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Current Marine Corps Medical Operations

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Title: Current Marine Corps Medical Operations


1
Current Marine Corps Medical Operations
Director, Health services, Headquarters, U. S.
Marine Corps RADM Richard R. Jeffries
2
IED
3
!!Corpsman Up!!
4
Iraq 2003 - Present
26 Hospital Corpsman KIA
 
5
Afghanistan 2001 - Present
12 Hospital Corpsman KIA
6
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
7
Iraq Today Sustainment and Security operations
11,900 Marines Currently in Iraq
8
Afghanistan Today
10,100 Marines Currently Fighting in Afghanistan
Current Focus of Marine Corps Combat Operations
RC SOUTH
9
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?

10
Our Enemy
11
Evolution of Surgical Capability
12
First Responders
13
Resuscitative Care BAS
GMO Now BAS Surgeon - Future
14
USMC Level I/II Medical THE BIG PICTURE
15
Level 2 Resuscitation
STP Team
FRSS
En-Route Care Team
16
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
17
GATEKEEPER
  • Afghanistan vs. Iraq
  • Expanded Company Operation
  • CASEVAC

18
Mobile Trauma Bay
19
Traumatic Brain Injury
  • Guidelines..return to duty.
  • Misguided.
  • CJCS Gray Team
  • Education
  • Dosimetry
  • Diagnosis
  • Treatment

20
Far Forward Resuscitation
FLET
Mobile Trauma Bay
21
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

22
(No Transcript)
23
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

24
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
25
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

26
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
27
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

28
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

29
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

30
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

31
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

32
Shock Trauma Platoon 2nd Battalion/ 7th
Marines After Action Report CDR James Hancock

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