s not necessarily unique to the center, but here we can do this more thoroughly than other places because we have greater numbers of different variants of the same tumor.”
It also helps young doctors gain more confidence in their own diagnoses.
“Nearby Walter Reed and the Uniformed Services University of the Health Sciences sends residents, students, and fellows to train under our pathologists so they can see some of the more difficult cases,” said Simon.
Although tracing its origins all the way back to the Civil War as part of the Army Medical Museum in Washington, the center celebrates its 100th anniversary as a tissue repository this month.
“A lot of our specimens came from the Spanish Flu from the early 20th century, doing autopsies on soldiers and casualties from World War I,” said Simon. “So all of the pathology specimens collected before 1917 in the museum got put into the repository, giving us some specimens more than 100 years old.”
The information today’s pathologists are able to use from these 100-plus-year-old specimens, along with the specimens still being collected – some from all over the world – help in modern countermeasures to lethal pathogens still out there. Without giving specifics for security reasons, Simon explained they’ve been able to counter a possible bioweapon.
“We don’t normally see people infected by these bacteria,” he said. “We were the only place in the world that had tissue infected by this bacterium, a specimen that went back more than 50 years. A researcher was able to use our sample to target the antigens to start developing a vaccine against it.”
The center helps with other areas of military medicine, such as traumatic brain injury research. The expansive collection of brain tissue samples helps them better understand the changes associated with blast injuries and head trauma more common in military members than their civilian counterparts.
“This time of pathology is very exciting, because we are switching over from a purely descriptive diagnosis to trying to understand what we see,” said Sesterhenn, pointing out how modern technology is unlocking the secrets hidden in the long history of the registry samples. “We have specimens that span all ages, races, and geographical origins. The diseases might look alike, but their causes may have evolved. The repository offers a unique resource to explore morphologic and genetic changes over a century.”
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'Dust Off' Demos Showcase Army Medical Evacuation ModernizationSoldiers from the 2nd Battalion, 30th Infantry Regiment “TF Wild Boars” test their triage and rapid transport skills during a mass casualty exercise at Tactical Base Gamberi. The goal of MEDHUB is to keep the medic or flight paramedic focused for performing life-saving tasks for multiple patients and remain unencumbered from documentation and reporting. (U.S. Army photo by Maj. Asha Cooper) As a crowd gathers, Army Transport Telemedicine Product Manager Jay Wang starts off by setting the scene.
"Imagine you are a medic on the battlefield and you just pick up six of your wounded battle buddies for a casualty evacuation. You are busy trying to save their lives and get them to the next level of care, which is a nearby field hospital that has no idea how many patients you are bringing or their conditions," Wang explained to attendees of the Military Health System Research Symposium in Kissimmee, Florida, Aug. 27-30. As the only scientific meeting addressing the unique medical needs of the Warfighter, MHSRS draws in thousands of military scientists, academia and industry from around the globe annually to exchange information on research and health care advancements.
"What is our current technology for sharing information about trauma care on the battlefield," Wang asked rhetorically, holding up a bloodied paper Tactical Combat Casualty Care card.
Wang and his team then demonstrate a solution they are developing at the U.S. Army Medical Materiel Agency, a subordinate organization of the U.S. Army Medical Research and Materiel Command. The system is called Medical Hands-free Ultra-wideband Broadcast, or MEDHUB, and it is designed to capture, store and forward data automatically from medical devices to receiving hospitals.
"The goal is to keep the medic or flight paramedic focused for performing life-saving tasks for multiple patients and remain unencumbered from documentation and reporting," Wang said.
The system's key components include individual wearable vital sign monitors that record vitals and provide littered or ambulatory status through accelerometers; peripherals to capture patient weight; and an end-user device, such as a tablet or phone, that captures and stores the data. Low band-width intensive data will be automatically sent ahead of the evacuation vehicle or aircraft on existing long-range DOD communication systems.
"MEDHUB will provide the medics a powerful companion to help them capture, store and forward medical data that will improve patient safety, care, and outcomes in all pre-hospital settings for both theater operations and consequence management response force operations," Wang said.
As MEDHUB evolves, more than 5,000 Army medical ground ambulances and more than 600 Army air ambulances could be outfitted with the system, which is in advanced development at USAMMA and on track to be fielded as early as 2020.
USAMMA's MEDEVAC Mission Equipment Project Manager Lt. Col. Christian Cook has more than 20 years of experience as a pilot and said he knows firsthand the challenges of patient care on the battlefield. Hospital teams in the field often have limited information on the number of patients they are receiving and their conditions.
"A MEDEVAC aircraft may go out for one or two patients and come back with five or six," said Cook. "This makes it difficult to the hospital staff to plan for patient arrivals. Forwarding accurate patient counts, nature of injuries and vitals well ahead of arrival allow the gaining medical unit to alert and form the reception litter teams, anticipate the triage, and assemble the right providers such as specialists."
Currently, the MEDHUB concept is designed to autonomously send de-identified patient information to a display screen at the field hospital where clinicians can see what is inbound, including both the number of patients and their vital statistics.
"With this improved technology, we can provide better patient outcomes," explained Wang. "A faster flow of data will help the field hospitals better prepare immediate treatment plans and, ultimately, shorten the time it currently takes for an injured service member to receive critical life-saving care."
The tool could also be designed to support tools that have already been approved by the U.S. Food and Drug Administration, such as the Compensatory Reserve Index (CRI), which assist clinicians in quickly identifying and appropriately managing the most severely ill and injured patients. However, Wang clarified, that MEDHUB is not being designed to replace direct clinical care decisions by the medic or clinicians.
The MEDHUB concept was developed from user feedback from flight paramedics of all Army Components, including flight paramedics stationed at the U.S. Army School of Aviation Medicine. The team is also working closely with the Army's Program Executive Office-Aviation.
In addition to MEDHUB, the Project Manager MEDEVAC Mission Equipment symposium exhibit included several fielded MEDEVAC Mission Equipment products, such as the Interim MEDEVAC Mission Support System - Patient Handling System, which is employed in medical companies' air ambulances to provide a means of transporting or evacuating up to four patients who may be on stretchers or able to walk. The system includes seat pallets, seats, interior components and litter support.
Also displayed was a MEDEVAC Mission Sensor, Forward Looking Infra-Red, which is designed to help pilots and crew locate patients in limited visibility scenarios, such as nighttime and poor weather operations. Additionally, the displays included a Blackhawk Advanced MEDEVAC (BAM) sliding window designed to provide crewmember critical external visibility of the tail rotor while keeping expensive and critical medical equipment within the aircraft.
"It is essential that we provide a better understanding to the entire medical community about our operational environment, as well as current and future MEDEVAC medical equipment package capabilities," said Lt. Col. Josephine Thompson, Medical Evacuation Product Director, Utility Helicopter Project Office, PEO-Aviation.
Thompson, who attended MHSRS, said that the user feedback has been very positive. For some people, however, the MEDHUB concept sounded a little too futuristic. Cook said that is why they wanted to show MEDHUB and other MEDEVAC equipment is available today at this year's symposium, which is the Department of Defense's premier medical scientific meeting.
"Some people thought this couldn't be done," said Cook. "So we are showing them that not only can it be done, but also that we are doing it."
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