Missionary Renegade: Military Health System of Washington, D.C., United States for Wednesday, 18 October 2017 "DHA symposium brings together minds to get the most out of research dollars"

Military Health System of Washington, D.C., United States for Wednesday, 18 October 2017 "DHA symposium brings together minds to get the most out of research dollars"

DHA symposium brings together minds to get the most out of research dollars
Navy Vice Adm. Raquel Bono, director, Defense Health Agency, addresses attendees of the Return On Investment Symposium, Oct. 11, 2017, at the National Oceanic and Atmospheric Administration building in suburban Washington, D.C. (Courtesy photo) bBy: Military Health System Communications Office
FALLS CHURCH, Va. — On Wall Street, measuring return on investment is pretty straightforward: You invest a certain amount of money and get back either more or less than you put in. Results aren’t so clear cut for military medicine.
“With health care, it’s a challenge. What does it mean to optimize the care we’re giving within the Military Health System, and how do we translate that to the support we give to operational forces?” said Navy Vice Adm. Raquel Bono, director, Defense Health Agency. “We’re … aiming to provide better health, better care at a lower cost. By investing in our people, that’s where we’re going to get the greatest returns.”
Bono opened the DHA-sponsored Return On Investment Symposium, Oct. 11, 2017, at the National Oceanic and Atmospheric Administration building in suburban Washington, D.C. The gathering brought together Military Health System experts in the medical and acquisition fields with their counterparts from other federal government agencies, academia, and private industry, to discuss how best to get the most out of taxpayer dollars going into care for warfighters. DHA’s director of research and development, Dr. Sean Biggerstaff, said returns in military health care are not primarily measured in dollars and cents.
“We’re not incentivized by cost savings,” said Biggerstaff. “Saving the life of one warrior is a big deal,” and he pointed to a number of products that have justified the costs of development by saving lives.
Navy Capt. Joseph Cohn, who works for Biggerstaff administering the DHA’s research program, pointed to a program he ran for the Defense Advanced Research Projects Agency about 10 years ago that changed training for information technology specialists. According to Cohn, it ended up saving the military billions of training dollars, but more importantly, it made the people who worked on the IT system better at their jobs in less time. Cohn recognized developing IT training is decidedly different from developing a new vaccine, but the principle is the same.
“At some levels, there are commonalities between approaches,” said Cohn.
Another example discussed at the symposium involved a system that uses vacuum pressure to decrease the amount of time for wound healing. Air evacuation crews commonly use the box-shaped devices. The problem is, the old, single-channel system could handle just one wound at a time, which meant it took several of the devices - costing $30,000 each - for patients with severe injuries, a common occurrence on the battlefield. Patients with multiple injuries could literally be covered with these devices, which also made it difficult for caregivers to treat their patient.
A new multichannel system, which costs $39,000 and can handle four wounds simultaneously, saves money and makes it easier for a doctor, nurse, or medic to treat the patient.
Air Force Lt. Col. Brandi Ritter recalled a case where seven single-channel devices had been used on a patient with multiple injuries, creating great difficulty for the caregiver who was trying to work around the devices to treat the patient. “The reduction to just two of these pumps, instead of seven, makes it much easier for him to take care of his patient,” she said. “And that’s why we’re here. We want to save lives and make their lives better.”
Biggerstaff also added that returns on investment don’t come immediately; it takes time to develop and deliver products with a science base intended for warfighter care.
Bono reiterated the importance of bringing together a group such as the one attending the symposium.
“We are looking to work and partner with all elements of all different sectors, because we realize within DoD, we don’t have all the answers,” she said. “We know there are other things going on out there that may actually mirror what we’re trying do here.”
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Medical residents aboard USNS Comfort help Puerto Rico recover
Navy Lt. Cmdr. Mary Bailey, an anesthesiologist, administers anesthesia to a patient prior to a surgical operation held in an operating room aboard the hospital ship USNS Comfort. Comfort is underway operating in the vicinity of Arecibo, Puerto Rico to provide medical services with additional visits being planned around the island. (U.S. Navy Photo by Mass Communication Specialist 1st Class Ernest R. Scott) by: Petty Officer 2nd Class Stephane Belcher
PUERTO RICO — Five emergency medicine physician residents from Naval Medical Center Portsmouth embarked on the Military Sealift Command hospital ship USNS Comfort in support of relief efforts for those affected by Hurricane Maria in Puerto Rico, as part of their residency training.
Comfort was to receive four staff emergency physicians from Navy Medicine East when the ship was activated. Navy Cmdr. John Devlin, the residency program director at NMCP, and the medical director of casualty receiving aboard Comfort, presented the idea to take two staff physicians and five residents, giving more physician manpower and allowing residents hands-on learning by executing the mission.

Sailors record information given by patients from the casualty receiving room inside the hospital ship USNS Comfort. The Department of Defense is supporting the Federal Emergency Management Agency, the lead federal agency, in helping those affected by Hurricane Maria to minimize suffering and is one component of the overall whole-of-government response effort. (U.S. Navy photo by Mass Communication Specialist 3rd Class Danny Ray Nunez Jr.)
The five are senior residents, who’ve been through four years of medical school, an internship, are in their third residency year and are only nine months away from graduating.
“I say it’s win-win,” said Devlin. “The people of Puerto Rico are getting more emergency medicine physician manpower than they would have had, had we gone with the original plan. And from the resident standpoint and the Navy’s standpoint, we are getting five junior physicians that, for their entire career, will have this experience base to carry forward to apply to missions in the future.”
Physicians in residency typically do not deploy.
“Here, we are coming out and doing medicine in a world that’s not at our own institution in response to a natural disaster, and that opportunity just does not happen,” said Navy Lt. Cmdr. Christopher Perry, an EM resident from NMCP.
Residents from NMCP embarked on Comfort in the past for Continuing Promise 2015. They came to provide primary care and humanitarian relief ashore.
“While [Continuing Promise] is a really great mission to be a part of,” said Navy Lt. Sean Murnan, an EM resident from NMCP, “as emergency medicine residents-in-training, the ideal setting is to work in a place that allows us to respond to situations that receive different emergency patients, and to run an actual emergency room.”
Physicians in residency programs, in both the military and civilian sector, already have the infrastructure of an emergency room in place for them in the hospital. They rarely get a chance to oversee what goes into setting up an emergency room until they’re on the operational side, after graduating.
The five residents on Comfort configured the casualty receiving area by combining existing standard operating procedures – those for humanitarian assistance and combat-trauma mass casualty response. The mass casualty operating procedure is geared for support of combat operations during time of war, and humanitarian procedure is geared to support missions similar to Continuing Promise.
All of us had an individual role,” said Murnan. “All we had to do was kind of mesh those two together and create a plan that could receive a blend of the sickest patients around the island, which is what we’re tending to receive.”
With the help of the “Sea Knights” of Helicopter Sea Combat Squadron 22, another opportunity that’s offered aboard Comfort is the chance for EM residents to personally medevac intensive care patients, with two physicians per patient treating them in the air.
“We offer a level of critical care in the air that the military system doesn’t normally provide,” said Perry. “Typically, for military air ambulances, it’s 20-year-old marines or soldiers who have traumatic injuries. Flying chronically ill, very sick patients in theirs 80’s and 90s is not something you ever do in a Navy helicopter. So it’s a little unique here.”
Perry is one of only two aeromedical dual-designated physician aviators in the Navy, having designations both as a doctor and a pilot. Aboard Comfort, he’s in the tower helping coordinate the en route care medevac system.
“It’s like the perfect scenario for us,” said Murnan. “We’re actually able to take on these tasks individually, and come together and build this department, and then see how well it does. And so far, everything’s been pretty smooth.”
Disclaimer: Re-published content may have been edited for length and clarity. Read original post.
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