Air Force Medical Service - Trusted Care Anywhere Published March 29, 2010 By Lt. Gen. (Dr.) Charles B. Green Air Force Surgeon General WASHINGTON -- NOTE: This article was published in U.S. Medicine's "This Year in Federal Medicine: Outlook 2010." It appears here with the publisher's permission. "Trusted Care Anywhere" is the Air Force Medical Service's vision for 2010 and beyond. In every domain of Air, Space and Cyberspace, our medics contribute to the Air Force and Joint team with world class medical capabilities. Our 32,000 active duty medics around the globe are trained and motivated for mission success. Over 1,600 are now deployed to 40 locations in 20 countries, delivering state of the art preventive and life-saving care. From our theater hospitals in Balad and Bagram, to the efforts of our Humanitarian Assistance Rapid Response Teams (HARRT)--that recently responded to earthquake ravaged Indonesia--to the care of our families at home, we put our patients first. Today's focus is on our missions in Afghanistan and Iraq, stability operations, health care delivery, and preparing for emerging threats. We continue to find ways to quickly adapt our medical systems, and implement organizational change to produce healthier outcomes in those diverse mission areas. While we've earned our nation's trust with our capabilities and the expertise of our people, we constantly seek to do even better! Here are our areas of strategic focus. Enhance expeditionary medicine and aeromedical evacuation capabilities Our success in battlefield medicine underscores our ability to provide Trusted Care Anywhere. The joint medical team brings a wounded warrior from the battlefield to an operating room within an unprecedented 20 to 40 minutes! That rapid transfer enables our medics to achieve a less than 10 percent died-of-wounds rate, the best survival rate ever seen in war. Our aeromedical evacuation system (AE) and critical care air transport teams (CCATT) are world class. We mobilize specially trained flight crews and medical teams on a moment's notice to transport our most critical patients across oceans. Since November 2001, we have transported more than 69,000 patients from Afghanistan and Iraq. We don't rest on our laurels. Among the innovations we have implemented recently from battlefield lessons learned is a device that provides spinal immobilization for AE patients. This device maximizes patient comfort and reduces skin pressure. We are also working towards an improved detection mechanism for compartment syndrome in trauma patients. The early detection and the prevention of excess compartment pressure could eliminate irreversible tissue damage for those patients. In February 2010, a joint Air Force and Army team will begin testing packages that will improve ventilation, oxygen, fluid resuscitation, physiological monitoring, hemodynamic monitoring and intervention, and flexible power utilization in critical care air transport. Provide patient-centered health care We are committed to bringing the same high level of trust we've earned in combat to our patients at home through patient-centered care. Our focus is to enhance the health of all our patients with the introduction of our Family Health Initiative (FHI). This initiative mirrors the American Academy of Family Physicians' "Patient Centered Medical Home" concept and is built on care provided by a dedicated team of professionals. The goal of this partnership between our patients and their health care teams is to increase prevention efforts and achieve better health outcomes. Our providers are given full clinical oversight of their care teams and expected to practice to the full scope of their training. We believe the results will be high quality care and improved professional satisfaction. Two of our initial bases Edwards AFB, Calif., and Ellsworth AFB, South Dakota, have dramatically improved their national standings in cost containment, patient satisfaction, access to care and quality of care. Eleven other bases are now organized to implement the FHI for their beneficiaries. In 2010, we will expand to 20 additional sites. We are particularly encouraged by the results of our patient continuity data for our FHI. Previous metrics showed that our patients only saw their assigned provider approximately 50 percent of the time. At Edwards and Ellsworth, provider continuity is now in the 80-90 percent range. We still have work to do, such as developing improved decision support tools, case management support, and revising our FHI training. The challenge of implementing change of this size and scope requires broad commitment. The AF Medical Service has that commitment and we are confident the FHI will deliver exceptional care in the years ahead. Patient safety is central to everything we do. By learning from mistakes and sharing information, we continually strive to enhance the quality of our care. Through alerts and advisories, we share our clinical lessons learned with the DoD Patient Safety Center and sister Services. We integrate clinical scenarios and lessons learned into our simulation training, and we securely share de-identified patient safety information across the Services through DoD's web-based Patient Safety Learning Center. To optimize our care, we also build on strong academic partnerships with St Louis University, Wright State University (Ohio); University of Maryland; University of Mississippi; University of Nebraska-Lincoln; University of California-Davis and University of Texas-San Antonio, among others. Our long history of collaborating with the VA enhances clinical currency for our providers, saves valuable resources, and provides a more seamless transition for our Airmen as they move from active duty to veteran status. The Air Force currently has five joint ventures with the VA, including the most recent at Keesler AFB, Miss. Additional efforts are underway for Buckley AFB, Colo., to share space with the Denver VAMC, which is now under construction. Safeguard the mental health of our Airmen Trusted care for our patients includes safeguarding their mental health and well-being. To do this, we are engaged in a number of initiatives to improve and optimize mental health access and support. In addition to constantly looking for ways to improve our existing training material such as the "Leaders Guide for Managing Personnel in Distress," "Community Suicide and Violence Awareness Briefings" and "Landing Gear Program," we are partnering with the Air Force personnel and logistics communities to develop a comprehensive Airman resiliency program that will provide services for targeted high-risk groups. We provide basic resiliency training, psychological screening and support for all deploying Airmen. Additionally, Airmen at higher risk for post traumatic stress are closely screened and monitored for psychological concerns post-deployment. We recently unveiled "Defenders Edge," which is tailored to security forces Airmen who conduct missions in or outside the wire. This is intended to improve Airmen mental resiliency to combat-related stressors. Unlike conventional techniques, which adopt a one-on-one approach focusing on emotional vulnerability, "DEFED" brings the mental health professional into the group environment, assimilating them into the security forces culture. Increase focus on recruiting and retention initiatives To gain and hold the trust of our patients, we must always have highly trained and qualified providers. To have those high quality providers in the future, we have numerous efforts underway to improve recruiting and retention. We've changed our marketing efforts to better target recruits, such as providing Corps-specific DVDs to recruiters. The Health Profession Scholarship Program remains vital to attracting doctors and dentists, accounting for 75 percent of these two Corps' accessions. The AF International Health Specialist program is another successful program, providing AFMS personnel with opportunities to leverage their foreign language and cultural knowledge to effectively execute and lead global health engagements. For our enlisted personnel, targeted Selective Reenlistment Bonuses, combined with continued emphasis on quality of life, generous benefits, and job satisfaction have positively impacted enlisted recruiting and retention efforts. Strengthen GME and officer/enlisted training We are working to further develop AFMS personnel in a manner that fosters excellence in clinical, operational and joint roles. We are increasing opportunities for advanced education in general dentistry and establishing a more formalized, tiered approach to Medical Corps faculty development. Senior enlisted collaboration in the National Capital Region and the San Antonio Military Medical Center (SAMMC) is fostering tri-Service collaboration, enlightening the Services to each others' capabilities and qualifications, and establishing opportunities to develop and hone readiness skills. Our Centers for the Sustainment of Trauma and Readiness Skills at St. Louis University, University of Maryland-Baltimore Shock Trauma and University of Cincinnati College of Medicine remain important and evolving training platforms for our doctors, nurses and medical technicians preparing to deploy. We recently expanded our St. Louis University training to include pediatric trauma. This training came about because, tragically, our medics while deployed treat hundreds of children due to war-related violence. Rebuild our hospitals Our patients appropriately expect our AFMS facilities and equipment will be state-of-the art and our medical teams clinically current. They trust that we will give them the best care possible. We are engaged in an extensive modernization of Wright-Patterson Air Force Base Medical Center in Ohio with particular focus on surgical care and mental health services. We are continuing our investment in a state-of-the-art new medical campus for SAMMC at Lackland AFB, Texas. Our ambulatory care center at Andrews AFB, Md., will provide a key capability for the delivery of world-class health care in the National Capital Region's multi-service market. In addition to upgrading our medical facilities, we are also rebuilding our capabilities to give our patients more choice and increase provider satisfaction with a more complex case load. In our larger facilities, we have launched a Surgical Optimization Initiative, which includes process improvement evaluations to improve operating room efficiency, enhance surgical teamwork, and eliminate waste and redundancy. This initiative resulted in a 30 percent increase in operative cases at Elmendorf AFB, Alaska, and 118 percent increase in neurosurgery at Travis AFB, Calif. By increasing the volume, complexity and diversity of care provided in AF hospitals, we make more care available to our patients; and we provide our clinicians with a robust clinical practice that ensures they are prepared for deployed operations, humanitarian assistance, and disaster response. Set clear research requirements Trusted care is not static-we must earn that trust over and over every day. The science of medicine is dynamic and we are always looking toward tomorrow's requirements. We will ensure our patients and warfighters always benefit from the latest medical technologies and clinical advancements. We are looking 5 to 10 years ahead to meet the changing needs of our peacetime beneficiaries. More critically, we look 20 to 30 years ahead to understand evolving technologies, changing weapon systems, and changes in doctrine and tactics to protect our warfighters from future threats. If injury does occur, we will quickly diagnose and effectively provide "cutting edge" treatment to our wounded warriors. Our expanding medical research capabilities across the AFMS are focused on identifying and correcting any capability gaps. Our planning processes ensure solutions are focused on critical AFMS mission needs. Further, deliberate planning approaches are used to maximize our research and development funding. We have a multi-functional team approach to determine our vital interests. We also compete for additional sources of funding and leverage efforts of sister Services or other federal agencies. By understanding gaps, we determine clear research requirements to make proper resource investments. I mentioned earlier a couple of innovations in the Air Evacuation realm, but the breadth of our research extends far beyond that unique clinical environment. Some examples include: · Directed energy force protection, which focuses on detection, diagnosis and treatment of laser threats. · The Virtual Lifestyle Manager (VLM), a web-based prevention program that provides education, training and support to diabetics, and at-risk patients. · Air Force Blue Strategic Plan for Diabetes, geared toward improving diabetes prevention and treatment across DOD. · Autism research, focused on the diagnosis, causes, and treatment of autism, in support of the Family Health Initiative. Conclusion As an enterprise, the AFMS is committed to success across the spectrum of operations. Where appropriate, we are increasing clinical capacity and the scope of our practice. We are strengthening our education and training platforms and are scanning the environment for research and development opportunities. We will continue to enhance our facilities and the quality of our health care delivery to ensure the health and wellness of all entrusted to our care. We will do all this in a patient-centered manner with a focus on patient safety and sound fiscal stewardship. In closing, I share a quote from our Air Force Chief of Staff, Gen. Norton A. Schwartz, who said, "I see evidence every day that the Medical Service is "All In," faithfully executing its mission in the heat of the fight, in direct support of the warfighter, and of families back home as well." "All in" is the right place to be. USAF. (U.S. Air Force Graphic by Rosario "Charo" Gutierrez) Photo Details / Download Hi-Res USAF. (U.S. Air Force Graphic by Rosario "Charo" Gutierrez)