Current Marine Corps Medical Operations

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Current Marine Corps Medical Operations
Director, Health services, Headquarters, U. S.
Marine Corps RADM Richard R. Jeffries
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IED
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!!Corpsman Up!!
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Iraq 2003 - Present
26 Hospital Corpsman KIA
 
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Afghanistan 2001 - Present
12 Hospital Corpsman KIA
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GLOBAL FORCE DISPOSITION (AS OF 17 SEP 09)
Active Duty 203,505
Active Reserve 2,172
Activated Reservists 8,762
Total 214,439



PACOM 3,000
OTHER CENTCOM 2,800
IRAQ 11,900
AFGHANISTAN 10,100
COMBINED ENDEAVOR LOYAL MIDAS MPF OFFLOAD 09 M2M
NAVAL INFANTRY BN ASSESSMENT M2M BASIC OFFICERS
COURSE-EUROPE GEORGIA DEPLOYMENT
PROGRAM-ISAF MORTUARY AFFAIRS TRAINING USEUCOM
MEB-A ANA ETTs MSOCs AFGHANISTAN
INTEL DET NCO DEVELOPMENT SEC FOR OEF-P
II MEF (FWD) VMAQ-3 VMAQ-4 IRAQ
MOJAVE VIPER WTI JTF-EX CONUS
HEAVY HELO DET USAFRICOM
31ST MEU USPACOM
22D MEU USCENTCOM
PANAMAX 09 SMALL UNIT TACTICS COLOMBIAN
ROE/RUF PERU MEDRETE USSOUTHCOM
M2M OEF TRANS SAHARA LOG ASSESS M2M NCO
DEVELOPMENT TCT MIBOC-A M2M LOGISTICS/EMBARK
TCT USAFRICOM
EOD DET GOLD EAGLE MARINE LEADERSHIP DEV KOREA
INTER OP USPACOM
FAST PLTS USEUCOM USCENTCOM USPACOM USSOUTHCOM
MSOT USSOUTHCOM USCENTCOM
OEF / OIF / COMBAT
EMBARKED WITH USN
AFRICOM 100
NORTHCOM 0
CONUS 2,200
EUCOM 400
SOUTHCOM 200
USMC DEPLOYMENTS
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Iraq Today Sustainment and Security operations
11,900 Marines Currently in Iraq
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Afghanistan Today
10,100 Marines Currently Fighting in Afghanistan
Current Focus of Marine Corps Combat Operations
RC SOUTH
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Our World Has Changed

• General Magnus at CMC Staff Meeting
• How are we doing medical care in Afghanistan
  today with small teams far forward with no air
  cover or CASEVAC after dark in the valleys and
  mountainous terrain in the winter, with limited
  comm (satellite at best) and in the enemies
  geography?

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Our Enemy
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Evolution of Surgical Capability
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First Responders
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Resuscitative Care BAS
GMO Now BAS Surgeon - Future
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USMC Level I/II Medical THE BIG PICTURE
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Level 2 Resuscitation
STP Team
FRSS
En-Route Care Team
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FRSS The Answer

• Small medical footprint
• Time and distance from wounding to definitive
  care can be markedly increased
• Need for surgical care in close proximity to
  battle
• Need for agility, flexibility and rapid mobility
• Need for movement of critical patients quickly
  and rapidly
• Must be modular and easily transportable
• New Surgical Company Concept March 2007
• HS-IL OAG

Expeditionary Maneuver Warfare
Dynamic, Asymmetrical, Rapidly moving Battlefield
Austere site
Obj
FOB
200 nm
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GATEKEEPER

• Afghanistan vs. Iraq
• Expanded Company Operation
• CASEVAC

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Mobile Trauma Bay
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Traumatic Brain Injury

• Guidelines..return to duty.
• Misguided.
• CJCS Gray Team
• Education
• Dosimetry
• Diagnosis
• Treatment

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Far Forward Resuscitation
FLET
Mobile Trauma Bay
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En-Route Care Capability

• Movement of stabilizing critical casualties
• Essential for forward surgical capability
• Performed by Critical Care Nurses
• Austere to adverse conditions with limited
  resources
• By rotary wing, fixed wing and ground transport
• One of the newest and most significant advances
  in combat casualty care

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What is OSCAR?

• OSCAR embeds mental health professional teams as
  organic assets in operational units
• Why should mental health professionals be
  organic? Because stress problems are
• Common
• Hard to detect
• Hard to admit (stigmatized)
• Treatable (respond best to early intervention)
• Potentially disabling
• Possibly preventable

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Expected OSCAR Rollout

• Existing assets at GCE and MFR will be converted
  to OSCAR T/O in FY09
• 3 MH providers and 3 psych techs at each GCE
  (Division Psychiatrist)
• 1 reserve MH provider at MFR
• To be replaced by full-time assets in FY11
• OSCAR will add to the above, 26 Mental Health
  providers and 29 Psych Techs on the following
  timeline
• FY09
• 3 MH providers and 25 psych techs to the GCE
• 4 psych techs to MFR
• FY11
• 19 MH providers to the GCE
• 4 MH providers to MFR

Updated 09 Apr 09
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OSCAR Extenders

• OSCAR Extenders will provide OSCAR functionality
  down to battalion and company level
• Will utilize existing battalion physicians,
  corpsmen, chaplains, RPs, and selected Marine
  officers and enlisted
• Will be trained and certified in basic OSCAR
  competencies
• Will assist commanders to implement the COSC
  program to maintain readiness
• Will assist Marines and Sailors to deal with
  combat stress reactions, injuries, and illnesses
• Prevention
• Early identification
• Referral
• Reintegration
• Peer support

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Traumatic Brain Injury
Secretary Gates
The military now has
more thorough reporting
mechanisms, requiring that any one affected by
a blast or blunt trauma in
theater go through and
evaluation and screening. We have a single TBI
registry and a single point
of responsibility the
Defense and Veterans Brain Injury Center to
consolidate all
TBI-related incidents and
information.
5 June 2008
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DVBIC Regional Care Coordination Program

• Provide 100 follow-up to identified Service
  Members with Traumatic Brain Injury (mild,
  moderate, severe and penetrating) from 13
  regional catchment areas across CONUS.
• Identify and connect Service Members to available
  TBI resources within DoD, VA and civilian
  communities
• Regional Database of Services and Facilities
• Provide education and support-serving as a TBI
  subject matter expert to all involved in the care
  and support of the Service Member and family.
• Identify barriers and/or gaps in service delivery
  for TBI Service Members as they transition
  between systems and settings
• Functional outcomes picture to look at quality of
  life issues related to home, work and social
  environments

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Where TBI Screening Occurs

• In-Theater
• Landsthul Regional Medical Center (LRMC)
• CONUS, during Post Deployment Health Assessment
  (PDHA) and Post Deployment Health Re-Assessment
• VA Medical Centers

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Tele-TBI Highlights

• Virtual TBI Clinic Expanding to 10 sites
  throughout NARMC
• Tele-consultation from theater
• Increasing usage of tbi.consult
• Awareness included in Deployed CPG Materials
• Instituted clinical VideoTeleCon program to
  support medical transfer of acute TBI patients
  between MTFs
• and VAs, including family involvement
• Provided TBI education to 500 providers serving
  National Guard and Reserve Service members via
  video teleconferencing

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HBOT Study Requirements
Investigation of Innovative Treatments

• Hyperbaric Oxygen Treatment (HBOT)
• DCoE as Sponsor (Facilitating in few months
  process of gt 1 yr)
• Air Force (AF) as Research Executive Agent to
  include IRB
• Army with Product Development (USAMMDA) and
  Logistical Actions
• Navy as Scientific Review, Data Safety Monitoring
  Board (DSMB) and FDA Agent
• Study Launch April 09
• Rate-Limiting Step FDA IND
• Complementary and Alternative Medicine (CAM)
• Included in DCoE Warrior Wellness Innovation
  Network
• Samueli Institute as Partner

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Critical Current Issues

• Vice Chiefs Third TBI/ PH Meeting 17 Sep 2009
• ACMCs Blue Ribbon Meeting Aug 2009
• DCOE TBI/PH Collaboration
• ACMCs Direction to HS and C4I 21 Sep 2009
• USMC Growth 202K/ NavMed Growth FY12
• Mil to Civ Buy Back
• QDR 22Billion Shortfall DHP
• Medical Lay-down Afghanistan

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Shock Trauma Platoon 2nd Battalion/ 7th
Marines After Action Report CDR James Hancock

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