We’ve also implemented an electronic health record in aeromedical evacuation. That’s helping us in terms of more fully capturing data in terms of the status of our patients and the interventions we provide and then being able to transfer that data into the patient’s electronic health record when they get to a hospital. Of course, the new electronic health record that the Department of Defense is acquiring now will include the capability to capture and transfer data as well.

 

Are there differences between Air Force deployable or expeditionary facilities and those of the other services?

There are. As in Air Force medicine, we’re part of a joint team, obviously. In Iraq and Afghanistan and in the operations today, we’ve got a strong track record of operating well as a joint team. What we bring to the joint team tends to be a ground medical capability that is more agile and … can be moved with relatively little airlift, can be established quickly, and be able to provide emergency room and surgical stabilization capability within hours of arrival.

Our field hospitals are not large in capacity. Our largest bed capacity in a field hospital is the EMEDS+25. That’s a 25-bed hospital. We have a smaller version that’s just a 10-bed hospital. The Army and Navy have much larger field hospitals with a greater bed capacity that require more time to move and be established. So what we bring to the joint team is the ability to get in quickly and rapidly establish emergency care and surgical stabilization.

 

You’ve served in the past with Air Force Special Operations Command (AFSOC). What special training, skills, or standards pertain to special operations medical airmen?

I first came to AFSOC in the aftermath of the engagement in Mogadishu [Somalia] that became part of the Black Hawk Down story. That was a time when special operations medicine was learning some things that have now translated into the conventional force. That was about the importance of controlling hemorrhage at the point of injury and the opportunity to save lives by doing that.

During my initial tour in AFSOC, Army, Navy, and Air Force special operations medics were working together to develop the techniques to control hemorrhage in a tactical environment. That begins with the operators providing care to each other or potentially to themselves in order to immediately control hemorrhage and then for the special operations medics to provide a hemorrhage control and resuscitation in the tactical environment.

That led to the creation of something called Tactical Combat Casualty Care. That proved to be a very successful concept that has become the foundation and the basis for training every military member and every deploying military medic. Tactical Combat Casualty Care is now fundamental to how we prepare soldiers, sailors, airmen, and Marines to go forward and be prepared to care for each other immediately to improve the opportunity to survive a serious wound.

When I came in the Air Force 30 years ago, we did not think we would deploy a vascular surgeon or a neurosurgeon, or even a burn surgeon. But over time, our medical professionals have developed the capability to take advanced techniques into the field environment. That means we’ve got a lot more capability in a field hospital than we once had.

That all started with a special operations experience that our military had in Mogadishu. Those lessons were captured. And so today’s special operations medics are a very, very capable force. Because of the nature of the mission they support being a very small but agile combat force, they have to be small, efficient, and agile as well. So some of the changes we made to our conventional capability to support the ongoing counterterrorism operations today really came from special operations.

Our conventional force also, of course, has to be ready for a large-scale combat operation because we know that is always something for which we must maintain our readiness. So special operations medical forces really focus on the agile support in an austere environment almost exclusively, whereas our conventional forces bridge between large-scale counterterrorism operations and then a major, more conventional combat operation.

 

Can you talk just a bit more about the ongoing requirement to maintain medical readiness for deployment?

Yes, when I came in the Air Force, the range of medical specialties we would deploy in military medicine was pretty narrow. For example, when I came in the Air Force 30 years ago, we did not think we would deploy a vascular surgeon or a neurosurgeon, or even a burn surgeon. But over time, our medical professionals have developed the capability to take advanced techniques into the field environment. That means we’ve got a lot more capability in a field hospital than we once had.

That means that we need to keep the medical professionals that make up that advanced capability in practice day to day at home station in the hospitals where they are assigned that will sustain that readiness to provide the kind of complex care they provide in a combat field hospital. And that creates some new requirements for us. The population that we serve, who are primarily active-duty members and their families, tends to be a relatively, young, healthy population [that does] not typically need the kind of complex care those professionals are able to provide.

We’ve found that we need to actually reach out and establish partnerships with trauma centers and academic medical institutions and with the Veterans Administration so that our surgical sub-specialists, our general surgeons, our orthopedic surgeons, and our critical-care specialists get the volume and the mix of complex care that they need to sustain their skills.

So we’ve found that we’ve evolved the practice of our surgical and our critical-care specialists such that they practice in our hospitals, but they also practice in partner institutions where there are more trauma patients or more patients with complex medical conditions. The agreements we’ve established with the Veterans Administration have been very helpful in that by virtue of receiving referrals from the Veterans Administration, we are able to provide great care to veterans in our hospitals and at the same time help keep our deployable medical teams current through a more diverse practice.

We continue to work to increase the number of our agreements. We currently have over 60 agreements with Veterans Administration hospitals to provide specialty care. And we continue to build that number.

That’s an endeavor that is underway. We have a concept that we published last year that describes the principles. We have a multi-phased action plan right now that is in progress. A significant part of that action plan is investing in the development of our medical professionals so that they are trained and knowledgeable in how to continuously improve how we provide care and also to have the strong communication and the focus on identification of risk early.

 

In addition to deployment readiness, where are the challenges in delivering safe and quality medical care to Air Force personnel and their families?

Every health system has as its primary focus the assurance that the care we provide is best quality and as safe as we can possibly make it. That is not easily done. It requires continued focus and attention. Last year, in Air Force Medicine, we reviewed our performance as a health system. While our performance was good and compared favorably with other health systems, we felt like we could be better.

We decided to apply our commitment to safe, high-quality care in a new way. It’s called Trusted Care. Under Trusted Care, we’re seeking to gain the highest possible reliability as a health care system. It is a new way of applying our commitment. Primarily, it’s a new approach to leading and developing a culture within Air Force Medicine, in which we have a laser focus on recognizing potential risk and then mitigating that risk before it turns into something that could reach a patient or even harm a patient.

That requires that as a team, every member of the team in Air Force Medicine has a duty and a responsibility day to day to be alert for things that could pose risk to a patient and then to communicate about that risk and then participating in the actions to ensure that risk does not turn into something that could harm a patient. That’s what I mean by a culture focused on risk.

We also need a culture that takes a systems approach to engineering safety into our operations. That engineering includes our processes by which we provide care. It also includes things like the sustainment, maintenance, and design of our equipment. And the purpose of that engineering is to catch errors before they reach a patient. We know that anything that involves human activity – such as provision of health care, flying aircraft, working on a construction site – those are all human endeavors, and so errors will occur. That’s just the nature of human activity.