Home » 2013
Yearly Archives: 2013
By Donna Miles
American Forces Press Service
WASHINGTON, Nov. 18, 2013 – Traveling around the combat theater over the past four months, Army Lt. Col. (Dr.) James Geracci was on a quest.
Like his contemporaries in military medicine, Geracci, a family physician and operational medicine specialist, is thrilled about advances over the past 12 years of conflict that have elevated casualty care to a whole new level.
Every soldier, Marine, airman and sailor on the ground is now trained as a medical first responder in basic lifesaving skills. Medical evacuation response times have dropped dramatically, and the system now moves casualties through progressive levels of care faster than ever imagined possible. Advanced lifesaving techniques are applied throughout the continuum of trauma care, reducing blood loss, controlling brain swelling, salvaging limbs and saving lives.
But the military trauma community sees its glass as half empty rather than half full. Instead of celebrating the advances that enable 98 percent of U.S. combat casualties that reach an advanced treatment facility to survive, they’re focused on improving the odds for those who don’t.
So as Geracci recently traveled around the combat theater, he went directly to the front-line commanders and combat medics he and his fellow medical professionals believe hold the key. All were familiar with new reporting and documentation procedures that require them to document the care they provide at the point of injury and as casualties are evacuated to advanced-level care.
But what Geracci quickly realized hadn’t trickled down through the chain of command was the “So what?” So he and his team took that message directly to more than 1,400 medics assigned to small combat outposts and forward operating bases across Afghanistan, as well as to their nonmedical commanders and noncommissioned officers.
“We looked them in the eye and said, ‘This is why this is important,'” Geracci said. “We tried to explain that although this is an enterprise-level initiative, it has to start at the ground level. And as we talked to them, it was amazing. A light bulb suddenly went on.”
Air Force Col. (Dr.) Mark Mavity, the U.S. Central Command surgeon, calls that recognition one of the most significant new developments in casualty care for troops in Afghanistan.
The Department of Defense Trauma Registry, established in 2005 as the Joint Theater Trauma Registry, offers detailed information about every trauma patient treated at an advanced theater facility. It tracks patients from the moment of arrival at the closest field hospital or other facility, through each movement to more advanced levels of care, and ultimately through rehabilitation.
The registry also includes autopsy results from every casualty who died.
Eight years since its introduction, the registry has become the world’s largest combat casualty care databank. By studying it, medical professionals have been able to verify which treatments were the most successful and which weren’t, and to flag areas where new or different procedures or technologies might improve survival rates and patient outcomes.
“This gave us an opportunity to step back and understand the population of patients that have moved through the continuum of care and to try to derive information about the care they received and the outcomes associated with that care,” said Air Force Col. (Dr.) Jeffrey Bailey, the Joint Trauma System director. “By being able to analyze and evaluate our practices, we have found points where we can make improvements that provide a survival advantage or some other advantage to our casualties.”
Lessons learned through the registry have resulted in “best evidence-based best practices,” he said, propelling many of the advances in caring for casualties and preventing them in the first place.
The formal documentation of injury patterns, for example, led to improvements in personal protective equipment ranging from protective ballistic undergarments to ancillary plating that protects the groin, shoulders and neck.
The registry also provided statistical evidence of the importance of immediate intervention during the so-called “golden hour.” That led then-Defense Secretary Robert M. Gates to institute a policy in 2009 reducing the timetable for medical evacuation to 60 minutes.
Data provided by the registry also validated the use of tourniquets and led to new approaches to transfusions, resuscitation procedures and hemorrhage control.
But trauma surgeons recognized a glaring weakness in the registry. Because it was based on care delivered at treatment facilities, it omitted critical information about the care provided before the patient ever got there. That “prehospital environment” was where most combat deaths occurred. “So that is where we saw the greatest opportunity to make improvements,” Bailey said.
“Some people call helicopter evacuation the ‘golden hour,’ but others have described what happens on the ground as the ‘platinum 10 minutes,'” he said. “It became clear that we needed to understand what was going on on the ground during those platinum 10 minutes before the helicopter showed up.”
That led to the stand-up of the Pre-Hospital Trauma Registry initiative earlier this year.
Army Col. (Dr.) Russ Kotwal, a family and aerospace medicine specialist assigned to the Joint Trauma System at Fort Sam Houston, Texas, was a pioneer in championing this concept. Working for more than a decade with the special operations community, much of it with the 75th Ranger Regiment, he formulated a precursor to the militarywide prehospital registry in the late 1990s.
“I saw a huge gap,” he said, lacking any documentation of patient care at the initial point of injury and on evacuation platforms.
But getting those who provided that initial care to take time out to annotate exactly what they were doing was no easy task, he acknowledged. “A lot of people find it more exciting to provide the care than to actually document the care,” Kotwal said. “Some don’t understand the big picture and how crucial it is to capture what you are doing for historical purposes, but also for performance improvement.”
So Kotwal made it his personal mission to change that. “I convinced the line command that if everybody has the potential to be a casualty on the battlefield, especially in a line unit, everybody has the potential to also be a first responder,” he said. “And if you don’t capture that information about what you are doing, that data, it is hard to effect performance improvement in that realm.”
Knowing that the success of his effort would depend on the first responders, Kotwal made the documentation process as simple and straightforward as possible. He and his senior medics changed an outdated field medical card that was standard at the time to one that focused solely on tactical combat casualty care.
Every 75th Ranger Regiment member was issued a card as part of their basic equipment, and required to keep it in a standardized location on their uniform. That way, first responders knew exactly where to look for the card if they had to report the care they provided a comrade.
“They filled it out as they provided care if they could,” Kotwal said. Sometimes they were overwhelmed with providing care or the evacuation process was so quick that they couldn’t immediately get to it, he said. “But they did it at the first opportunity,” he added.
As a double-check to ensure the reporting wasn’t overlooked, Kotwal also got the requirement integrated into the after-action review process. “This is something line guys do very well. Every time they come off a mission, they go directly into an AAR and do reports based on the mission so they can assess it and make improvements,” he said.
“The medical community didn’t do it at that level,” Kotwal said. “So we instituted a [medical] AAR that had to be done within 72 hours after a mission.”
Through this process, the 75th Ranger Regiment developed a rudimentary pre-hospital trauma registry, refined it over time and expanded across the special operations community, Kotwal reported.
Kotwal later joined the Joint Trauma System team to expand this concept to conventional forces.
Geracci, a former division surgeon in Afghanistan, said he, too, was “excited about the advancements taking place in facilities-based care,” many attributable to the Joint Trauma System and its trauma registry.
“But I was also frustrated that we hadn’t been able to apply the same degree of rigor in the prehospital environment,” he said. “I saw this as a blind spot in the JTS process. So my goal was to help [the military medical community] go after that blind spot.”
Geracci said he “jumped” at the chance to be one of the Centcom Joint Theater Trauma System’s first pre-hospital directors in the combat theater to address the gap.
“We’re building on the work already proven for about a decade on the special operations side and taking those exact same principles and importing them into the [combat] theater,” he said.
Just months after the Pre-Hospital Trauma Registry was introduced, Geracci said, he’s already seeing its rewards. We have already seen tangible benefits from putting that in place,” he said. “This is proving to be an incredibly valuable tool.”
He credited combat medics and their commanders on the ground who are putting that tool to work as they complete casualty-care cards and AARs.
“They are the reason we have seen success in such a short period of time,” Geracci said. “They understand that this information, and the data they produce, provides better care not only for their comrades, but for anyone who passes through the different levels in the continuum of care.”
(Follow Donna Miles on Twitter: @MilesAFPS)
- The Injury Burden of Recent Combat Operations: Mortality, Morbidity, and Return to Service of U.K. Naval Service Personnel Following Combat Trauma (hispanicbusiness.com)
- Battlefield Surgeons Add Data to Trauma Kit (enterprisetech.com)
- Centcom Strives to Preserve, Share Combat Trauma Lessons (defense.gov)
WHITE BEACH NAVAL FACILITY, Okinawa, Nov. 17, 2013 – Approximately 900 Marines and sailors of the 31st Marine Expeditionary Unit, part of the 3rd Marine Expeditionary Brigade, aboard the USS Germantown and USS Ashland dock landing ships are heading for the Philippines to join U.S. and Philippine forces in support of ongoing humanitarian assistance and disaster relief efforts as part of Operation Damayan, which means “lend a helping hand” in Filipino.
“Our condolences are with the people of the Philippines, who have
experienced incredible loss as a result this horrific disaster,” said
Marine Corps Col. John Merna, the 31st MEU’s commanding officer. “The
Marines and sailors of the 31st MEU, along with our counterparts of
Amphibious Squadron 11, have trained extensively for these types of
missions. By working with the (armed forces of the Philippines) during
recent exercises, we have built lasting relationships that will better
help us to ease the suffering of our Filipino friends.”
The 31st MEU recently completed a regularly scheduled patrol of the
Asia-Pacific region and was in the midst of unit turnover when the order
was received to support Operation Damayan.
Marines from the 3rd MEB, along with supplies and equipment, have
already been sent to the affected region with more expected to follow in
the coming days.
It has been reported that Typhoon Haiyan has impacted nearly 7
million Filipinos. The storm has destroyed 150,000 homes across the 41
provinces in the Philippines.
President Barack Obama pledged
U.S. support to the Philippines on Nov. 14. At that time, he noted, one
of the United States’ core principles “is when friends are in trouble,
While the scope of the disaster
is still being assessed, the duration and extent of the 31st MEU’s
operations will depend on requests from the government of the
Philippines and the priorities of the U.S. Agency for International
“The Marine Corps as a whole,
and the 31st MEU in particular, has had a long-standing relationship
with the people of the Philippines,” Merna said. “It’s an important
mission anytime we do something like this, but when it’s a close friend
and ally, it makes it that much more serious for us and we’ll stay as
long as we’re asked to.”
In October 2012, the 31st MEU
trained in various locations in the Philippines with that country’s
military during Amphibious Landing Exercise 2012, a bilateral training
event designed to enhance interoperability and response during missions
such as this.
The 31st MEU and its partner,
the U.S. Navy’s Amphibious Squadron 2, have responded to four
humanitarian assistance disaster relief situations during the last five
years. The Marines and sailors have a robust air, ground, and maritime
transportation capability, as well as medical and dental health
services, distribution services, and engineering assets ready to provide
The 31st MEU includes more than
2,200 Marines and sailors and is comprised of four elements: the Command
Element; Battalion Landing Team 2nd Battalion, 5th Marines; Marine
Medium Tiltrotor Squadron 265; and the Marines’ Combat Logistics
The 31st MEU provides a
forward-deployed, flexible, sea-based force capable of conducting
amphibious operations, crisis response and limited contingency
operations in the Asia-Pacific region. The 31st MEU is the only
continually forward-deployed MEU and it remains the Marine Corps’
force-in-readiness in the Asia-Pacific.
- Continual maintenance ensures continual readiness (dvidshub.net)
- US sending additional military to aid in Philippines typhoon relief (stripes.com)
- Opinion: U.S. Amphibious Forces Are Key to Nation’s Security (news.usni.org)
- Military Airlifts Supplies, Displaced People In Philippines (albanytribune.com)
- Navy to Send Two Amphibious Ships to the Philippines (jcsmarinenews.wordpress.com)
At 12:05 p.m. PDT the MQ-8C Fire Scout took off and flew for seven minutes in restricted airspace to validate the autonomous control systems. The second flight that took off at 2:39 p.m. was also flown in a pattern around the airfield, reaching an altitude of 500 feet.
The MQ-8C is a larger air vehicle, has a range of 150 nautical miles and a payload capacity of more than 700 pounds.
“It is a big accomplishment for the integrated government and industry team to fly this air vehicle for the first time,” said Capt. Patrick Smith, Fire Scout program manager at Patuxent River, Md. “MQ-8C will require fewer aircraft [than the MQ-8B] to operate at maximum performance and will meet the U.S. Africa and Special Operation Commands urgent needs requirement.”
The MQ-8Cs will conduct initial shipboard testing on Guided Missile Destroyers (DDG)-class ships but the program is looking into supporting Littoral Combat Ship (LCS) missions. The Navy will continue to use the MQ-8B as it phases in the MQ-8C. Lessons learned from MQ-8B have been applied to MQ-8C variant, Smith said.
Initial operating capability for the MQ-8C is planned for 2016, with a potential for early deployment in 2014.
- Bigger And Better: MQ-8C Takes To The Skies (xbradtc.com)
- Better Security Measures Are Needed Before Drones Roam the U.S. Airspace (preview) (scientificamerican.com)
- Drone helicopter made for Navy closer to inaugural flight (stripes.com)
- Fire Scout Begins Ground Testing (defense-update.com)
FEMA Releases the National Incident Management System (NIMS) Intelligence/Investigations Function Guidance and Field Operations Guide
The NIMS Intelligence/Investigations Function Guidance and Field Operations Guide provides guidance on utilizing and integrating the Intelligence/Investigations Function while adhering to the concepts and principles of the NIMS doctrine. The document includes information and tools intended for the Incident Command System practitioner that will assist in the decision-making process regarding the placement and implementation of the Intelligence/Investigations Function within the command structure. This document can be used by jurisdictions and agencies for planned events, incidents, and the development of emergency planning efforts. This guidance does not replace emergency operations plans, laws, regulations, or ordinances.
The NIMS Intelligence/Investigations Function Guidance and Field Operations Guide has involved stakeholder input from 34 agencies across multiple communities of practice to include the three fields most affected by the implementation of the function: law enforcement, medical, and the fire service. The Intelligence/Investigations Function has aspects that cross disciplines, including traditional law enforcement, epidemiological investigations, regulatory investigations, and medical examiner/coroner investigations, as well as those conducted by the National Transportation Safety Board or other investigatory agencies.
The NIMS Intelligence/Investigations Function Guidance and Field Operations Guide can be found at the following website: http://www.fema.gov/related-guides-annexes-and-documents.
This guidance aligns with the NIMS to provide a common and standard understanding about the tools and resources needed to sustain, build, and deliver the core capabilities necessary to achieve a secure and resilient nation. For more information on the NIMS and its implementation, visit FEMA’s NIMS website.
This effort is part of the National Preparedness System, a process that organizes the tools and resources needed to promote unity of effort and achieve the National Preparedness Goal. For more information on national preparedness efforts, visit FEMA’s National Preparedness website.
By David Vergun
Army News Service
WASHINGTON, Oct. 18, 2013 –
U.S. Special Operations Command wants its operators to be protected
with what it informally calls an “Iron Man suit,” named after the
In September, Socom announced it is seeking proposals for prototypes of the Tactical Assault Light Operator Suit, or TALOS.
The goal of TALOS is to
provide ballistic protection to Special Operations Forces, along with
fire-retardant capability, said Michel Fieldson, TALOS lead for Socom.
“We sometimes refer to it
as the ‘Iron Man’ suit, frankly, to attract the attention, imagination
and excitement of industry and academia,” Fieldson said. “We’re hoping
to take products we’re developing in several technology areas and
integrating them into a consolidated suit to provide more protection for
the [special operations forces].”
Other technologies include sensors, communications, energy and
material that can store and release energy to prevent injuries and
Materials that can store and release energy might be similar to the
Intrepid Dynamic Exoskeletal Orthosis, now used by some wounded warriors
for lower-leg injuries. So TALOS could benefit wounded warriors too,
The Homeland Security Department and firefighters have expressed an
interest in this technology as well, he said, and it eventually might
become available for other service members.
“Our goal right now is to try to get the word out and bring industry
partners together,” Fieldson said. The technologies that will go into
the suit’s development are varied, he said, so it is unlikely one
contractor would be able to specialize in the entire ensemble.
The traditional approach, Fieldson said, was to pick a prime
contractor, usually a traditional defense partner, give them the design
requirements and let them come up with the solution. That would take a
long time, he noted.
“In this case, the government will be the lead integrator, and we’ll
look to work with traditional or nontraditional partners in industry and
academia who are innovative,” he said. “We’ll leave no stone unturned.”
The goal, he said, is to begin integrating capabilities over the next
12 months and have the first suit ready for full field testing in four
to five years.
Fieldson thinks TALOS will become a reality because it protects the
warfighters and has the backing of Socom’s commander, Navy Adm. William
“I’m very committed to this,” McRaven said to industry
representatives at a July 8 TALOS demonstration in Tampa, Fla. “I’d like
that last operator that we lost to be the last one we ever lose in this
fight or the fight of the future, and I think we can get there.
“I’m committed to this,” he
continued. “At the end of the day, I need you and industry to figure
out how you are going to partner with each other to do something that’s
right for America.”
- TALOS: Army working on real-life ‘Iron Man’ suit for soldiers (VIDEO) (baltimorenewsjournal.com)
- TALOS is the Army’s plan to create an Iron Man suit (washingtonpost.com)
Texas’ Largest Law Enforcement Organizations Form Powerful Alliance to Protect Working Officers and Their Families
- Texas Law Trumps NFL Policy Prohibiting Armed Off Duty Officers In Stadiums (dfw.cbslocal.com)
- Popeye Holmes remembered as one of the longest serving law enforcement officers in Texas during funeral (kfdm.com)
- Law Enforcement Officers Back Push for More Preschool Funding (kcrg.com)
- State law enforcement officers join forces to help with firearm purchase applications (baltimorenewsjournal.com)
By Army Sgt. 1st Class Tyrone C. Marshall Jr.
American Forces Press Service
WASHINGTON, Oct. 6, 2013 – The Defense Department‘s top financial official provided details on which DOD civilians would and wouldn’t be able to return from furlough following Defense Secretary Chuck Hagel‘s determination some could return under the Pay Our Military Act.
Robert F. Hale, DOD comptroller and chief financial officer, first and foremost, emphasized that the defense secretary values all DOD employees and views their jobs as critical, even though some will be unable to return immediately, and described it as a “painful” decision.
“They do essential and important work, and I want to underscore that, but it is less directly related to military [support],” Hale said.
In a couple of cases, he noted, certain areas simply were not covered by POMA, which was signed into law on Sept. 30.
Hale said areas here included chief information officer functions, but not Internet protocol and cyber functions; legislative and public affairs functions, but not internal public affairs communications; deputy chief management office functions at the Office of the Secretary of Defense and component levels, and auditors and related functions.
This list also included, according to a Defense Department new release, work done in support of non-DOD activities and agencies except the Coast Guard, and civil works functions of the Department of the Army.
“Let me say again that those on this list that we’re not going to recall from furlough do critical functions,” Hale said. “What they do is important, but because of the letter of the law, and the advice from the Department of Justice, we had to identify those with less direct impact on military members.”
Hale explained how the Defense Department came to the determination they could bring some DOD civilians back.
“When we got POMA … we immediately began working with the Department of Justice on how to implement it,” he said. “The [Department of Justice] expressed the opinion that the law does not permit a blanket recall of all DOD civilians.”
The Department of Justice did say that we can undertake a careful review of civilians who support members of the armed forces and determine who to recall,” Hale added. “Needless to say, it has been a difficult process and time consuming one, but we now have … guidance, which the secretary issued in his determination today.”
Hale said under DOD’s current reading of the law, the standard for civilians who provide support to members of the armed forces requires that qualifying civilians focus on the morale, well-being, capabilities and readiness of military members that occurs during a lapse of appropriations.
With this in mind, he said, DOD established categories of civilians beginning with some excepted civilians who already are working to ensure military operations of safety, lives and property.”
“They’ll be working now, and under POMA, we can pay them in a timely manner their Oct. 11 pay will be on time and in full,” Hale stated.
The Pentagon comptroller highlighted two categories of DOD civilians that, under POMA, the Defense Department will recall, and he noted the act ensures the military will be paid on a timely basis “next payday, Oct. 15, and future ones.”
“We’ll recall a category of civilians who provide ongoing support to military members,” he said, such as health care activities and providers, sexual assault prevention and response providers, behavior health and suicide prevention, transition assistance programs for military members in active service, commissary and payroll operations and family support programs and activities, among others.
“We’ll also recall a second category of civilians whose work, if interrupted by the lapse for a substantial period, would cause future problems for military members,” Hale said.
Falling into this category, he said, are acquisition program oversight, contract logistics, financial management, intelligence functions and supply chain management.
Hale said it also appears an act approving retroactive pay will be approved soon, because while Senate approval is pending, “the House passed it 407-0 and the president has said he would sign it.”
“If this act is passed, everyone, even if they remain on furlough, will eventually be paid,” he said. “Those who remain on furlough will not be paid until we have an appropriation.”
Hale also offered a “final note of caution” stating DOD can recall “most of our civilians and provide pay and allowances,” but doesn’t have the authorities to enter into obligations for supplies, parts, fuels, and such unless they are for excepted activities tied to “safety to a military operation or safety of life and property.”
“So as our people come back to work, they’ll need to be careful that they do not order supplies [or] material for non-excepted activities,” he said.
Hale said the military services will be responsible for identifying those they will recall, and believes it will leave no more than “a few tens of thousands who will remain on furlough,” if not less than that.
“I hope we can get a substantial number back by Monday, we’ve got to give the services time enough to identify and notify those that will come back,” he said.
Unfortunately, Hale said, the law doesn’t cover other departments of government, only “DOD employees and those employees of the Department of Homeland Security that support the Coast Guard.”
“I think this underscores the point that although this is very important and we’re glad we’re getting most of our employees back, we haven’t solved all the problems associated with the lapse of appropriations by any means,” he said.
“And we still very much hope that Congress will act quickly to end this government shutdown and this lapse of appropriations,” Hale said.
- Statement by Secretary Hagel on the Pay Our Military Act (onguard4america.wordpress.com)
- Pentagon: Most Furloughed Civilians Ordered Back – ABC News (abcnews.go.com)