This, 11 March, US Navy Vice Admiral C. Forrest Faison, III, Surgeon General, Chief, Bureau of Medicine and Surgery responded to a wide range of questions from Halldale Group Editor Marty Kauchak. The Navy medical community leader’s insights are provided below.
Medical Training Magazine: In your efforts to prepare Navy Medicine for the future fight, update us on how the community is optimizing learning (training and education).
Vice Admiral C. Forrest Faison (VAF): There are enormous possibilities for the future of military medicine. We have maintained unprecedented survival rates during the conflicts in Iraq and Afghanistan. As we look ahead, our main focus will be to prepare for future conflicts to sustain high combat survival while also keeping our forces healthy and on the job. This requires us to look at new ways of providing health care.
The last conflict was fought largely on land, where the United States had significant control over the battlefield and access to massive logistics support. In military medicine, that has translated to rapid recovery and evacuation of injured personnel during the golden hour, when trauma patients are stabilized and airlifted to the next level of care.
We will ensure our health care professionals have the skills and mindset necessary to provide unparalleled combat care to our men and women of the Navy and Marine Corps in what may be very different circumstances in the future.
Navy Medicine recently implemented a new trauma training curriculum to improve the knowledge, skills, abilities and utilization of hospital corpsmen in 2017 and 2018.
We established a new training partnership between Navy Medicine, the Capt. James A. Lovell Federal Health Care Center (Lovell FHCC), and John H. Stroger Jr. Hospital of Cook County, a Level 1 trauma center in Chicago, Illinois, referred to as “Cook County.”
We have completed three iterations of this training program, which have proven to be largely successful, and are exploring other partnerships around the country.
MTM: A first follow up, highlight how learning for Navy medical health care providers may evolve in the next five or so years.
VAF: In the multi-domain battle, patient survivability is highly dependent on minimizing the time from point of injury to receiving damage control resuscitation and damage control surgery (DCR/DCS). Analysis and real-world demand identified gaps in this capability, especially in the maritime domain.
The next warfighting environment may involve a near peer competitor in a maritime battle that requires our corpsmen to stabilize and care for wounded Sailors for extended periods of time before medically evacuating them to a higher level of care.
Trauma injuries in a maritime environment will be different compared to what we have seen on the battlefield. Injury extent and severity, as well as the numbers of injured personnel in a short period of time will also be very different. For example, rapid medical evacuation may be challenged. We are taking this opportunity of unprecedented change to shift our focus back to readiness and fleet operational support.
As another example, the Role Two Light Maneuver concept is one of the solutions, along with en-route care and other capabilities being developed to mitigate identified gaps. Navy Medicine is proposing a formal program of record for these capabilities. New challenges require new concepts and Navy Medicine is working to implement new solutions to ensure the highest combat survival possible in the next conflict.
MTM: Another follow up, tell us the role simulation and training technologies (simulations, serious games, simulators, others) will have in Navy medicine's learning programs.
VAF: Navy Medicine is modernizing the way training is delivered as it shifts to prepare for a very different future and different conflicts. Individual and team clinical skills are introduced, solidified, refreshed and tested on medical simulators of varying styles and realism. Task-specific training devices allow practice of procedural skills from intravenous line insertion to robotic surgery.
Augmented and virtual-reality are being introduced into medical training to speed acquisition of knowledge and provide shipboard experiences to trainees on land. Computerized medical training is also available for procedural purposes and practicing small-team dynamics.
Traditional computer-based training is moving into the hands of medical personnel on their own mobile devices. In the near-term future, virtual medical exercises will be possible with participants at different locations who can play their role in real-time or asynchronously in a limitless variety of command, control and coordination scenarios. Likewise, artificial intelligence engines have the potential to personalize training to the task level. It also has the ability to optimize the blend and frequency of training as individuals maintain proficiency with the knowledge, skills, and abilities they need to save lives.
With the explosive growth in virtual and gaming technologies, training modalities unimagined just a few years ago are being evaluated and incorporated into Navy medical training in the coming years to deliver effective training to a new generation of Sailors in a way that is relevant to the manner in which they learn.
MTM: Your "help wanted" list: how can the simulation and training industry and academia, address some of the learning requirements emerging on your service's horizon.
VAF: Last year, I visited Case Western University and learned about technology that allows providers to manipulate a virtual cadaver. I found that incredibly interesting and innovative. Medical knowledge is doubling every couple of months. Keeping up with clinical practices and maintaining medical knowledge for every member of the Navy Medicine team will be a top priority when seeking new partnerships in industry and academia. Every Sailor, Marine, and their family for whom we are privileged to care is depending on us to ensure every member of our team is ready.
MTM: Update us on Navy medicine's efforts to improve patient safety and Access.
VAF: Patient safety and access are a priority for Navy Medicine.
Since September 2017, “Connected Corpsmen in the Community,” a Navy Medicine initiative, has allowed active duty service members on an installation to be seen by their corpsmen, with remote guidance from a provider, outside of the hospital or clinic and beyond normal working hours to assess the impact on convenience and access to care and with minimal impact to their training or work schedule. This has been accomplished by having corpsmen work at the highest level of their training, appropriate for their operational platform.
The initiative also provides Navy corpsmen, with additional training experience while assigned to shore-based facilities, keeping their skills proficient and ready for operational assignments. Corpsmen provide care for low risk medical needs at an independent location with full tele-health connectivity and communication with a medical provider at all times.
In addition, I would argue that MHS Genesis is helping us maintain patient safety in that it helps us respond to an increasing demand for access, availability, entry and portability of health information across the spectrum of military operations while providing clinical guidance to standardize healthcare delivery to best practices worldwide.
MHS Genesis is a modernized and interoperable electronic health record system that will be implemented across the Military Health System.
Navy Medicine’s embedded mental health initiative is another example of care being brought to the service member. Navy Medicine has found that embedding mental health providers directly into Navy and Marine Corps operational units has had a powerful effect on decreasing stigma and making care more accessible to our Sailors and Marines. We currently have 25% of our mental health personnel embedded with the Fleet and Fleet Marine Force and are working to grow that number.
MTM: Tell us how Navy medicine will expand its collaboration with US private sector medical institutions in terms of training, preparation for mass casualties during natural and man-made disasters and other events.
VAF: This brings me back to our trauma training initiatives. As I mentioned before, we have tested a concept with our corpsmen and partnered with the Capt. James A. Lovell Federal Health Care Center (Lovell FHCC), and John H. Stroger Jr. Hospital of Cook County, a Level 1 trauma center in Chicago, Illinois. The corpsmen studied and practiced in-patient, out-patient clinic and trauma care during the proof-of-concept, which has proven to be mutually beneficial and subsequently an official program of record.
A fourth iteration at FHCC and Stroger is planned for April 2019. HM Trauma Training is also in the planning phase of a partnership with the University of Florida Health Shands (UF Health Shands). A pilot class started Jan. 28, 2019. We are also in exploratory talks for a similar program in Cleveland.
Furthermore, Naval Medical Center Camp Lejeune (NMCCL) has established a partnership with Vidant Medical Center, a level one trauma center. This partnership will afford physicians, nurses and corpsmen increased patient encounters and complexity of cases to sustain clinical skillsets.
MTM: On the topic of collaboration, preview how US military medicine will increasingly become joint, in particular, in terms of training.
VAF: Military medicine by nature has to be a joint effort in order to be successful. The Medical Education & Training Campus (METC) is the primary entry point for Navy, Air Force and Army enlisted medical trainees. METC offers more than a dozen consolidated courses aimed at educating and training all three branches of medical trainees together. For example, the computer based medical systems course, telemedicine systems course and ultrasound imaging systems course are all joint curriculums. METC courses and curriculums are expected to expand as the medical field advances.
MTM: And finally, anything else to add?
VAF: Military medicine, including Navy Medicine, is undergoing some of the most significant changes we have seen in several decades. From changes mandated by Congress, to Department of Defense-directed reforms, we have an opportunity to successfully navigate these changes and create an improved Navy Medicine to support our Navy and Marine Corps. In doing so, our focus will be on three major areas: the next fight, a renewed emphasis on readiness, and our new organization. In navigating these opportunities, we are ever-mindful of those for whom we are privileged to care for and who sacrifice and serve to defend us.
Originally published in Issue 2, 2019 of MT Magazine.