Conference Promotes, Enables Medical Research

By Jeffrey Soares, USAMRMC Public Affairs

The latest advancements in healthcare for warfighters and related cutting edge research, is the focus of the 2012 Military Health System Research Symposium that opened Aug. 13 in Fort Lauderdale, Fla. The four-day symposium, sponsored by the Office of the Assistant Secretary of Defense for Health Affairs, and organized by the U.S. Army Medical Research and Materiel Command, is a joint effort supported by the U.S. Army, Navy, and Air Force, and brings together scientific leaders and researchers from throughout the world.

“This is the first time that we are combining three previously separate conferences into one joint conference by the Army, Navy, and Air Force,” Col. Dallas Hack, chair of the MHSRS said. “We now have a broader range of topics. Before it was primarily trauma care, and now it is this, plus infectious disease, operational medicine, medical simulation and training and force health protection. The interest thus far has been truly amazing.”

The vision of the MHSRS is to offer an academic-based forum in which to discuss recent accomplishments and share knowledge regarding military research and development. The annual event, which has expanded rapidly over the last decade, provides an opportunity to exchange ideas on planning and developing future studies aimed at optimizing care for members of the uniformed services in operational settings

“This year, we have over 450 presenters, including podium speakers and poster presentations,” Hack said, “and we actually had to limit the number of submissions we could accept. We have nearly 1400 people registered, and we probably will see over 1500 when all is said and done. This year’s conference is shaping up to be the biggest one yet.”

Originally established 15 years ago as Advanced Technology Applications for Combat Casualty Care, the conference has helped to unify researchers who seek ways to aid the nation’s warfighters -- both on and off of the battlefield -- before, during and after deployment. To date, the research has been successful.

For example, the general concept of the Armed Forces Institute of Regenerative Medicine grew out of conversations during the 2006 ATACCC meeting, and during the same meeting, the Army and Navy agreed to collaborate on damage control resuscitation, which has greatly speeded up research in this particular area. At the 2001 conference, a discussion between researchers from the University of Florida and Walter Reed Army Institute of Research on the concept of traumatic brain injury biomarkers led to  research collaboration on the topic. This meeting resulted in the first ever blood test for TBI to enter Phase III clinical trials. In 2008, ATACCC was the site of a joint meeting to discuss spinal cord Injury medevac litter efforts, which led to three successful studies regarding the assessment of the effects of vibration, G-force, and shock on casualties during medevac transportation.

“The only reason to have a meeting like this is to provide output -- to ensure that new things happen in the research field because of all the information shared,” Hack said. "Our focus remains the same:  to protect, sustain, and treat the warfighter with the most current technology.”

Hack added he has seen an increase in the number of non-DoD personnel attending the conference, such as those from corporations, academia, and clinics, who come to learn more about new advances in the field. Another draw is that continuing education units are offered for many in attendance as well.

“I truly believe the non-DoD personnel are coming to this meeting because they recognize that the DoD is a leader in the field of this type of research,” Hack said, “and we’ve had some major breakthroughs lately.”

Because of the increased use of improvised explosive devices during conflicts overseas, one of the topics gaining much attention is TBI, and Hack said this has become a key area of research.

“Over the course of the war, we’ve had huge progress in the area of massive trauma and massive hemorrhage, and how to treat this,” he said. “Now we’re starting to see big advances in the area of TBI, and we can look forward to seeing brain injury care translating into larger clinical trials, and into practice within the next year or two. We’re looking at the long-term, chronic effects of brain injury, which is very different than past research where we only looked at the short-term effects.”

Since the results of research aimed at the warfighter make their way into civilian medical practice, millions across the world could reap the benefits of these breakthroughs. 

And this remains the silver lining of the annual MHSRS gathering.

“What continues to amaze me,” Hack said, “is the amount of support we get for this conference. So many folks throughout the year write or phone us to say how much they look forward to this meeting, and that it is the best medical meeting of the year.”

Utah Guard members provide aid to Moroccan villagers during African Lion 2012

By Army National Guard Sgt. Nicolas A. Cloward

Utah National Guard

AGADIR, Morocco (4/23/12) – Soldiers from the Utah State Medical Command, Utah Army National Guard, worked alongside Moroccan military medical personnel April 13, providing medical aid for as many people as they could during African Lion 2012, an annual partnership training exercise between U.S. forces and the Royal Moroccan Military.

Throngs of Moroccan villagers gathered around the Humanitarian Civil Assistance site in Sidi Moussa, Morocco and pathways to the examination rooms were crowded with parents eagerly trying to receive medical aid for them and their children.

Army Sgt. Robert W. Carpenter, a combat medic for MEDCOM, said MEDCOM arrived on site early in the morning and began setting up each individual clinic. The HCA site provided several clinics such as general medicine, dermatology, respiratory, pediatric, gynecology, ear, nose and throat, Ophthalmology and dental.

Because of the large number of Moroccans seeking medical aid, the HCA crew was only able to provide care in one of the areas per person – medical, dental or ophthalmology. Once the villagers got into the clinic the crew was faced with another problem – language.

Carpenter said a major obstacle was the language barrier. In Morocco, the three main languages are French, Arabic and Berber. Berber is a common language spoken among the small villages of Morocco and has three dialects. Each one is so unique that people that speak one dialect may have a difficult time understanding one of the other dialects.

Luckily, interpreters from the 300th Military Intelligence Brigade, Royal Moroccan Military and Peace Corps were available to help bridge the language gap between the villagers and physicians. Many times, information about a patient’s condition would have to be translated through several people before getting back to the care provider, Carpenter said.

Army 1st Lt. Emily S. Smith, a physician assistant for MEDCOM, worked in the pediatric clinic and said she understood first-hand the value of overcoming the language barriers. “If it weren’t for the interpreters, we wouldn’t have been able to accomplish what we did.”

Despite the overwhelming demand of health care needs and the labyrinth of linguistic daisy chains, the service members and volunteers of the HCA were able to provide medical care for more than 1,000 in a single days work.

“There’s still just so much work to be done,” Carpenter said.

U.S. Army Medicine Civilian Corps Begins the New Year with Web Fair, Career Fair and Focus Group Sessions

Chief of Recruitment and Retention Comments On MEDCOM’s Efforts To Fill Various Positions at 70+ Military Medical Facilities Across the Nation and How Holding Focus Groups Helps Strengthen MEDCOM Hiring Practices

Washington D.C. - The Civilian Corps of the United States Army Medical Command (MEDCOM) opens 2012 by bringing awareness to the many medical career opportunities available for civilian healthcare professionals by holding both web and career fairs in the month of January.  In addition, focus group sessions will be held in the upcoming months to assist MEDCOM in its continuous efforts to hire wounded warriors and disabled professionals.

“MEDCOM has several hiring initiatives scheduled for this year, each planned to highlight current and future positions ultimately leading to the hiring of qualified medical professionals," says Dr. Harrison, Chief, Recruitment and Retention, Headquarters U.S. Army Medical Command, Civilian Human Resources Division. "The web and career fairs being held this month are great ways to kick-off what is destined to be a year of new opportunities and new hires. “

The online career fair beginning January 9th at  www.CivilianMedicalJobs.com/webfair will provide job seekers with an interactive environment to learn more about openings, job locations and the benefits of working with the Army Medicine Civilian Corps. Visitors are also able to submit questions and receive feedback from career consultants until January 13th. After January 13th, job seekers are still able to apply and check back regularly for updates and new job listings.

On January 20th starting at 8 am at the Renaissance Austin Hotel, the Fort Hood-Darnall Army Medical Center is recruiting for immediate positions including behavioral health providers, physicians, physician assistants, nurses, and administrators. For more information, visit http://CivilianMedicalJobs.com/jobfair.

Starting the last week of January, focus group sessions will be held in Ohio, Florida, New Mexico, Oregon, and North Dakota. “We look forward to the opinions and input we will receive from our peers as well as those who are potential candidates,” says Harrison. “The information gathered will play an important role in the development of programs and affect the way MEDCOM will recruit and hire in the immediate future.”

For more information please visit the website, www.CivilianMedicalJobs.com and be sure to view the on-site calendar for a MEDCOM job fair near you. All press inquiries and interview requests go to kross@agencymabu.com.

Research Examines Blast Impact on Human Brain

By Donna Miles

American Forces Press Service

FORT DETRICK, Md., April 12, 2011 – There’s little debate about the risk of a brain injury when a service member gets a blow to the head -- whether from an enemy round or from crashing against a wall or being inside a vehicle during an explosion.

But some of the foremost academic researchers from around the world, working in cooperation with the Defense Department’s Blast Injury Research Program, are trying to determine exactly what happens to a service member’s brain when it’s exposed to a blast, but with no direct head impact.

Their answers could change the way the military protects tens of thousands of deployed troops from improvised explosive devices, mortar rounds and other explosions, Michael J. Leggieri Jr., director of the Defense Department’s Blast Injury Research Program Coordinating Office, told American Forces Press Service.

DOD has long recognized the risks of overpressure and shock waves associated with blasts on the human body, Leggieri said.

For the past 18 years the Army Medical Research and Material Command based here has conducted a robust research program focused on occupational exposures to blasts -- such as when an artillery crewman fires a howitzer.

As a result, the command helps the Army evaluate the blast impact of every weapons system before it’s fielded.

But the current conflicts, and the frequency of percussive blasts and explosions, leave researchers questioning: What effect are they having on the brain, and how can we better protect service members against traumatic brain injuries?

The answer isn’t as easy as it may appear, Leggieri explained. That’s because, despite decades of study in the United States and around the world about brain injury, no one completely understands what happens to the human brain during a blast.

In fact, DOD has a lot of clinical data about the impact of blasts on the brain, but that’s from animal studies, Leggieri said. Comparing animal data to humans, particularly when dealing with something as complex as the brain, raises as many questions as it answers, he said.

In terms of humans, DOD has just one confirmed clinical case of a deployed service member who suffered a brain injury in a blast without hitting his head, Leggieri said.

“We know a lot about what happens when you get hit in the head or hit your head against something and it causes a brain injury,” Leggieri said. “That has been studied for decades, primarily by the automotive industry. Impact is something we know quite a bit about. But this whole question about blast is still a question.”

And although the Army is at work on its second-generation helmet sensor with plans to field it soon to about 30,000 soldiers, there’s still no clear indication of what those blast readings will mean in terms of the brain.

Theories abound in how blasts can cause brain injuries, Leggieri said. One prevalent theory advocates that the blast shock wave causes the skull to flex and as a result, damages the brain. Another theory actually has nothing to do with the head. It supports the idea that the blast pressure squeezes the thorax -- much the way fingers squeeze a tube of toothpaste. The result, theorists say, is a sudden vascular surge that goes up into the brain, causing an injury.

Getting to the bottom of what exactly happens is more than a scientific exercise, Leggieri said, it’s critical to finding the best way to protect service members.

The first theory might support a new kind of combat helmet protection, or modification to the current helmet. The latter might call for modified body armor. But providing the wrong solution, no matter how well-intentioned, could actually backfire in adding more weight and less mobility to the warfighter.

“If you are restricting their ability to perform the mission, you are actually putting them at risk because now they can’t do what they need to do to survive,” Leggieri said. “So you have got to be very careful about what protection systems you put on a soldier. You have to make sure they are really effective at what they are supposed to be doing.

“My point is, if you don’t understand the mechanism, you can’t possibly protect against it,” he added. “You may end up doing something that has no effect whatsoever.”

Leggieri assembled a forum of about 100 of the world’s leading brain-injury researchers to determine, first, whether their work shows that blast-induced mild traumatic brain injuries actually exist, and, if so, what happens within the brain to cause them.

“With this expert panel, we are reaching out to this community of modelers, clinicians, and experimentalists who do animal research in blasts, and getting these communities to finally work together and to communicate with each other,” he said. “We are going to have them help us pin down what we don’t know and to get to a solution.”

The meeting proved to be a huge success. Attendees “started to communicate, to share information, to come up with ideas about how we might approach this,” Leggieri said.

What’s needed, they agreed, is a validated mathematical model to show how a blast interacts with the human head, and how that might cause a brain injury. Current models -- and there are several -- are based on simulations that can’t be scientifically validated, Leggieri said.

So Leggieri established a DOD Brain Injury Modeling Expert Panel, made up of 19 leading modelers from academia, industry and government. So far they have met four times, with their fifth and final session slated for this summer.

“Their work is going to help us develop a research roadmap that will take us from where we are today … to a validated model of blast-induced brain injury that we can say with confidence is an accurate model of what happens to humans,” Leggieri said.

That milestone, he said, will help the Defense Department better tailor protective systems for its service members.

“The goal and the focus are on how to prevent this,” he said. “Let’s understand it and find a way to prevent it. If we can make a difference just in these areas, I think would be a huge advancement.”

Advocates see trouble for misdiagnosed soldiers

By ANNE FLAHERTY, Associated Press Writer Anne Flaherty, Associated Press Writer – 

WASHINGTON – At the height of the Iraq war, the Army routinely dismissed hundreds of soldiers for having a personality disorder when they were more likely suffering from the traumatic stresses of war, discharge data suggests.
Under pressure from Congress and the public, the Army later acknowledged the problem and drastically cut the number of soldiers given the designation. But advocates for veterans say an unknown number of troops still unfairly bear the stigma of a personality disorder, making them ineligible for military health care and other benefits.
"We really have an obligation to go back and make sure troops weren't misdiagnosed," said Dr. Barbara Van Dahlen, a clinical psychologist whose nonprofit "Give an Hour" connects troops with volunteer mental health professionals.
The Army denies that any soldier was misdiagnosed before 2008, when it drastically cut the number of discharges due to personality disorders and diagnoses of post-traumatic stress disorders skyrocketed.
Unlike PTSD, which the Army regards as a treatable mental disability caused by the acute stresses of war, the military designation of a personality disorder can have devastating consequences for soldiers.
Defined as a "deeply ingrained maladaptive pattern of behavior," a personality disorder is considered a "pre-existing condition" that relieves the military of its duty to pay for the person's health care or combat-related disability pay.
According to figures provided by the Army, the service discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.
But after an article in The Nation magazine exposed the practice, the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn't the underlying cause.
After that, the annual number of personality disorder cases dropped by 75 percent. Only 260 soldiers were discharged on those grounds in 2009.
At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.
The Army attributes the sudden and sharp reduction in personality disorders to its policy change. Yet Army officials deny that soldiers were discharged unfairly, saying they reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006.
"We did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder," wrote Maria Tolleson, a spokeswoman at the U.S. Army Medical Command, which oversees the health care of soldiers, in an e-mail.
Command officials declined to be interviewed.
Advocates for veterans are skeptical of the Army's claim that it didn't make any mistakes. They say symptoms of PTSD — anger, irritability, anxiety and depression — can easily be confused for the Army's description of a personality disorder.
They also point out that during its review of past cases, the Army never interviewed soldiers or their families, who can often provide evidence of a shift in behavior that occurred after someone was sent into a war zone.
"There's no reason to believe personality discharges would go down so quickly" unless the Army had misdiagnosed hundreds of soldiers each year in the first place, said Bart Stichman, co-director of the National Veterans Legal Services Program.
Stichman's organization is working through a backlog of 130 individual cases of wounded service members who feel they were wrongly denied benefits.
Among those cases is Chuck Luther, who decided to rejoin the Army after the Sept. 11 attacks. He had previously served eight years before being honorably discharged.
"I knew what combat was going to take," he said.
Luther, who lives near Fort Hood, Texas, said throughout his time in the Army, he received eight mental health evaluations from the Army, each clearing him as "fit for duty."
Luther was seven months into his deployment as a reconnaissance scout in Iraq's violent Sunni Triangle in 2007 when he says a mortar shell slammed him to the ground. He later complained of stabbing eye pain and crippling migraines, but was told by a military doctor that he was faking his symptoms to avoid combat duty.
Luther says that he was confined for a month in a 6-by-8 foot room without treatment. At one point, Luther acknowledges, he snapped — biting a guard and spitting in the face of a military chaplain.
After that episode, Luther says, the Army told him he could return home and keep his benefits if he signed papers admitting he had a personality disorder. If he didn't sign, he said, he was told he would be kicked out eventually anyway.
Luther, whose account was first detailed by The Nation, signed the papers.
His case highlights the irony in many personality discharges. A person is screened mentally and physically before joining the military. But upon returning from combat, that same person is told he or she had a serious mental disorder that predated military service.
As in the civilian world, where many insurance companies deny coverage for illnesses that develop before a policy is issued, the government can deny a service member veteran health care benefits and combat-related disability pay for pre-existing ailments.
Despite the Defense Department's reforms, groups such as the National Veterans Legal Services Program say they don't have enough manpower to help all the veterans who believe they were wrongly denied benefits.
Stichman says his organization has more than 60 law firms across the country willing to take on the legal cases of wounded veterans for free. But even with that help, the group doesn't know when it would be able to take on even one new case.
A congressional inquiry is under way to determine whether the Army is relying on a different designation — referred to as an "adjustment disorder" — to dismiss soldiers.
Sen. Kit Bond, a Missouri Republican, wants the Pentagon to explain why the number of these discharges doubled between 2006 and 2009 and how many of those qualified to retain their benefits.
As for Luther, he got lucky. After about a year, he says the Veterans Administration agreed to reevaluate him and decided that he suffers from post-traumatic stress syndrome coupled by traumatic brain injury. The ruling gives him access to a psychologist and psychiatrist every two weeks, despite his discharge status, he said.
But Luther acknowledges that he still struggles. In June, he received word that the Army had turned down his appeal to correct his record, which means he could never return to the service or retire with full benefits.
A week later, he says, he lost his job delivering potato chips because a superior felt threatened by him. Luther says he misses the Army.
"When I was in uniform, that defined me," he said. "It's what made me, me."
___
Online:
U.S. Army Medical Command: http://www.armymedicine.army.mil
Department of Veterans Affairs: http://www.va.gov/
"Give an Hour": http://www.giveanhour.org
National Veterans Legal Services Program: http://www.nvlsp.org/