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Military medical reform is an opportunity to make trauma care better

Army Lt. Gen. R. Scott Dingle, U.S. Army Surgeon General, spoke to surgeons at the Defense Committee on Trauma and Committees on Surgical and En Route Combat Casualty Care Conference held in San Antonio, Texas, on November 13. He spoke about the plans for current and future trauma and surgical initiatives within Army Medicine and that surgeons must be involved in improving trauma care during this time of military medical reform. (U.S. Army Image by Rebecca Westfall) Army Lt. Gen. R. Scott Dingle, U.S. Army Surgeon General, spoke to surgeons at the Defense Committee on Trauma and Committees on Surgical and En Route Combat Casualty Care Conference held in San Antonio, Texas, on November 13. He spoke about the plans for current and future trauma and surgical initiatives within Army Medicine and that surgeons must be involved in improving trauma care during this time of military medical reform. (U.S. Army photo by Rebecca Westfall)

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SAN ANTONIO, Texas – “I am biased, I believe that our Surgeons are the best in the world,” said U.S. Army Surgeon General, Lt. Gen. R. Scott Dingle, at the Defense Committee on Trauma (DCOT), Committees on Surgical and En Route Combat Casualty Care (CCC) Conference on November 13, in San Antonio, Texas.

As a medical recruiting brigade commander, Dingle would go to universities where presidents and deans of the schools would tell him, “Your surgeons are rewriting the standards and practices for trauma care. We are setting up our trauma system on what you do in the military.”

Dingle explained to the audience of Army surgeons that the atmosphere within the pentagon is different for Army Medicine. There is an opportunity to bring real change to how the military handles combat trauma care.

“The CSA said, I need you to come with innovative changes, and that is what the Army Ready Surgical Force Campaign Task Force (ARSFC TF) is working on. We are going to bring change,” said Dingle.

The task force is working to synergize the Army’s ongoing skills sustainment efforts with Department of Defense, Veterans Affairs, and our civilian trauma partners, to serve as medical readiness platforms for surgical skills sustainment. Solutions to continually improve the Army trauma system require a multifaceted, collaborative approach that includes partnerships, training and research investments, and competitive financial incentives to recruit and retain qualified surgeons to fill gaps.

Programs already in place include the Army Military-Civilian Trauma Team Training (AMCT3) partnerships that deliver vital medical training opportunities by embedding a 15 person team in a civilian trauma center for 2-3 years. Agreements are currently in place at Camden, New Jersey; Portland, Oregon; and Milwaukee, Wisconsin, with two additional sites being implemented at Vanderbilt, Tennessee, and Seattle, Washington.

The Army has also implemented the Strategic Medical Asset Readiness and Training (SMART) program which allows teams to train 119 Army medical positions in a two week trauma rotation at programs in Cincinnati, Ohio; Hackensack, New Jersey; San Juan, Puerto Rico; Camden, New Jersey; and Laredo, Texas.

Dingle stated that he is encouraging other approaches including the development of Individual Collective Tasks Lists (ICTLs) and Knowledge, Skills and Abilities (KSAs) that define and quantify the requirements to keep individuals ready to deliver the best trauma care as well as leveraging advancements in simulation and synthetic training to keep medical personnel trained and ready.

“Things are moving at the speed of relevance and if we aren’t relevant to today’s fight, then we’ll become extinct,” said Dingle.

The task force is looking to ensure larger roles and training opportunities in military exercises such as Medical Readiness Exercises (MEDREX) in support of U.S. Army Africa (USARAF), Expeditionary Resuscitative Surgical Team (ERST) in support of AFRICOM, Expeditionary Health Readiness Platform – Honduras (EHRP-H) in Support of ARSOUTH, and Global Health Engagement (GHE) Medical Readiness Training Exercise (MEDRETE) in support of ARSOUTH.

Dingle urged the audience to provide feedback and have honest discussions on how to improve trauma care and surgical readiness. “I can’t change the past but together we can change the future,” said Dingle. “We can get it right, but it’s not me, it’s we. It’s going to take all of us to bring change.”

Following the remarks, Dingle joined Lt. Gen. Ronald Place, Director, Defense Health Agency, and Brig. Gen. Wendy Harter, Commanding General, Brooke Army Medical Center, for a senior leader round table discussion to field questions from surgeons.

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