Navy Medicine Medical Engagement

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Navy Medicine Medical Engagement

RADM Tom Cullison, MC, USNDeputy Surgeon General of the Navy

18 June 2010

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Leadership - OrganizationExecutive Leadership

Surgeon General

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Chief of Naval Operations OPNAV

Navy Medicine National Capital

Area

NHC AnnapolisNNMC BethesdaNHC Patuxent RiverNHC Quantico

Navy MedicineSupport

Command

NMPTE BethesdaNMIMC BethesdaNMLC Fort DetrickNEHC NorfolkNMRC Bethesda

Navy Medicine East

NH BeaufortNH Camp LejeuneNH CharlestonNH Cherry PointNH Corpus ChristiNH Great LakesNH Guantanamo BayNH JacksonvilleUSNH NaplesNHC New EnglandNH PensacolaNMC PortsmouthUSNH RotaUSNH SigonellaEPMU Norfolk

Navy Medicine West

NH BremertonNH Camp PendletonUSNH GuamNHC HawaiiNH LemooreNH Oak HarborUSNH OkinawaNMC San DiegoNH Twenty-nine PalmsUSNH YokosukaEPMU Pearl HarborEPMU San Diego RESEARCH AND DEVELOPMENT

Naval Medical Research Center, Bethesda, MDNaval Health Research Center, San Diego, CANaval Submarine Medical Research Lab, Groton, CTNaval Aerospace Medical Research Lab, Pensacola, FLNaval Health Research Center Environmental Health Effects Lab, Dayton, OHNaval Health Research Center Directed Energy Bioeffects, San Antonio, TXNaval Institute for Dental and Biomedical Research, Great Lakes, ILNavy Medical Research Unit 2, Jakarta, IndonesiaNavy Medical Research Unit 3, Cairo, EgyptNavy Medical Research Center Detachment, Lima, Peru

Fleet Forces Command Surgeon

The Medical Officer of the Marine Corps

POLICY

EXECUTION

Reference: Office of the Navy Surgeon General

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Navy Medical Community

OperationalMedicine

OperationalMedicine

InformationManagement Information

Management

Education & TrainingEducation & Training

Research & DevelopmentResearch & Development

Environmental & Preventive Medicine

Environmental & Preventive Medicine

3 Medical Centers 16 Military Treatment Facilities (hospitals)189 Health Clinics (includes dental facilities)

*Over 29 million square feet

3 Medical Centers 16 Military Treatment Facilities (hospitals)189 Health Clinics (includes dental facilities)

*Over 29 million square feet

2 Hospital Ships2 Hospital Ships 10 Fleet Hospitals 10 Fleet Hospitals


http://www.msc.navy.mil/inventory/pics/comfort.jpg

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Readiness MissionBenefit Mission

Force Health Protection

OperationalFleet and

Fleet MarineForces

Casualty Receiving

and Treatment

Ships and

Medical Battalions

Fleet Hospitals

& EMFs

TRICARENetwork

HospitalsShips

&Soft Power

US OverseasHospitals Hospitals

Navy Medicine’s Dual MissionThe Readiness Health Care Continuum

Navy Medicine


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Marines and Navy MedicineA Special Bond

Photo: Department of the Navy/Department of Defense collection

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Navy Medicine’s Priorities

• Future Force- Readiness• Graduate Health Education • Quality Care/Customer Service • Prevention/Wellness• Medical Research• Patient and Family Centered Care/Value• Casualty Care• Recruitment/Retention• VA Integration• External Communication• Internal Communication

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UNCLASSIFIED//FOUO 7Reference: Office of the Navy Surgeon General

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Patient and Family Centered Care


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Marine Corps Recruit Depot, San Diego, CA

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NM East Military Treatment FacilityNM West Military Treatment FacilityNM NCA Military Treatment FacilityNM Support Command Activity

Fixed Assets Worldwide in support of the Warfighter

Prepared 5 Mar 10

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EMF-KuwaitFDPMU-Kuwait

OEF USMCUS Role 3UK Role 3FDPMU2 x FSE3 x FST

EMF-Djibouti

EMF-GTMO

LRMC

2 x AST

ContinuingPromise

PacificPartnership

OIF USMC

AfricaPartnership

Station

Deployed Forces Providing the Dual Mission of Navy Medicine

Prepared 5 Mar 10

Enduring missions Recurring missions Emergent missions

JTF-Haiti

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As of 7 Dec 09

NUMBERS IN PARENTHESES = BSO 18 REQUIREMENTS

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Average Joint IA Requirements (718)

//// EMF Kuwait (287) //// EMF Kuwait (238) ////

EMF Djibouti (31) //// EMF Djibouti (31) ////EMF Djib (31)

Average USMC HSAP Requirements (426)

LRMC 292 (277 RC / 15 AC) //// LRMC 292 (269 RC / 23 AC)

PP09 USNS R. E. BYRD (26)

EMF GTMO (115) //// EMF GTMO (115) EMF GTMO (115) ////

FDPMU-K (15) //// FDPMU-K (16)

//// INDICATES TRANSITION PERIOD WHERE FORCES DEPLOY/REDEPLOY

UK BAS (43)/CAN KAF (48) ////UK BAS (48)/US KAF (151)

CP09 T-AH USNS COMFORT (358)

CY 09 BSO-18 Support Requirements2009

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Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Average Joint IA Requirements (718)

//// EMF Kuwait (207) //// EMF Kuwait (207) ///

EMF Djibouti (31) //// EMF Djibouti (31) ////EMF Djib (31)

Average USMC HSAP Requirements (426)

LRMC 292 (269 RC/ 23 AC) //// LRMC 292 (274 RC / 18 AC)

PP10 T-AH USNS MERCY (398)

EMF GTMO (115) //// EMF GTMO (115) EMF GTMO (115) ////

///// FDPMU-K (15) /// FDPMU-K (16)

//// INDICATES TRANSITION PERIOD WHERE FORCES DEPLOY/REDEPLOY

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As of 7 Dec 09

///// UK BAS (43)/US KAF (151) //// UK BAS (48)/US KAF (151)

NUMBERS IN PARENTHESES = BSO 18 REQUIREMENTS

CP10 USS WASP (66)

CY 10 BSO-18 Support Requirements2010

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0

500

1000

1500

2000

2500

3000

3500

4000

4500

1Q F

Y03

3Q F

Y03

1Q F

Y04

3Q F

Y04

1Q F

Y05

3Q F

Y05

1Q F

Y06

3Q F

Y06

1Q F

Y07

3Q F

Y07

1Q F

Y08

3Q F

Y08

1Q F

Y09

3Q F

Y09

1Q F

Y10

3Q F

Y10

1Q F

Y11

3Q F

Y11

1Q F

Y11

3Q F

Y11

BSO-18 RESERVES

MERCYBOXER

KEARSARGE

COMFORTDUBUQUE

OEF

OIFEMF-KLRMC

COMFORTPELELIU

OIFEMF-KLRMC

OIFEMF-KLRMC

OIF/OEFEMF-KLRMC

MERCYLHA/LPD

OIF/OEFEMF-KLRMC

COMFORTLHA/LPD

OIF/OEFEMF-KLRMC

MERCYLHA/LPD

OIF

OIF 2

OIF 4-6TSUNAMI

KATRINA

BSO-18 OPERATIONAL SUPPORTHistorical and Projected (AC/RC)

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Navy Medicine at Home

Navy Medicine DeployedPhoto: Department of the Navy/Department of Defense collection

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UNCLASSIFIED//FOUO 23Photo: Department of the Navy/Department of Defense collection

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Operation Iraqi Freedom


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Operation Enduring Freedom


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Guantanamo Bay, Cuba

http://upload.wikimedia.org/wikipedia/commons/b/bd/Guantanamo_Bay_map.png

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JTF GTMO Det

Provides task-organized theater hospitalization (Level III) Medical, General and Ortho Surgical, Dental care, Prev Med, 24/7 ER, Mental Health Services, and Mass Casualty support to personnel at all Detainee Camps, Detention Hospital, Detainee Mental Health Services, Optometry, Internal Medicine, Pharmacy, Physical Therapy, Prosthetic services, and Special Care Unit. In addition to Detainee care, JTF GTMO provides both general and mental healthcare services to all JTF active duty service member population.


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Djibouti

http://upload.wikimedia.org/wikipedia/commons/7/72/Gulf_of_Aden_map.png

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Afghanistan

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The Continuum of Care

Forward Resuscitative Care (Level II)

Forward Definitive Care (Landstuhl) (Level IV)

Theater level care (Level III)

Corpsman in the Field(Level I)

Restorative-Rehabilitative Care (Level V)


http://www.navy.mil/view_single.asp?id=6355

http://www.navy.mil/view_single.asp?id=6269

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UNCLASSIFIED//FOUOPhoto: Office of the Army Surgeon General (86th CSH)

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UNCLASSIFIED//FOUOPhoto: Office of the Air Force Surgeon General

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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collectionPhoto: Office of the Air Force Surgeon General

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In 2006, JFCOM tasked the Navy with providing medical staffing in support of the Army's Landstuhl Regional Medical Center (LRMC), Germany. Since then, the Navy Medical Augmentation Det has continued to augment LRMC with Navy medical personnel in support of wounded OEF/OIF warfighters. Currently, the Navy augmentation staff includes; 292 Navy medical personnel (260 reservist/32 active).

Landstuhl Regional Medical Det, Germany


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National Naval Medical Center


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GuamHawaii

Okinawa

Landstuhl

USMC Wounded Warrior Regiment-- Single Command with Strategic Reach --

CampLejeune

CampPendleton

Quantico

WWR services the Total Force –

Active Duty / Reserve / Retired / Former Marines

Level of EffortCurrent (Mil / Civ): 212Contractor Support: 24Future Total: 361

WW RegimentWW Battalions

Patient Affairs Team (PAT)/VA Liaisons

District Injured Support Cells (DISC)

WW Company

Reference: Wounded Warrior Regiment Command Brief

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Navy Safe Harbor – Strategic ReachWounded, Ill, and Injured (WII)

BETHESDA / WRAMC (2)

BAMC (2)

SAN DIEGO (2)AT-LARGE WEST (1)

TAMPA (1)

PALO ALTO (1)

JACKSONVILLE (1)

PORTSMOUTH/RICHMOND (1)

MILLINGTON TN (2)

WASHINGTON DC (12)AT-LARGE EAST (1)

BREMERTON (1)

GREAT LAKES / MINNEAPOLIS (1)

VA POLY TRAUMA CENTER

MILITARY TREATMENT FACILITY

SAFE HARBOR HEADQUARTERS STAFF

NAVY OPERATONAL SUPPORT CENTER

NATIONAL NETWORK OF NAVY OPERATIONAL SUPPORT CENTERS

Reference: Navy Safe Harbor Program Command Brief

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USNS MERCY (T-AH 19) anchored off the coast of Chuuk, Federated States of Micronesia

PACIFIC PARTNERSHIP

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PACIFIC PARTNERSHIP 2007-2009

San DiegoSan Diego

Dili, TL12-25 Jul

Dili, TL12-25 Jul

Singapore2-7 July

Singapore2-7 July Port Moresby, PP

4-17 AugPort Moresby, PP

4-17 Aug

Pearl Harbor8-10 May15-18 Sep

Pearl Harbor8-10 May15-18 Sep

Chuuk State, FM22 Aug-1 Sep

Chuuk State, FM22 Aug-1 Sep

Nha Trang, VM19-29 June

Nha Trang, VM19-29 June

Manila, RP15-17 JuneManila, RP15-17 June

Samar, RP14 June

Samar, RP14 June

Guam20-24 May

3-7 Sep

Guam20-24 May

3-7 Sep

Darwin, AS27-31 Jul

Darwin, AS27-31 Jul

Majuro, RMI27 Aug-7SepMajuro, RMI27 Aug-7Sep

Da Nang, VM14-24 July

Da Nang, VM14-24 July

I/P Manila, RP17-18 June

I/P Manila, RP17-18 June

Bicol Region, RP20 June – 8 JulyBicol Region, RP20 June – 8 July JOA OPS

14 June – 11 JulyJOA OPS

14 June – 11 July

Pearl Harbor29 May – I June

12-15 Sept

Pearl Harbor29 May – I June

12-15 Sept

San DiegoSan Diego

Soloman Islands18-24 Aug

Soloman Islands18-24 Aug

Madang, PNG6-16 Aug

Madang, PNG6-16 Aug

I/P Singapore27-30 July

I/P Singapore27-30 July

Cotobato, RP29 May-12 June

Cotobato, RP29 May-12 June

Solomon Islands30 July – 12 AugSolomon Islands30 July – 12 Aug

Tonga22 Aug – 2 Sept

Tonga22 Aug – 2 Sept

Samoa5 – 16 Sept

Samoa5 – 16 Sept

Kiribati1 – 14 July

Kiribati1 – 14 July

New Caledonia

16 – 19 Aug

New Caledonia

16 – 19 Aug

Cairns23 – 26 July

Cairns23 – 26 July

Pearl Harbor 8-9 June

24-25 Sept

Pearl Harbor 8-9 June

24-25 Sept

San DiegoSan Diego

Marshall Islands

17 - 28 June

Marshall Islands

17 - 28 JuneGuam9-11 June

Guam9-11 June

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Eye surgery aboard USNS MERCY: Republic of the Philippines


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A young patient onboard USNS MERCY walks for the first time in seven years after surgery on his leg: Republic of the Philippines


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UNCLASSIFIED//FOUOThe U.S. Navy Amphibious Assault Ship USS Kearsage (LHD 3)

CONTINUING PROMISE

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Port Au Prince, Haiti9-20 Apr

Port Au Prince, Haiti9-20 Apr

Santo Domingo,Dominican Republic

21 Apr – 2 May

Santo Domingo,Dominican Republic

21 Apr – 2 May

St Johns, Antigua5-16 May

St Johns, Antigua5-16 May

Norfolk, VANorfolk, VA

Miami, FL 4-6 AprFt. Lauderdale, FL 26-28 Jul

Miami, FL 4-6 AprFt. Lauderdale, FL 26-28 Jul

La Union, El Salvador21 Jun – 2 Jul

La Union, El Salvador21 Jun – 2 Jul

Corinto, Nicaragua3-14 Jul

Corinto, Nicaragua3-14 Jul

VBN, Panama18-21 Jul

VBN, Panama18-21 Jul

Colon, Panama24 May-2 Jun

Colon, Panama24 May-2 Jun

Tumaco, Columbia6-17 Jun

Tumaco, Columbia6-17 Jun

Cartagena, Columbia20-23 May

Cartagena, Columbia20-23 May

53

Port Au Prince, HaitiPort Au Prince, Haiti

Belize City, BelizeBelize City, Belize

Manta, EcuadorManta, Ecuador

Buenaventura, Colombia

Buenaventura, Colombia

Acajutia, El Salvador

Acajutia, El Salvador

Corinto, NicaraguaCorinto,

Nicaragua

Salaverry, PeruSalaverry, Peru

Puerto Barrios, Guatemala

Puerto Barrios, Guatemala

Colon, PanamaColon, Panama

Port of Spain, Trinidad

Port of Spain, Trinidad

Georgetown, Guyana

Georgetown, Guyana

Paramaribo, Suriname

Paramaribo, Suriname

Norfolk, VA Norfolk, VA

CONTINUING PROMISE 2007 & 2009

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Cooperative Surgery with Dominican medical staff on board the USS Kearsarge: CARIBBEAN SEA

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Operation Smile patient after successful surgery onboard the USS Kearsarge: Puerto Cabezas, Nicaragua

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Cooperation Afloat Readiness and Training (CARAT) Program

3. Malaysia

6. Brunei

4. Thailand1. Philippines

5. IndonesiaNaval Engagement Activities

2. Singapore

CARAT 2009

Philippines 20 May - 30 May

Singapore 05 Jun - 18 Jun

Malaysia 22 Jun - 02 Jul

Thailand 08 Jul - 16 Jul

Indonesia 21 Jul - 25 Jul

Brunei 03 Aug - 10 Aug

SEACAT 17 Aug - 20 Aug

Exercise Observers

Vietnam Singapore

Cambodia SEACAT

Indonesia SEACAT


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Eastern Europe &

Central Asia10

Caribbean &Latin America

14

Africa46

Asia &Southeast Asia

9

Funding Source

PEPFAR DHP

Middle East 3

DoD Global Fight Against HIV82 Countries Benefited by DoD Activities

(As of FY09)


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7,779 Health care

workers trained

278counseling and testing centers

supported

26,800 individuals

currently on ARVs

353 counseling and testing centers

supported

42,350Troops &

families on palliative care

597,374reached with prevention messages

233,684counseled and

tested

4,728peer educators

trained

78laboratories

equipped and supported

FY 2009 DHAPP Program Accomplishments


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NAMRU-3 AOR2005-9

Influenza

Active DutyHIV/BBPVector studies

Active Programs/PartnersAFI/HFV

Program

NAMRU-3

Ghana Detachment

Afghanistan Satellite Lab

Meningitis

Rotavirus

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OPERATION UNIFIED RESPONSE: HAITI 2010


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USS Carl Vinson / Carrier Air Wing (CVW) 17

14 Ja

n 10

18 Ja

n 10

19 Ja

n 10

20 Ja

n 10

22 J

an 10

23 J

an 1

0

24 J

an 1

026

Jan

10

USS Bataan / 22nd Marine Expeditionary Unit

USNS Comfort

Fleet Antiterrorism Security Team

24th Marine Expeditionary Unit

Navy Forward Deployed Preventive Medicine Unit

USNS Lummus


Operation Unified Response

*Specialty Surge Packages and Non-Governmental Organization Fills Throughout

USS Nassau

12 Jan 10

http://www.cvn70.navy.mil/news/photo_gallery/2010/images/01_jan/15/100115-N-6247V-551.jpg

http://upload.wikimedia.org/wikipedia/commons/8/8f/24MEULOGOsm.jpg

http://www.msc.navy.mil/inventory/pics/lummus.jpg

http://www.bing.com/reference/semhtml/File:Mcsfbn.gif

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USS CARL VINSON

62

• Treated 60 American and Haitian Patients

• Performed 12 Surgeries• Provided Neonatal Care to Infant

Born Onboard the USS Mohawk (USCG)


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USS BATAAN

• Major/Trauma Surgeries: 21• Minor Surgeries: 77• 90% Orthopedic Related• 10% General Procedures

63Photo: Department of the Navy/Department of Defense collection

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On Station in Record Time• 76.5 hrs from notification to sail (5 day norm)• 1st patient via helo before ship anchored PaP• Treated ~1000 earthquake patients• 843 major surgeries

“Largest single orthopedic trauma center in the

hemisphere”

THE FACE OF OUR NATIONAL RESPONSE!

USNS Comfort (T-AH 20)


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Non-Governmental Organizations

• Non-Governmental Organizations expand mission capabilities onboard COMFORT:– American College of Surgeons– Johns Hopkins University– National Nurses United– Operation Smile– Orthopedic Trauma Association– Project HOPE– UCLA– University of Michigan– American Red Cross


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Retention: Top 10 Reasons Sailors Stay and Leave

Number Reasons to Stay113,317 Your medical benefits

109,358 Your dental benefits

99,409 Value of your benefits

94,020 Leave amounts

91,623 Availability of Navy Exchange

90,485 Availability of commissary

87,759 Education benefits offered

82,978 Interest in my current job

80,717 Availability of MWR programs

77,949 Advancement/Promotion

opportunities

Number Reasons to Leave

70,732 Being Selected for an IA

62,903 The red tape

55,545 Separation from family/friends

50,350 Time Away from Home

49,074 Morale in your unit

46,325 Communication within the unit

44,094 Appropriateness of awards

43,764 Administration of award

system in my unit

42,894 # of personnel to do the job

41,728 Time spent training away from

home

66

Zone A Argus Survey Data / ALL NAVY

Data as of Aug 09

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Medical Corps Health Professions Scholarship Program (HPSP)

Note: FY08 –FY10 Data include both HPSP and Health Services Collegiate Program

FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY100

50

100

150

200

250

300

350

400

Goal

Accessions

FY10 as of Apr 10; Additional 96 in process

371 net under-recruiting of HPSP from 2004-2007. Goal met FY08 and FY09On track to fully meet goal in FY10

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Loss Rates FY02-FY09

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

MC 8.7% 9.2% 10.6% 10.4% 9.6% 10.2% 8.2% 8.8%

DC 12.2% 11.7% 10.6% 12.9% 14.4% 14.7% 10.8% 8.5%

MSC 6.9% 7.3% 9.1% 10.2% 10.2% 9.4% 9.0% 9.0%

NC 7.6% 8.4% 9.5% 9.7% 11.4% 9.9% 9.2% 8.9%

FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09

Source: BUMIS Sep 2009

Medical Department Officer Loss Rates

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Parent Services and Med Dept Comparisons

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

550,000

600,000

FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 TD

Ser

vice

s E

nd

Str

eng

th

Army Navy Marine Corps Air Force Navy&MC combined

Marine Corps

Air Force

Navy

Army

Navy & Marine Corps Combined

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Medical Department Officer Communities

0

50

100

150

200

250

300

TOP HIGH DEMAN/LOW DENSITY PERSONNEL CURRENTLY DEPLOYED

Community Manning Personnel Deployed Operational Billets

PA EM Gen Surg CC Nurse Psychiatry Clinical Psych

Community Manning 180 136 176 283 93 106

Personnel Deployed 22 23 27 69 16 11

Operational Billets 54 23 32 19 10 29

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UNCLASSIFIED//FOUO 71Loss Rate (%)

0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00%

Psych Nurse

Nurse Anesthetist

Pediatric Nurse Practitioner

Perioperative Nursing

Family Nurse Practitioner

Critical Care Nurse

Entomologist

Env Hlth Officer

Psychologist

Physician Assistant

Anesthesiologist

Emerg Physician

Psychiatrist

General Surgeon

5 year average annual loss rate 2005-2009 FY09 loss rate

Medical Department Officer Corps Critical Wartime Specialty Manning