Military medical professionals have to always be ready for war and for whatever contingency the future brings. They need to either improve or remain current in medical skills necessary for any future battlefield, with its host of wounds and injuries, and for humanitarian assistance or disaster relief missions.
To meet this challenge, the Air Force Medical Service (AFMS) has developed the Sustained Medical and Readiness Trained (SMART) program, a centrally-supported process for commanders at Medical Treatment Facilities (MTFs) to ensure their staffs remain clinically and readiness current. Key to the program is optimizing internal capabilities and using other close-by medical facilities and schools so that personnel can have clinical experiences based on a standardized curriculum developed for their particular Air Force Specialty Codes (AFSC) on a regular basis.
“There are multiple factors impacting currency sustainment,” said Colonel Janet Robinson, the Chief of the AFMS Modernization Division, at Wright-Patterson Air Force Base, Ohio. “We’re drawing down from wars and decreasing the number of in-patient facilities across the AFMS in a challenging fiscal environment.”
SMART is a mechanism to help Air Force medical personnel maintain proficiency in their particular medical specialty. Clinical currency is the foundation for medical readiness skills, regardless of the particular specialty area. Advanced medical readiness training, such as the Center for the Sustainment of Trauma and Readiness Skills (C-STARS), builds even further on that foundation.
Robinson’s job is to make sure SMART provides an avenue to help doctors, nurses, and technicians maintain their clinical abilities for that sudden change from peacetime responsibilities to the urgency of a wartime deployment. “If our medical personnel deploy, they would have to know how to do things they may not have had much opportunity to do at their home station outpatient clinic,” explained Robinson, “such as running a ward or intensive care unit or managing complex surgical patients.”
The key to the curriculum’s efficiency is a three-tiered concept, making use of as many capabilities as possible to keep medical staffs current.
- Tier 1 utilizes the home Air Force MTFs to provide experience in routine operations and simulation-based training.
- Tier 2 partners with community hospitals, trauma centers, Veteran Affairs hospitals, and other facilities to expose medical staffs to cases they do not see in-house.
- Tier 3 sends staff members to a Regional Currency Site (RCS) to gain clinical experience at a high-volume medical center through a prescribed curriculum . (RCS attendance is a centrally funded, TDY-to-School formal course through the U.S. Air Force School of Aerospace Medicine (USAFSAM))
The tiers are united through a standardized curriculum, ensuring consistency experience for a particular specialty area. Presently 15 AFSCs have approved curriculums through USAFSAM, with expansion as a goal. The SMART program’s greatest challenge is balancing a staff’s training requirements with their facility’s mission needs. “We have to figure out when and where to take a hit, because we’re about readiness and performance, it’s not one or the other.” Both needs have to be balanced.
“There are also locations where providers can’t go to downtown hospitals for currency experiences, such as Europe or Asia,” explained Robinson. “Their laws don’t allow it.” In those cases, the AFMS is finding ways to get the clinical experience prior to the overseas assignment, or decrease their time downrange so they keep their proficiency.
The expansion of the SMART program will help. By partnering with facilities in a local area, treatment facilities can maximize their capabilities by allowing their personnel to rotate regularly and have constant exposure to additional clinical experiences versus sending people on temporary duty for a longer period of time. “Agreements with VA, civilian, or sister services, is the key.” said Robinson.
Standardized training allows medical teams to be prepared for various types of missions. “In a war scenario, there is usually a need for trauma injury management,” said Robinson. “While during a humanitarian mission we’ll often see requests for OBGYN and pediatric support.”
The goal is for SMART to efficiently assist all Air Force medical personnel with their currency as well as readiness skills. “Everyone needs currency,” explained Robinson, “and being clinically current is the basis for being medically ready.”