Air Force Secretary Addresses Priorities at Aspen Security Forum

By Amaani Lyle

DoD News, Defense Media Activity

WASHINGTON, July 25, 2015 – The Air Force secretary yesterday discussed her top national and homeland security issues, as well as current personnel challenges, during a question and answer session with Fox News at the sixth annual, three-day Aspen Security Forum in Colorado.

Regarding her perspective of the current top U.S. threats, Secretary Deborah Lee James said Russia tops the list, followed by Islamic State of Iraq and the Levant, Al Qaida and general extremism in the Middle East, China, North Korea and Iran.

“We have had budget cuts and we’re the smallest Air Force we’ve ever been,” James said. “Whatever we are called upon to do, we will step up to the plate, we will send our most effective and our best trained personnel and most modern capabilities, and we will get the job done.”

The secretary also noted the significance of cyber threats and space investments not only to the Air Force, but the Defense Department.

James also recounted that while the U.S. Air Force once enjoyed decades-long absolute control of the skies, other countries are catching up.

“My job is not to pick a fight with anybody … but my job is to make sure we’re ready,” James said. “We’ve got to have the right people, the right training, the right capabilities today, and … invest in the future.”

According to James, the 1980s and 1990s were the first decades in which the world at large saw the fruits of stealth and precision-technology investments, particularly during the Persian Gulf War. “Ever since that time, countries have been investing, testing … and replicating to the greatest extent possible.”

They’ve also been investing in asymmetric capabilities, James added. “I don’t ever want a fair fight; if I have to fight, I want to be one or two or three steps ahead of the competition.”

Vulnerabilities Out there

But the secretary acknowledged she remains concerned about cyber security, and hopes for ongoing collaboration with industry to buffer against attacks.

“We probably have the best protections in the world, but are they good enough? Are the vulnerabilities out there?” James asked. “We are constantly serving [and] looking and when we find issues that concern us, we try to plug the holes.”

Confidence in Iran Nuke Deal

Regarding the United States’ recent deal with Iran to potentially lift the arms and intercontinental ballistic missiles embargo in 5 to 8 years, James expressed confidence in the arrangement.

“It’s the best deal that we could hope for under these circumstances,” James said. “The totality of the deal takes off the table the various paths that Iran might have to develop this nuclear weapon over the next decade or so.”

Domestic Issues

Of domestic nuclear issues, James acknowledged the fallout from the 2011-2013 Malmstrom Air Force Base, Montana, debacle in which some 100 missile officers cheated on a nuclear proficiency test via cell phone.

“We never found evidence of cheating beyond that one base, but we did find evidence of systemic problems across the board,” James said, adding that the Air Force opted to take a holistic approach in addressing the problem as a “people” rather than “cheating” issue.

James said the service therefore redirected money and manpower to bolster training, incentive and development opportunities for the nuclear force. “I think we’re making good progress … so we just have to keep on it.”

Sexual Identity and Gender

Following Defense Secretary Ash Carter’s recent order to implement a six-month study reviewing what he called “outdated” barriers to military service based on sexual identity and gender, James emphasized that her concerns focus primarily on a military member’s job capability and adherence to their service’s core values.

“If you are doing your job capably and if you’re living those core values, then you’re the type of person I want in my Air Force,” James said. “Times have changed.”

Similarly, James said her former membership on the Defense Advisory Committee on Women in the Services, helped her better examine the issue of gender-neutral opportunities in the military.

“We were tracking on closed specialties and efforts to open up those specialties,” James said, adding that the standards might be of a mental nature, physical nature or both. “We need … gender neutral standards for all of these jobs in military, because that will tell us whether or not an individual, be it a man or a woman, can do the job.”

Currently, the Air Force offers the greatest number of open jobs with only six or seven positions closed to women, and those positions, James said, are “closely aligned to the special operations world.”

James said the Air Force will open remaining currently closed jobs for women, provided gender neutral standards are in place, and the service will allow people to compete.

“If there is a request coming up to me for an exemption, the burden of proof would be heavy to demonstrate to me why that should be if we’re talking about gender-neutral standards and simply requiring that all sorts of people be able to meet those standards.”

Each summer, senior government and industry leaders discuss current key security issues in order to foster leadership at a nonpartisan venue. The Aspen Institute has campuses in Aspen, Colo., the Wye River on Maryland’s Eastern Shore, offices in New York City as well international partnerships.

Pacom Chief: China’s Land Reclamation Has Broad Consequences

By Terri Moon Cronk

DoD News, Defense Media Activity

WASHINGTON, July 24, 2015 – China’s land reclamation in the South China Sea could have far-reaching U.S. security and economic consequences by disrupting international rules and norms that have supported the global community for decades, the commander of U.S. Pacific Command said today.

In a security forum panel discussion in Aspen, Colorado, Navy Adm. Harry B. Harris Jr. said China’s assertiveness in the South China Sea is an issue the American public must know about and the United States must address.

“While Vietnam, Malaysia, the Philippines and Taiwan have also conducted land reclamation in the South China Sea, their total -- approximately 100 acres over 45 years -- is dwarfed by the size, scope and scale of China’s massive buildup,” Harris said. “In only 18 months, China has reclaimed almost 3,000 acres.”

Each year, he noted, more than $5.3 trillion in global sea-based trade relies on unimpeded sea lanes through the South China Sea, adding that the Strait of Malacca alone sees more than 25 percent of oil shipments and 50 percent of all natural gas transits each day. This is made possible through the regional countries’ adherence to longstanding customary international law, which protects freedom of navigation, he added.

Fundamental to Global Economy

International recognition and protection of freedom of navigation are fundamental to the global economy and the U.S. way of life, Harris said, and unilateral attempts by any nation to disrupt freedom of navigation place the international system and global economy at risk.

“The South China Sea is front and center in the tug-of-war between the majority of regional nations that want to maintain the status quo and China that wants to change it to suit its narrow self-interest,” he said. “This is why Deputy Secretary of State [Tony] Blinken recently compared the aggressive actions of China in the South China Sea to Russia’s actions in Crimea. They both demonstrate desire by individual actors to change the status quo.”

China Not Using Diplomacy

Rather than pursing diplomatic actions to address their disputes, China is changing tactics “through aggressive coercive island building without meaningful diplomatic efforts toward dispute resolution or arbitration,” the admiral said.

Harris said China is building false sovereignty as it builds man-made islands on top of coral reefs, rocks and shoals, which destroys surrounding underwater environment.

“That severe environmental impact is one aspect of China’s land reclamation that I don’t believe has received enough attention, because protecting our fragile environment is a global responsibility,” he said. China’s has actions have led to “the most rapid rate of permanent loss of coral reef area in human history,” he added, citing University of Miami marine biologist John McManus.

And while President Barack Obama is designating an additional 490,000 square miles as marine sanctuary in the Pacific, “China’s destructive activities will result in the permanent loss of coral reef in one of the most important reef systems in the Pacific,” Harris said.

China’s Destruction Exceeds Environment

But more damage is taking place because of China’s land reclamation, the Pacom commander said. The shared principles that ensured security and prosperity in the region for decades also are threatened, he noted.

“Secretary of Defense [Ash] Carter stated at last month’s Shangri-La Dialogue that China is out of step with both the international rules and norms that underscore the Asia-Pacific’s security architecture, and the regional consensus that favors diplomacy and opposes coercion,” Harris said. “These are the reasons that the U.S. has called for peaceful resolution of South China Sea disputes, an end to attempts to unilaterally change the status quo, and an immediate halt to land reclamation by all claimants.

“We call on China to use the mechanisms of international dispute resolution in good faith,” he continued, “and to abide by those decisions as so many of its regional neighbors have already done.”

China’s actions are inducing its South China Sea neighbors to build stronger relationships with each other and with the United States, the admiral said, “driven not by a sudden U.S. effort to increase stability and security within the region, but by China’s conspicuous failure to do the same.”

Military Hospital’s Surgical Care Ranks Among Best in Nation

By Elaine Sanchez

Brooke Army Medical Center

WASHINGTON, July 24, 2015 – The San Antonio Military Medical Center here ranks among the top hospitals in the nation for surgical care, according to a recent report from the American College of Surgeons.

SAMMC earned an exemplary or average rating in 180 different surgical quality variables, placing the facility in the upper half of hundreds of esteemed hospitals throughout the nation.

The report is issued by ACS’ National Surgical Quality Improvement Program, or NSQIP, a voluntary program that gauges the quality of surgical programs across the nation. The aim is to help surgeons better understand their quality of care compared to similar hospitals with similar patients, according to the program’s website.

“The largest and best hospitals in the U.S. are part of this program, and our percentages place us in the top half of those hospitals,” said Air Force Col. Joseph Brennan, chief of SAMMC’s Department of Surgery. “We are very proud of that.”

Data Collection is Key

Data collection is key to the program’s success, Brennan noted. At SAMMC, a surgeon oversees the program and two nurses are dedicated to inputting preoperative through 30-day postoperative data into a secure, web-based platform. ACS analyzes rates of mortality and morbidity, such as pneumonia, surgical site infections, urinary tract infections, sepsis and readmissions.

“Blinded” information is then shared with all participating hospitals, offering a snapshot of how hospitals rank according to surgical outcomes.

This data offers priceless insight, noted Army Maj. (Dr.) George Kallingal, surgeon champion for NSQIP at SAMMC.

“NSQIP foremost offers us an internal metric to ensure our surgical quality outcomes continue to progress at SAMMC and sets in motion the process of continual analysis and improvement,” he said.

SAMMC’s surgical outcome data has been increasingly positive over the past three years, Brennan noted, an uptick he attributes to SAMMC’s care providers and infection control, quality and process improvement teams.

Improvements to Surgical Processes

“As a result of the data, we’ve made multiple improvements to our surgical processes,” he said, citing efforts to improve operating room preparations and catheter use. “And our exceptional staff did a great job pushing initiatives focused on better patient care.”

While NSQIP provided the framework for analysis, “the dedication of SAMMC personnel and their commitment to quality improvement is what fostered meaningful change,” Kallingal said. “It will continue to be an important tool to provide the framework for improving surgical quality outcomes in the future.”

The program is an easy sell at SAMMC, added Mariea Shelton, process improvement coordinator. The aim, she said, is to always strive for “great outcomes in surgical procedures.”

With an eye on further improvements, Brennan hopes to add a third NSQIP surgical clinical reviewer soon to enable more data to be inputted and more feedback to be gained. “The more numbers we can track, the better off we’ll be when it comes to gauging our strengths and weaknesses,” he said.

While the program is voluntary, the Defense Department requires all military hospitals to participate in NSQIP. SAMMC has been a voluntary member of the program since 2009.

“Participation in NSQIP means there is a total commitment to deliver the highest quality surgical patient care,” said Marilyn McFarland, a NSQIP surgical clinical reviewer.

Multiple Recent Successes

"Quality patient care is [the] priority here and it shows,” added Laura Van Dyk, surgical clinical reviewer.

Brennan praised the hospital’s exceptional care, citing recent successes on The Joint Commission reaccreditation survey, Level I trauma center reverification, and a Commission on Cancer silver designation for SAMMC’s cancer program.

“Our focus has always been on providing the best patient care,” the colonel said. “That emphasis has never wavered. This is just a great organization, from the leadership on down.”