The Mercury

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The Mercury
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Army Medicine Mercury
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Vaccines, DNA
Hemorrhage -- prevention & control
Hemostatic Techniques
Evidence-Based Practice
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Hantavirus Infections -- prevention & control
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ARMY MEDICINEMERCURY A worldwide publication telling the Army Medicine StoryVolume 44, No. 2 SUMMER 2018


CONTENTS U.S. Army Medical Command TeamLt. Gen. Nadja Y. WestThe Surgeon General and Commanding General U.S. Army Medical CommandCommand Sgt. Maj. Michael L. GraggCommand Sergeant Major U.S. Army Medical CommandU.S. Army Medicine Directorate of Public AffairsCol. Wayne MarottoDirector, Public AffairsCraig DyerDeputy, Public AffairsCourtney DockEditorJennifer DonnellyGraphic DesignerThe MERCURY is an authorized publication for members of the U.S. Army Medical Department, published under the authority of AR 360-1. Contents are not Defense, Department of the Army, or this command. The MERCURY is published quarterly by the Directorate of Public Affairs U.S. Army Medical Command, 2748 Worth Road, Fort Sam Houston, TX 78234-6011. Questions, comments or submissions for the MERCURY should be directed to the editor at: 210-221-7109 (DSN 471-7109), or by email; The deadline is 25 days before the indicated, all photos are U.S. Army photos. MEDICINEMERCURYusarmy.jbsa.medcom.mbx. ArmyMedicine armymedicine


CONTENTS COMMANDER'S CORNER INNOVATIONS KIDS CORNER HEALTH IN OTHER NEWS FEATURES MEDICAL READINESS JULYJuly 4 Independence Day July 27 243rd Army Medical Corps & Army Medicine July 29 Army Chaplain Corps AUGUSTNational Immunization Antiterrorism August 26 Women's Equality DaySEPTEMBERChildhood Obesity September 3 Labor Day September 11 Patriot DayUPCOMING EVENTS3


Our Army is undergoing a transformation. Secretary of the Army Mark T. Esper recently discussed how by 2028, the Army will be fully ready to deploy, ght and win decisively against any adversary, anytime and anywhere in a joint, multi-domain, high-intensity conict. While doing those things, the Army will also be able to simultaneously deter the aggression of adversaries and conduct irregular warfare. As the Army continues to evolve to ght in a complex environment, so to, does Army Medicine. Our focus will continue to be on the readiness of the force. It is what I emphasize when it comes to understanding the strategic environment in which we operate. Our responsibility is to focus on the strategic implications of medical readiness of the force and understanding how every one of us plays an integral part when our Nation calls. A few years ago, I worked with an Air Force colonel who said something during her promotion ceremony that resonated with me. She spoke about why she ser ved so long in the Air Force and that was because she knew and understood how she, and her job, t in the bigger picture. When she was a brand new second lieutenant newly arrived to her rst unit, her supervisor took her over to a large white board. The supervisor showed her where she was within her unit and how it t into the overall National Security Strategy. This story is amazing to me, as I believe that we in Army Medicine all need to know and understand how what we do every day plays a role in the overall success of our Army and our Nation. If you are the one responsible for working in a medical treatment facility (MTF) taking someones vital signs, your job is impor tant. It is your job to explain to the Soldier what those vital signs mean, and relay that information regarding his or her overall health. Maybe you are taking the vital signs of a family member. That fa mily member provides care and support to their deployed Soldier. Your professionalism in the MTF and helping that family member understand his or her overall health will bring peace of mind to the deployed Soldier so that he or she can focus on the mission. Our Army is changing and modernizing and Army Medicine is changing and evolving as well. The Army Medicine vision is nested in the Armys vision and it will remain synchronized. We are the premiere military medical force. We will strive for excellence in everything we do, but we must also be agile and expeditionary. We need to be ready at a moments notice to do things we might not have done before. We need to be resilient, both mentally and professionally, in order to remain responsive and to do what we are asked to do. As Army Medicine professionals, we are more than just medically trained professionals, we also understand the environment in which we operate. We are quiet professionals. We exist to enable the war ghter and to provide medical support in a forward deployed combat environment. We must not lose sight of that. We must remain steadfast in our professionalism and remain focused on supporting the ever-growing needs of the future of our Army and joint forces. Lt. Gen. Nadja Y. WestThe Surgeon General and Commanding General U.S. Army Medical CommandTSG SPEAKS 4MERCURY


Ive spent the last several weeks traveling the Army Medicine foo tprint, meeting with all of our great Soldiers responsible for the care of our operational forces and their families. First and fo remost, thank you to each and every one of you who contribute to the Army Medicine Team. Your hard work and dedication allows us to continue to conserve the ghting strength. What I love most about traveling to each of the dierent commands is meeting and speaking with the Soldiers about pertinent topics within the Army Medicine Department and Enterprise. There have been many spirited conversations about the DHA transition and possible changes to 68 CMF MOS breakdown. One of my biggest take-aways from all of these interactions has been what were doing to lead our NCOs and junior enlisted to the next level in their careers. If youre a Soldier looking to progress in your career eld, one of my answers to you is this: impressions matter and its time to step up your game. Your rst job, the one thats required to uphold the oath of enlistment you swo re to, is being a Soldier. Remember, you are a Soldier rst, who happens to be medically trained. Maintaining your Soldier skills and taking pride in yourself, your unit and your Army is whats required of you every day. Every Soldier, from the sergeants ma Army Medicine legacyjor down to the brand new private, needs to understand that each and every one of you plays an important role in our Army. With each of those roles comes a large responsibility. You are responsible for staying up-to-date on all of your qualications and training. Those requirements are there to ensure you and your fellow Soldiers are ready when the nation calls you to the ght. As Soldiers of Army Medicine, I cannot stress enough the importance of remembering and living up to the legacy of Army Medicine. Your professional development and commitment to service is what makes our Army better. When someone requires our assistance, care or listening ear, your professionalism, duty, and seless service will determine their thoughts. Your impression on them will determine how they view all of Army Medicine. Your everyday interactions is what allows Army Medicine to lead the way as the pinnacle of military medicine. This is your Army, and your enterprise. Its up to you to step up, take the lead, and move Army Medicine to the next level. Your professional development will have an unparalleled impact and contribution to the future of Army Medicine and the Enlisted Medical Corps. As you are celebrating America this 4th of July remember that our Freedom is not free and it demands the most of us and our commitment to preserve it. Happy Birthday America!Command Sgt. Maj. Michael L. GraggCommand Sergeant Major U.S. Army Medical CommandCSM SPEAKS 5MERCURY


The Association of the United States Armys 2018 Annual Meeting is the largest land power exposition and professional development forum in North America. For more than 30 years, the power of this proven show provides military and industry with access to essential professional development, connection building, and the oppor tunity to touch and see a large concentration of machinery, tools and technologies up close on the show oor. Within the exhibit hall, youll nd leading manufacturers, solution providers and suppliers to help you discover new resources and gather important insights on the latest equip ment, products and materials for your needs. The 2018 AUSA Annual Meeting, designed to deliver the Armys message by highlighting the capabilities of Army organizations and presenting a wide range of industry products and services. In addition to the expansive show oor lled with 700+ exhibitors attendees have access to: informative and relevant presentations on the state of the Army panel discussions and seminars on pertinent military and national security subjects a variety of valuable networking events including ticketed dinners and receptions a hands-on opportunity to specify and see the latest technology in action AUSAs Annual Meeting includes the total Army regular Army, guard, reserve, civilians, and family members. It is one of the three key communication platforms employed by the Army to educate and inform government, aca demic, civic, and veteran advocates and leader ship on Army priorities and issues impacting todays Army. Started in 1985, the Army Ten-Miler (ATM) takes place each October in Washington, D.C. to promote the Army, build esprit de corps, support Army tness goals, and enhance community relations. All race proceeds benet Soldier MWR programs. General Registration Opens May 23 at 7 a.m. Open to the general public and military. Learn more at This symposium will provide a venue for collaborative discussion and education on key topics by identifying leading practices and innovations from Joint, Interagency, Intergovernmental, and Multinational (JIIM) organizations and industry partners that will better enable Army Medicine to prepare for future challenges in support of our Army and the Joint Force.AUSA ANNUAL MEETING & EXPOSITION October 8-10, 2018 Walter E. Washington Convention Center, Washington, D.C. ARMY MEDICAL SYMPOSIUM & EXPOSITION June 26-27, 2018 Henry B. Gonzalez Convention Center San Antonio, TXARMY 10-MILER October 7, 2018 Pentagon, Washington, D.C. UPCOMING EVENTS THROWBACK Feedback is important to us. We at the MERCURY welcome any feedback on how we can improve. If you enjoyed reading content or have story ideas, please forward comments and suggestions to our e-mail inbox at: Your recommendations may be published in a future edition of this publication. 6


to San Antonio, whether for courses or clinical rotations at BAMC as a medical student. Morgan served in the Joint Special Opera tions Command at Fort Bragg, and went on to become the battalion surgeon for the 1st Battalion, 3rd Special Forces Group. He then embarked on a special operations assignment in Washington, D.C., before completing his sports medicine fellowship. In 2011, Morgan saw an announcement that NASA was selecting another astronaut class. "I had always been interested in space exploration, but gured I didn't have the right background," he explained. "But I decided to give it a shot anyway." The selection process took more than 18 months and involved extensive interviews, medical testing and language aptitude testing. With an initial 120 interviewees, NASA eventually narrowed the group to eight astronaut candidates. Morgan vividly recalls when he received the good news from former astronaut and chair of the selection board, Dr. Janet Kavandi. "Her rst question in the phone call was, 'We wanted to know if you'd like to come to Houston and join our team?'" Morgan recalled in a 2013 article. "I couldn't believe it; the thought that I had been chosen choked me up. It was surreal." The selection involved a relocation to Johnson Space Center in Houston where Mor gan was slated to start the two-year astronaut candidate training program in July 2013. Once his wife and four children were settled in, the Army ocer began to search for a hospital where he could maintain his medical credentials. BAMC immediately came to mind. "They welcomed me to the sta," he said. "It was incredibly important to me that I maintain my credentials and my military rea diness. It's a huge treat for me to make perio dic visits to BAMC and interact with residents, service members, patients, military retirees and combat veterans. Fort Sam Houston is the home of military medicine, so it feels like home to me." Over the two years following his selection, Morgan's training transported him from physician to astronaut. Candidate training included ight training, Russian language prociency, extra-vehicular activity (space walking), robotics and space station systems and maintenance. "Everybody gets trained to do everything, no matter what your professio nal background might be," he explained. Aer candidate training, Morgan focused his attention on spacesuit development and researching injuries caused by spacesuits. Now assigned to a ight, he'll undergo in-depth refresher training over the next year to prep him for his upcoming trip. Morgan cites his military experience and training as keys to his success. "At the core, I was selected as an astronaut because they saw a unique set of skills. Everything I brought to the table was given to me by the Army -my undergraduate and graduate education, residency, and operational experiences." Army Col. Bret Ackermann, BAMC's deputy commander for surgical services, has ser ved alongside Morgan in past assignments for more than a decade. "We are all very proud of Drew and his well-earned success," he said. BAMC Commanding General Brig. Gen. (Dr.) George N. Appenzeller, a fellow emer gency medicine physician, is also aware of Morgan's stellar reputation. "Drew's service and leadership is always about the team..... his patients, colleagues, and their families. We are looking forward to his leadership from space next year." You can follow Morgan on social media at:,, and While many have reached for the stars, a physician who calls Brooke Army Medical Center home is aiming to be the rst Army doctor in space. NASA announced last week that Lt. Col. (Dr.) Andrew Morgan, a NASA astronaut and emergency physician credentialed at BAMC, has been assigned to Expedition 60/61, which is set to launch to the International Space Sta tion in July 2019. "Joint Base San Antonio and the San Anto nio community have been part of my life since childhood," Morgan said. "When I y in space, I'll be taking Army history, military medicine and this supportive community with me. I'm hugely honored to represent all of that." Morgan became the rst Army Medical Corps ocer selected as an astronaut aer an arduous selection process in 2013. Aer ve years of training, the ocer will make his rst voyage to the space station next year on a Russian Soyuz rocket and spacecra alongside an Italian astronaut and a Russian cosmonaut. Once on board the ISS, he'll join American astronaut Christina Koch and her Russian cosmonaut crewmate who will launch to the ISS in April 2019. While Morgan is excited about the oppor tunity to conduct experiments and explore the station, "I'm most looking forward to ga zing down at the Earth and doing a few spa cewalks," he said. Morgan's upcoming journey to Earth's or bit is a path paved in his childhood, when a love for science, history and military aviation sparked an interest in space exploration. He recalls living in San Antonio in the mid-1980 when his father was a dental resident at La ckland Air Force Base, Texas. "I was in third and fourth grade at Braun Station Elementary School at the height of the space shuttle program," he said. "When the space shuttle flew piggyback on a 747 between Florida and California, it occasionally stopped in San Antonio while en route, and from our home near Leon Valley, we could often see this incredible sight as it made its final approach into Kelly AFB. I remember it distinctly and it made a lasting impression on me." While inspired by space, Morgan's expo sure to the military as an Air Force "brat" tipped him in a dierent direction. He decided to pursue an Army career and earned his ba chelor's degree in environmental engineering at the U.S. Military Academy at West Point, followed by a doctorate of medicine from the Uniformed Services University of Health Sciences. His career circled back periodically By Elaine Sanchez, Brooke Army Medical Center Public Aairs and emergency physician credentialed at Brooke Army tion in July 2019. (Photo credit: NASA photo) 7


Know How to Protect Yourself Zika virus (Zika) is one of several infections transmitted by the Aedes mosquito, which also transmits Dengue and Chikungunya. It is also possible to spread Zika through blood transfusions and sexual contact. The best way to prevent Zika is to prevent mosquito bites. No vaccine or specic treatments are available to prevent or treat Zika. The American Red Cross is asking people to avoid donating blood if they traveled to Latin America or the Caribbean in the past 28 days. Until more is known, if your sexual partner has traveled to or lives in an area with active Zika virus transmission, you should abstain from sexual contact or correctly use condoms everytime you have vaginal, anal, and oral sex for the duration of the pregnancy. BLOOD TRANSFUSIONS SEXUAL CONTACT What is Zika virus?With proper precautions, Zika is not expected to pose a health risk to troops. Due to a potential connection with birth defects, pregnant women should avoid exposure. Zika is common in areas of Africa and Asia. Most recently, it has been rapidly spreading in South and Central America. The virus is expected to spread to nearly all countries in the Americas. Where is it found? What can you do to protect yourself?The best way to prevent Zika is to prevent mosquito bites. No vaccine or specic treatments are available to prevent or treat Zika. CIVILIANS AND OFF DUTY SOLDIERS: Minimize time outside when mosquitos are active. Empty water from containers such as garbage cans, wading pools and ower pots. Control mosquitoes around the home by eliminating standing water where mosquitoes breed. Wear long-sleeved shirts and long pants. Stay in places with air conditioning or use screens that keep mosquitoes outside. Use DEET or picaridin insect repellent on exposed skin. Treat clothing and gear with permethrin or buy permethrin-treated items.COVER CONTAINERS CLEAR CLOGGED GUTTERS EMPTY WATER CONTAINERS During pregnancy Zika may pass from mother to baby. Some women infected with Zika while pregnant have had babies born with microcephaly, a condition where a baby is born with an abnormally small head and incomplete brain development. Studies are underway to learn more about the spread of Zika from mother to baby and the risks of Zika infection during pregnancy.FEVER RASH JOINT PAIN CONJUNCTIVITIS RED EYES About 1 in 5 people infected with Zika becomes ill. The illness is usually mild and symptoms last from several days to a week. Recently, Zika infection has been linked to Guillain-Barr syndrome and to infants born with birth defects. 0.5% permethrin spray can NSN 6840-01-278-1336 IDA kit NSN 6840-01-345-0237Women who are pregnant (in any trimester) should consider postponing travel to any area where Zika virus transmission is ongoing. If you must travel to one of these areas, talk to your doctor rst and strictly follow steps to prevent mosquito bites during your trip. Use of approved insect repellents is safe during pregnancy. Speak with your healthcare provider to discuss the risk of infection with Zika. The ACU with permethrin is safe to wear; however, if you are pregnant, nursing, or trying to get pregnant you are authorized to temporarily wear an ACU without permethrin. If your uniform is not treated with permethrin (maternity or untreated ACU) and you and your healthcare provider decide that wearing an ACU with permethrin is the best choice, you can learn how to treat your ACU by visiting: When applying permethrin, always read and follow the label directions. Note: If you are pregnant and live or work in an area with active Zika transmission, then talk to your chain of command. All Army medical facilities have been notied of the concerns surrounding Zika infections and are prepared to assist patients who may have been infected. More information Connect with us! #ZikaVirus Follow us on Facebook Follow us on Twitter TA-342-0216Approved for public release, distribution unlimited. What are the symptoms? What are the dangers for pregnant women? Pregnant, nursing, or trying to get pregnant? Normal head size Child with microcephaly SOLDIERS SHOULD USE THE DOD INSECT REPELLENT SYSTEMWear a factory-treated Army Combat Uniform (ACU Permethrin). Check the tag in your uniform to conrm it is factory-treated. The Army Physical Fitness Uniform (APFU) is not treated with permethrin. Apply DEET or Picaridin repellent to exposed skin. Properly wear your uniform: tuck trousers into boots and undershirt into trousers, and wear sleeves down and snugly fastened Sleep inside a permethrin-treated bed net.


Tips if your child has a feverBy Dr. Grace Chen O'Neil, Tripler Army Medical Center Department of Emergency MedicineHEALTH Fevers can be a concerning symp tom for parents. Your child may not act like their normal self when they have a fever. They may be more fussy and irritable. They may be more tired than usual, have a poor appetite, and they may experience other symptoms associated with an infection that they are ghting such as a sore throat, stuffy nose, cough, vomiting, diarrhea, or ear pain. A fever stops the growth of dangerous bacteria and viruses and is usually not dangerous; it is oen a symptom of another problem. Most fevers are of short duration and actually protect the child from infection. It is usually the body's reaction to an infection or other illness. The brain will raise the body's temperature to combat the illness. The fever itself oen does not cause long-term brain damage. Everyone has their own regular body temperature, which is usually around 98.6 degrees Fahrenheit, plus or minus one degree. Most people have some change in their body temperature during the day. It is generally lower in the morning and higher at night. It can also increase when children run around and exercise. Smaller infants can get fevers if they are in a hot environment or wearing too much clothing because their temperature regulation is not well developed yet. Children can also get a fever aer getting immunizations, and teething might cause a slight rise in body temperature but likely is not the cause of a temperature higher than 100 degrees Fahrenheit. A rectal temperature of 100.4 degrees Fahrenheit or more is a fever. The most important things to do if your child has a fever is to improve your child's comfort by doing several things: Most people feel better when a fever is treated with medications that reduce the temperature, such as Tylenol or Motrin. (Motrin should only be given to children older than six months of age. Please read instructions on the bottle or ask your doctor for dosing.) Children will feel the eects of the medica tion in about 30-60 minutes aer administration. Motrin and Tylenol can be given at the same time since they are dierent types of medications. More children maintain more relief when both medications are given rather than when one medication is given alone. Motrin is given every six to eight hours, and Tylenol is given every four to six hours. However, there is no need to wake your child up from sleep to administer medication for fever if your child is comfortable sleeping. Children with a fever usually have a faster than average heart rate and breathe faster than normal. So make sure your child is well-hydrated and getting plenty of uids to avoid dehydration because a fever will cause more uid loss. Reasons to see the doctor right away include: 1. Your child has been in a hot place such as a closed car in the summer. 2. Your child has a sunken so spot on their head, cannot tolerate uids, has not made a wet diaper for a long time, or has other symp toms of dehydration. 3. Your child looks very ill, is inconsolable, or unusually sleepy. 4. Your child is taking steroids or has an illness that compromises the immune system such as sickle cell disease or cancer. 5. Your child is younger than three months. 6. Your child has a severe headache and sti neck, cannot swallow or has a rash. 7. Your child has a seizure. 8. Your child is having diculty breathing. Please make an appointment with your child's doctor if your child seems to be getting worse despite the fever being brought down, or if the fever persists more than 24 hours in a child younger than two years old, or persists more than three days in a child older than two years old. There are multiple ways to schedule an appointment for your child if needed, at your convenience. You can schedule a variety of appointments at any time online by visiting the TRICARE Online Patient Portal at, or call your local appointment line to schedule an appointment. To reduce unnecessary appointments and stress you can communicate virtually and directly with your health care team by accessing the RelayHealth Patient Portal at Nyan Schoeman, left, licensed practical nurse at the Tripler Army Medical Center, TAMC, Pediatric, Adolescent Thomas). 9


Plastic surgeons at William Beaumont Army Medical Center successfully transplanted a new ear on a Soldier who lost her le ear due to a single-vehicle accident. The total ear reconstruction, the rst of its kind in the Army, involved harvesting cartila ge from the Soldier's ribs to carve a new ear out of the cartilage, which was then placed under the skin of the forearm to allow the ear to grow. "The whole goal is by the time she's done with all this, it looks good, it's sensate, and in ve years if somebody doesn't know her they won't notice," said Lt. Col. Owen Johnson III, chief, Plastic and Reconstructive Surgery, WBAMC. "As a young active-duty Soldier, they deserve the best reconstruction they can get." The revolutionary surgery has been over a year in the making for Clarksdale, Mississippi native, Pvt. Shamika Burrage, a supply clerk with 1st Battalion, 35th Armored Regiment, 2nd Brigade Combat Team, 1st Armo red Division. In 2016, while returning to Fort Bliss, Texas, aer visiting family in Mississippi, a tire blowout changed Burrage's life in an instant. "I was coming back from leave and we were around Odessa, Texas," said Burrage, who was traveling with her cousin. "We were driving and my front tire blew, which sent the car o road and I hit the brake. I remember looking at my cousin who was in the passenger seat, I looked back at the road as I hit the brakes. I just remember the rst ip and that was it." The vehicle skidded for 700 feet before ipping several times and ejecting the Soldier. Burrage's cousin, who was eight months pregnant at the time, managed to only suer minor injuries while Burrage herself suered head injuries, compression fractures in the spine, road rash and the total loss of her le ear. "I was on the ground, I just looked up and (her cousin) was right there. Then I remember people walking up to us, asking if we were okay and then I blacked out," said Burrage, whose next memory was waking up in a hospital. She was later told by doctors that if she on Soldier's forearmBy Marcy Sanchez, William Beaumont Army Medical Center would not have received medical attention for 30 more minutes, she would have bled to death. Aer several months of rehabilitation, Burrage began to seek counseling due to emo tions caused by the accident and its eects on her appearance. "I didn't feel comfortable with the way I looked so the provider referred me to plastic surgery," said Burrage. "She was 19 and healthy and had her whole life ahead of her," said Johnson. "Why should she have to deal with having an articial ear for the rest of her life?" When explained her options for reconstruction, Burrage was shocked and initially resistant to go through with the total ear reconstruction. "I didn't want to do (the reconstruction) but gave it some thought and came to the conclusion that it could be a good thing. I was going to go with the prosthetic, to avoid more scar ring but I wanted a real ear," said Burrage, who is now 21. "I was just scared at rst but wanted to see what he could do." In order to avoid any more visible scar ring, Johnson selected prelaminated forearm free ap, which involved placing the autolo gous cartilage into the patient's forearm to allow for neovascularization, or the forma tion of new blood vessels. This technique will allow Burrage to have feeling in her ear once the rehabilitation process is complete. "(The ear) will have fresh arteries fresh veins and even a fresh nerve so she'll be able to feel it," said Johnson. In addition to the transplant, epidermis from the forearm, while attached to the ear, will cover up scar tissue in the area immedia tely around Burrage's le jawline. "I didn't lose any hearing and (Johnson) opened the canal back up," said Burrage, whose le ear canal had closed up due to the severity of the trauma. "The whole field of plastic surgery has its roots in battlefield trauma," said Johnson. "Every major advance in plastic sur gery has happened with war. This was trauma related." With only two more surgeries le, Burra ge states she is feeling more optimistic and excited to nish the reconstruction. "It's been a long process for everything, but I'm back," said Burrage.INNOVATION "She was 19 and healthy and had her whole life ahead of her," said Johnson. "Why should she have to deal with having an articial ear for the rest of her life?"10 10


Brig. Gen. Bertram Providence, Regional Health Command-Pacific Commanding General, inducted three new members into military medicine's prestigious Or der of the Military Medical Merit, or O2M3, during a ceremony at Tripler Army Medical Center April 26, 2018. The O2M3 recognizes people who have ser ved in an Army Medical Department for at least 10 years, and through selessness, have made a sustained contribution to the betterment of Army Medicine. These individuals demonstra te high standards of integrity, moral character and professional competence. The O2M3, founded in 1982 by the U.S. Army Health Service Command commanding general, recognized excellence and promotes fellowship and esprit de corps among Army Medicine members. According to Providence, an O2M3 ceremony is a time of reection and a ceremony he really enjoys. "I remember who inducted me into the order. It was a dear friend who died in Iraq," he said speaking of Col. Brian Allgood, who has an Army hospital named in his honor in Korea. "It was such a special moment for me having him do it. We were partners together. We were both orthopedic surgeons. We worked together at Fort Bragg (North Carolina) and the ability to serve with him in Korea has always been a very special time for me." Providence said he was honored to be part of an O2M3 ceremony and "induct some very special people into our order." Col. Andrew Leiendecker, RHC-P assistant chief of sta for operations, demonstrated professional excellence, national prominence and exceptionally meritorious service throughout his 26-year career. He's described as an exemplary Soldier and professional whose innovative and extraordinary contributions will have a lasting impact on Army Medicine. In addition, as the rst medical operations ocer at the NATO Special Operations Headquarters in Mons, Belgium, Leiendecker established NATO doctrine that dened NATO special operations forces medicine standards for all NATO allied and partner nations. He created and resourced medical courses on subjects such as medical planning, prolonged eld care, combat medical simulation training and medical partnering and engagements. He also designed a $1.5 NATO SOF allied center for medication education, the rst of its kind in direct support of NATO. Sgt. 1st Class Erron Alor, RHC-P equal opportunity advisor, is described as helping shape the Army Medical Department. His lega cy of hundreds of well-developed leaders coupled with leading three major programs and initiatives have changed the way organizations do business across the Army. While assigned to 18th MEDCOM in Korea, Alor spearheaded the relocation of two MEDEVAC companies to Fort Campbell, Kentucky, improving the ability to evacuate patients in the Global War on Terrorism. This was the largest movement of air medical assets since World War II. Additio nally, he served as the U.S. Army Central lead on nine medical theater security cooperation engagements, improving partner nation medical capabilities, signicantly contributing to Army Medicine by enhanced relationships with 375 key leaders and improving medical capabilities of partner countries. Sgt. 1st Class Fulton Winder, RHC-P operations noncommissioned ocer, has a track record of superior performance through his 13-year career in Army Medicine. Early in his career during the Iraqi surge, while assigned as a line medic supporting Charlie Company 5-73rd RECON (ABN), also known as Task For ce 300, Winder coordinated the training and certication of 30 Soldiers in the Combat Lifesaver course. His ability to forecast healthcare needs played an instrumental role in keeping his unit medically ready during their 15-month deployment. More than half of the Soldiers in his platoon and more than 40 percent of the Task Force received Purple Hearts. Due to Winder's eorts, they were able to remain in the ght and continue their mission. In all, he par ticipated in 13 named combat operations and numerous combat patrols treating hundreds of real world casualties while under re. "It's a great week for the region," said Sgt. Maj. Larry Reyes congratulating the inductees. "That ribbon that all three of you are wearing and that medallion, it represents what you've contributed to the AMEDD and the outstanding things that you've done. You've made major impacts ... and continued to improve the medical corps daily. You are an incredible team to work with." ny at Tripler Army Medical Center April 26, 2018. (U.S. Army photo by Cody Ford). By Amy Parr, Regional Health Command PacicTHREE RHCP MEMBERS INDUCTED INTO ORDER OF MILITARY MEDICAL MERIT11


Breastfeeding has been shown to have numerous benets for both the infant and mother. Infants receive active immunoglobulins, also known as antibodies, through breastmilk. Babies who are breast-fed have fewer respiratory infections, gastrointestinal infections and ear infections. Although breastfeeding may not be for all new mothers, the doctors and nurses at Eisenhower Army Medical Center work diligently to encourage and support breastfeeding families. In June 2017, EAMC began delivering its infants at Doctors Hospital of Augusta. Doctors Hospital is the rst hospital in the Central Savannah River Area to have the prestigious accreditation as a Baby-Friendly birthing center. This important designation recognizes hospitals and birthing centers that oer an optimal level of care for infant breastfeeding and mother/baby bonding. From the start, families are oered breastfeeding information, condence and skills needed to successfully initiate and continue breastfeeding their babies. Breastfeeding decreases the incidence of chidhood allergies, eczema and even certain forms of leukemia. Mothers who breast-feed lose their pregnancy weight more quickly and have a decreased incidence of both ovarian and breast cancer. Breastfeeding also strengthens maternalinfant bonding and decreases the incidence of postpartum depression. The American Academy of Pediatrics recommends breastfeeding exclusively for the rst six months and continued breastfeeding until at least the rst year of life. In EAMCs clinics, the sta continues to be strong breastfeeding advocates and educators. Many nurses attended a lactation training course this past fall. There are now nine lactation counselors/consultants at EAMC, more than any pediatric practice in the CSRA. New mothers are oered lactation consult-ations at each visit and EAMC also has walk-in hours available for lactation help. The physicians in both the Family Medicine Clinic and the Com-Breastfeeding allowed anywhere at EAMC including two dedicated areasmunity Care Clinic have also received extensive training on breastfeeding support and education. Last February EAMC sponsored a daylong breastfeeding seminar for physicians, hosted by the Georgia American Academy of Pediatrics. Ninety percent of the sta that cares for newborns attended. Physicians also receive continued lactation education through the lactation program at Doctors Hospital. Eisenhower fully sup -ports Georgia state law, Ga. Code An. 31-1-9, that supports a mothers right to breastfeed her baby wherever she and her baby are legally authorized to be. (See the sidebar for details.) Additionally, EAMC oers two breastfeeding and pumping rooms one in the FMC clinic on the second oor, and one on the 10th oor and an additional room is always available in the CCC, if mothers would prefer this space. EAMC also has adapter kits for mothers to hook up to hospital-grade pumps if they desire or, preferably, the sta can work with mothers with their own pumps so they can increase their comfort. Tricare will pay for a breast pump with a prescription lled out by the mothers obstetrician. Mothers are also welcome to breastfeed openly anywhere they choose in the hospital or the hospital grounds. It is important to give mothers all the support and encouragement they need to give their newborns this important benet. The decision whether or not to breastfeed is complex and should be made by the mother herself with help from their physician as needed. Some mothers are unable to breastfeed for a variety of reasons including inadequate supply, the need to be on a medicine unsafe for breastfeeding, need for radiation therapy, or infant with digestion diculties or any other medical condition incompatible with breastfeeding. The Eisenhower care team understands that exclusive breastfeeding is not always the best option for all mothers and will work extensively with each family to come up with the feeding plan that is best for the infant and the mom in all situations. The most important goal is for the mother to take care of herself medically and physically so she can enjoy and care for her beautiful new baby. Check with your local military treatment facility for breastfeeding resources available. Editors note: Dr. Mary Lewis Black is a board-certied fellow of the American Academy of Pediatrics and is the chief of Pediatrics for Eisenhower Army Medical Center. She also is the mother of two boys who she successfully breastfed for the rst year of their lives. By Mary Lewis Black, M.D., Chief of Pediatrics, Eisenhower Army Medical Center 13


met the highest standards of care and patient sa fety through a rigorous evaluation of the adequa cy of the facility, equipment, sta and training to ensure that the utmost quality is maintained within the specialty. The Accreditation Council of the UHMS has a new set of objective criteria that must be met for a hyperbaric facility to be accredited "with distinction." For a hyperbaric facility to be accredited WD, the facility must achieve a minimum score of 6 out of the available 10.5 points. "I'm very proud of the work my folks have done." Richards said. "We have a tradition of ear ning accreditation with distinction, but this sur vey was extra special since we had the challenge of moving to a new facility and the criteria for achieving the 'with distinction' designation are more stringent." The clinic houses a multi-person chamber to accommodate up to six patients at one time. It is pressurized with air and patients breathe oxygen underneath a hood or with a mask. Generally, a treatment plan will consist of 90 minutes of hyperbaric oxygen daily for six weeks or more. While in the chamber, patients can recline in a comfortable chair and watch TV or read. A single chamber is also available for an individual patient to receive treatment. The facility was built so that an additional multi-person can be added if needed in the future. According UHMS, hyperbaric oxygen is an intervention in which an individual breathes near ly 100 percent oxygen while inside a hyperbaric chamber that is pressurized to greater than sea level pressure. "While hyperbaric chambers have been around for a few hundred years, hyperbaric oxygen is a more recent treatment," Richards explained. "Initially, patients were simply treated in pressurized rooms, but they just breathed air. In the 1800s, we knew that breathing oxygen under pressure could be toxic, so we avoided it. In the 1930s, some investigators began looking into using oxygen under pressure and developed safe protocols for its use." The hyperbaric mission moved from Wilford Hall Ambulatory Surgical Center to BAMC in June 2017. Richards credits the support of BAMC sta and leadership. "We couldn't have done this without BAMC support," he said. The Undersea & Hyperbaric Medicine Clinic at Brooke Army Medical Center received a four-year reaccreditation with distinction from the Undersea & Hyperbaric Medical Society last month. "Achieving this signicant milestone reects you and your organization's commitment to excellence," stated a letter from Derall Garrett, UHMS director, to Air Force Col. (Dr.) Michael Richards, Undersea & Hyperbaric Medicine Ser vice chief, here. "The surveyors were impressed with our comprehensive checklists and checklist discipline," Richards said. "All three surveyors were generally extremely impressed with the physical structure, the sta, and our operations." UHMS is an international nonprot associa tion formed in 1967, which serves about 2,000 physicians, scientists, associates and nurses from more than 50 countries in the elds of hyperbaric and dive medicine. The Joint Commission and UHMS have a complementary accreditation agreement. Under the agreement, hyperbaric medicine is still responsible for maintaining TJC standards. A UHMS Accreditation means the facility has Undersea & Hyperbaric Medicine By Lori Newman, Brooke Army Medical Center Public Aairs INNOVATIONS 14


However, DoD employees may not participate in any political activity while on duty or in a federal building; use the insignia of a government office while participating in political activities; solicit, accept or receive political contributions; display campaign photos, posters, bumper stickers, or other campaign material in a federal building; engage in political activity while using a gover nment vehicle; host a fundraiser for a partisan candidate; or run for public office in a partisan election. Most General Schedule employees are not restricted by additional guidelines, and therefore may participate in a variety of other activities, such as volunteering with a partisan campaign while off duty, attending political rallies and meetings, and volunteering at the polls on Election Day. However, individuals appointed by the president and confirmed by the Senate, career and non-ca reer members of the Senior Executive Service, contract appeals board members and all employees of the National Security Agency, the Defense Intelligence Agency and the Na tional Geospatial-Intelligence Agency are further restricted and may not participate in any partisan campaign activities. As social media has become a major mode of communication, employees should also be aware of the Hatch Act as it applies to po litical activities conducted on social media. Employees may not: 1) tweet, retweet, share or like a post or content that solicits political contributions; 2) like or follow the social media page of a candidate or partisan group while on duty or in the workplace; or 3) use their social media account while in their official capacity to engage in political activity. Finally, employees should understand that they may not engage in political activity via social media (e-mail, blog, tweet, post) while on duty even if using a personal device or email account. This means that employees may not like, follow, tweet, retweet or share a post while "teleworking," even if the employee is using his or her own per sonal device or email account in their own home. Active-duty service members have restrictions not applicable to civilians. Military rules on partisan activities are outlined in DoD Directive 1344.10, Political Activities by Members of the Armed Forces. The penalties for violating the Hatch Act are severe, and employees should seek advice before participating in any questionable activities. Employees should contact their local Office of General Counsel with specific questions. To view a full copy of the Hatch Act at html/USCODE-2010-title5-partIII-subpartF -chap73-subchapIII.htm. With the 2018 election season in full swing, people are getting involved in political activities and supporting their favorite party or candidate. However, federal employees need to be aware of legal restrictions on their political activity set forth in the Ha tch Act. The Hatch Act governs the political activity of employees in the executive branch, which includes all Department of Defense employees. Specifically, the Hatch Act for bids activity directed at the success or failure of a political party, a partisan political candidate or a partisan political group while the employee is on duty or in a federal building. The purpose of the Act is to protect employees from coercion about how they vote and to assure the public that the government is being run in a nonpartisan manner. Thus, there are many political activities employees may engage in while off-duty and on their personal time. In general, all DoD employees may vote, express personal opinions about candidates or issues, make monetary contributions to a political campaign or candidate, display a political bumper sticker on a personal vehicle, attend political events and participate in nonpartisan activities not specifically identified with a political party. Political discussions among coworkers are also permitted as long as the discussions are casual and do not include any person trying to convince others to adopt partisan political ideas or support a certain candidate or party. Hatch ActWhat you need to know 15


Prior to the eld exercise, residents participa ted in classroom and simulation training that reviewed the M.A.R.C.H. algorithm -massive hemorrhaging, airway, respiration, circulation and head injury/hypothermia -used for assessing a patient in a trauma situation. Maj. (Dr.) Jerey Burket, a family medicine physician at Madigan who was involved as faculty for the FTX, stressed that the residents need to rely on that algorithm because, "Nobody gets smarter in an emergency." The mission for the residents was complex. In congurations of eight teams of four to ve residents and a nurse, they collected and prepared their equipment, received a mission brief and rolled out. At Leschi Town, the teams worked along one of two lanes that lead them through the continuum of care from point of injury to a combat support hospital or MTF. With the 1SFG Soldiers, they performed a care under re tactical eld care urban patrol, administering tactical combat casualty care (TCCC) throughout, moving through the dierent levels and roles they are likely to nd in a deployed situation -a casualty collection point (CCP), batta lion aid station (BAS) and forward surgical team (FST). In addition to the care on the ground, they loaded, unloaded and performed medical inter ventions on casualties with various aircra to include a UH-60 Blackhawk, a CH-47 Chinook and walking through a C-17 Globemaster III, a critical care air transport craFort They also treated their patients in a Stryker ambulance. In assessing the exercise once complete, residents and faculty agreed it displayed how vital teamwork and communication are. Sta Sgt. Virgil, an "18 Delta" or Special For ces medical sergeant with 1SFG, said the exercise showed, "How much you have to rely on people that you go to support." Maj. (Dr.) Michael Braun, ight surgeon with the WAANG's 66th TAC, explained, "When we're deployed, we're all the same unit." While a two-day exercise could never prepare a doctor for an operational situation, it did give a realistic view of what a day downrange could be for them. They dealt with equipment breakdown, running out of supplies and a need to improvise. Speaking to all those points, Braun said, "The training was more realistic than you guys would imagine." Throughout the week, the eld exercise and the eight months it took to plan the event, rela tionships were established and strengthened. Relationships that will be relied upon for years to come. "That's how the Army works -you could call one of us ve years from now and we'll say, 'Yeah, what do you need?'", said Braun, the main link to all the units involved. At JBLM since 2008, Braun has been assigned to 1SFG, Madigan and brought his current unit, the 66th TAC, their Blackhawks, Chinooks and expert aviators to the exercise. Lt. Col. (Dr.) Christine Vaccaro, Sim Center director, was one of a number of facilitators for the event to point out its training capacity. "This event is very unique, no other (medical center) has this. It's a benet for our residents and the other units as well. Mutually benecial is our wa tchword," she said. As Braun and Col. (Dr.) Imad Haque, surgeon and deputy director of the Sim Center, both added, all units were accomplishing their own training objectives within this exercise. Haque oered the example of the 62nd MED Many Army doctors may spend a fair amount of their careers practicing medicine in a large MTF (military treatment facility). But, what they must always be ready for is rendering life-saving care in the most austere of environments -of caring for the Soldier down range. For all the care they give in garrison, the Soldier on the battleeld is their ultimate priority. "You may be an excellent provider or phy sician within your MTF, but when you go into operational medicine, that's a whole dierent area of practice," said Lt. Col. Thomas Bryant, Interservice Physician Assistant Program Phase II coordinator and deputy director of operational medicine at Madigan Army Medical Center. Over the last eight years, Madigan's Graduate Medical Education and the Andersen Simula tion Center (Sim Center) have been staging and expanding a culminating event, known simply as "Capstone", that ends with a eld training exercise (FTX). This year's event, which spanned April 23 through 27, provided graduating residents at Madigan a chance to understand what operational medicine performed in a tactical setting is like. This year's FTX involved units across Joint Base Lewis-McChord to include the 1st Special Forces Group (1SFG), 62nd Medical Briga de (62nd MED BDE), 7th Infantry Division, the 66th Theater Aviation Command (TAC) with the Washington Army National Guard (WAANG), and the U.S. Air Force's 446th Aeromedical Evacua tion Squadron. "The entire experience was extremely humbling and eye-opening. I've been in the Army for nearly 18 years now, and I've never really experienced that specic aspect of it. Trying to do the job the medics do -it's not an easy job. It just gave me even more appreciation for what the medics do to get that patient to me so I can cut them open and x them," said Capt. (Dr.) Geor ge Black, a surgical resident following a week of professional, simulation and eld training that culminated in the FTX. A substantial development over previous events -the inclusion of 1SFG -resulted from feedback from last year's exercise that expressed a need for more weapons familiarity and tactical exposure. The 1SFG also enabled the use of JBLM's premier training site -Leschi Town.Residents get ready for operational medicineBy Kirstin Grace-Simons, Madigan Army Medical Center Graduating residents at Madigan Army Medical Center are supported and lead by personnel from 1st Special to practice their medical skills in an operational setting. (U.S. Army photo by Ryan Graham).MEDICAL READINESS 16


exposure to other units and their personnel's ro les. "That entire concept is one of the main rea sons this is such a big deal to us as an organiza tion," explained Virgil. 1SFG brought the concept to life, infusing it with more realism than it had in previous iterations. "We took Col. Haque and Lt. Col. Vacca ro's concept and did the (noncommissioned officer) job of actually putting it down on a piece of paper step-by-step to validate the feasibility of actually doing those concepts," explained Virgil. Braun would like to see this become a launching pad for future training eorts. "We hope to model it for other states and other MTFs," he said. As Madigan's graduating residents leave the well-stocked hospital as they are assigned to other locations, some operational and austere, they will have a greater appreciation of all these other assets that play a role in Army Medicine. They will also now have a sense of what downrange medicine will include. Editor's note: Due to the mission of Special Forces Soldiers, some members of the 1st Special Forces Group (Airborne) do not release their full names. BDE's 102nd FST involvement. Their unit stood up and broke down the FST and provided that portion of training each day. This provided a validation of their own readiness for their upcoming deployment in the next month. From the 1SFG's perspective, the exercise t right in with their interest in joint training. "Any opportunity we have to work with conventional forces means that that relationship down the road is one that we can take advanta ge of later and the relationship is already there," said Virgil. In addition to the training element, every unit found this opportunity appealing because of the Do you have TRICARE Retiree Dental Pro gram (TRDP) coverage now? If so, then you need to know that the TRDP will end on Dec. 31, 2018. Not to worry Anyone who was in TRDP this year or would have been eligible for the plan will be able to choose a dental plan from among 10 dental carriers in the Federal Employees Dental and Vision Insurance Program (FEDVIP). You can begin reviewing program options now at vip. You'll be able to enroll in FEDVIP during the 2018 Federal Benets Open Season, which runs from Nov. 12 to Dec. 10, 2018; coverage will begin on Jan. 1, 2019. At some point, you may need specialty care that your primary caremanager (PCM) or general physician can't provide. He or she may refer you to a specialty provider, like a cardiologist, dermatologist orobstetrician. Under some TRICARE programs, you may need a referral or prior authorization from your PCM to seek care from a specialty provider. Read the full article at Sign up for TRICARE email updates at Connect with TRICARE on Facebook and Twitter at and Previously, FEDVIP wasn't available to Department of Defense beneciaries, but it will now be available to those who would have been eligible for TRDP. As an added bonus, they will also be able to enroll in FEDVIP vision coverage, along with most active duty fa mily members. More than 3.3 million people are currently covered by FEDVIP. You can choose from dental plans oered by 10 dierent carriers. To enroll in FEDVIP vision, you must be enrolled in a TRICARE health plan. You can decide if one of four vision plans meets your family's needs. TRICARE Young Adult enrollees are not eligible to enroll in FEDVIP vision. You may only enroll in a FEDVIP plan out side of open season if you experience a Qua lifying Life Event that allows you to do so. Any election in a FEDVIP plan remains in eect for the entire calendar year. For more information, visit the FEDVIP website at and sign up for email notications. You'll get an email when new information is available and key dates approach. Future updates will include eligibility information, plans, carriers, rates, educational webinars and more. Take Command: Changes Coming to the TRICARE Retiree Dental ProgramAs of 3/19/2018Seeking Referrals or Prior Authorizations for Specialty Care with TRICARE5/25/201817


Participants in the 2018 Annual Military Veterinary Research and Development Short Course completed another successful year by wrapping up their course in Silver Spring, Maryland, April 9-13. Sponsored by the U.S. Army Medical Resear ch and Materiel Command, the ve-day course provides 40 total hours of education, training and exposure related to Department of Defense research and development mission requirements. Participants came from across the U.S. and included those that are stationed outside of the U.S. as well. The course serves as the principal recruiting tool geared towards Veterinary Corps Ocers. The course exposes participants to research and development specialization oered via the U.S. Army Long Term Health Education and Training program, providing a unique glimp se into the career opportunities available and giving attendees the exclusive opportunity to really see what a day would be like in the life of a lab animal veterinarian, a pathology veterinarian, or a scientic researcher in comparative medicine. "The large segment of the Veterinary Corps involved in Medical Research and Develop ment missions contribute immeasurably to the overall military eort," said Lt. Col. Sarah Bro, executive ocer for the Animal Care and Use Review Oce, part of the USAMRMC Oce of Research Protections. "Vaccine, antitoxin, and antidote development, directed toward the pro tection of military personnel, has been and will continue to be, heavily reliant on military veterinary expertise." The course participants visited six dierent U.S. Army institutes where they were able to have hands-on animal interactions and facility tours. Seeing the dierent Army Medicine research fa cilities where Veterinary Corps Service Members work is always a highlight for the participants. "It was fantastic getting to tour all of the research facilities and being able to hear about their missions," shared one student. "I plan on applying for one of the programs in 2020." A 2017 participant added, "Hearing from the principal investigators was fantastic. It was great to see how vets and the principal investigators work together and what the research accomplishes." Participants visited the Uniformed Services University of the Health Sciences, the Armed Forces Radiobiology Research Institute, the U.S. Army Medical Research Institute of Infectious Diseases, the U.S. Army Medical Research Institute of Chemical Defense, the Joint Pathology Center and the Walter Reed Army Institute of Research. "This course is a very successful recruiting tool for the Army," said Bro. "In 2017, 14 out of 15 attendees reported by survey they would apply to an R&D program. In 2018, eight of nine attendees committed to applying to an R&D specialty. By having educational courses such as the Veterinary Research and Development Short course, the Army ensures that the Veterinary Corps will be able to continue its broad functions of food sa fety and security, animal care, veterinary public health, and research and development." By Crystal Maynar, U.S. Army Medical Research and Materiel Command Public Aairs DEVELOPMENT COURSE PROVIDES OPPORTUNITIES FOR SPECIALIZATION FOR MILITARY RESEARCH VETERINARIANS18


27 JULY 2018Each year on July 27th, we honor and celebrate the Army Medical Department's birthday. The Army Medicine team has been supporting our nation's warfighters since 1775. Soldier-medics have served in every American conflict dating back to the Revolutionary War. In those 243 years, we have evolved, leveraging innovation and technology. Today, we serve more than 3 million Soldiers, Families and beneficiaries around the world. Your dedication and professionalism is what makes the Army great. Thank you for all that you do. Happy Birthday Army Medicine!


Ready People to Hand off Ready 'Stuff'By Ellen Crown, U.S. Army Medical Materiel Agency Public AairsMEDICAL READINESS for the MLST. Some team members, such as those with medical maintenance expertise, may stay with the unit and continue to provide assistance. "The MLST are some of the top 'All Star' players of USAMMA," said USAMMA's Chief of Materiel Fielding Maj. Daniel O'Neill. "We send our best because we want to do everything necessary to get the receiving unit equipped, and then sustain them until the ground forces establish long-term medical logistics supply and support." According to O'Neill, an MLST configuration is flexible and can come in all shapes and sizes, depending on the scope of the mission. For example, handing off several sets, kits and outfits of medical equipment and supplies to a smaller detachment may take about 14 team members. However, more than 25 members may be needed to field the amount of equipment and supplies needed to equip a full Combat Support Hospital. Almost a quarter of the USAMMA's employees -or nearly 100 people -are assigned to po sitions that could deploy in support of the MLST missions. If necessary, the USAMMA can deploy more than one MLST at a time or split an MLST on ground to support dual-ba sed operations. "The goal is to keep a steady supply of MLST members who are ready to deploy very quickly," said O'Neill. In the past five years, USAMMA MLSTs have deployed six times to field APS, including training exercises. MLSTs have also deployed to support fieldings and upgrades involving Army Medicine contingency pro grams, such as the Medical Materiel Rea diness Program. The MMRP, which is centrally managed by the USAMMA in Herlong, California, consists of four fully maintained Role 3 hospital configurations, including three 248-bed CSHs and one 240-bed Hospital Center of Class VIII medical materiel. Cpt. Bryan Pamintuan, an MLST member who will deploy soon on his first MLST mission, said team members must keep their Army readiness status "green" and their medical logistics skills sharp. "MLST training is really built in the day -to-day operations at USAMMA," said Pa mintuan. "The only thing that changes is our location." Can you imagine moving a whole hospital from one continent to the next with little or no notice? In the military, troops have to be ready for rapid deployments -and supporting medical teams have to be just as fast and agile. Instead of always shipping large quantities of equipment and supplies to distant locations, units may leverage Army Prepo sitioned Stocks. The APS program strategically stores equipment and supplies on land and at sea all around the world. APS allows units to mobilize quickly and efficiently, knowing the equipment and supplies they need will meet them in a deployed setting. The current APS program began in 1992 when the Chief of Staff of the Army directed a reduction in War Reserve and operational project stocks, and transferred management and accountability responsibilities to the U.S. Army Materiel Command -all except for medical materiel (i.e., Class VIII). The Army's APS medical materiel falls under the responsibility of the Army Surgeon General, who delegated central management to the U.S. Army Medical Materiel Agency, a subordinate organization of the U.S. Army Medical Research and Materiel Command. While many Soldiers may be somewhat familiar with the concept of APS, the lesser known part of this program is how these complex medical sets of equipment and supplies are transferred quickly and efficiently to units. That essential function is completed by a team of specialized experts -the USAMMA Medical Logistics Support Team. The MLST is an essential part of the USAMMA's worldwide medical logistics support mission. MLST members include a mix of military, civilians and contractors with specialty skills ranging from logistics, to medical maintenance and repair, to support services such as resource management and information technology. Once the Department of the Army appro ves the release of APS to a unit, the USAMMA activates a MLST to meet that unit and rapidly transition the Army's centrally ma naged pre-positioned medical stock, while also ensuring that all of the equipment the unit receives is fully mission ready. But handing off the APS is only part of the mission Prepositioned Stocks. (U.S. Army photo). (U.S. Army photo). 21


The top enlisted leaders of U.S. Army Medical Command gathered for a two-day summit focused on the future of enlisted ta lent management with the Army Medical Department. Hosted by MEDCOM's command sergeant major, more than 30 sergeants majors discussed developmental and operational overviews along with best practices to ensure the Enlisted Medical Corps stays relevant, adaptive and responsive to the Army's need for medical care. "We are here to move Army Medicine forward," said Command Sgt. Maj. Michael Gragg, MEDCOM command sergeant major. "We need to drive our people back to our Soldier skills." "We've done a great job of collaborating and building understanding. We want to develop individual Soldiers as we move them up into the system." Hot topics of discussion included the upco ming changes to the Expert Field Medic Badge, which will consist of a refocusing on wea pons qualications, PT test scores and overall training requirements. "The discussions are focused on how we improve the mission. One of the things we talked about is the EFMB," said Command Sgt. Maj. David Rogers. "Back when I came into the Army in the 80's, if you didn't have it, people looked at you and wondered if you really were a medic. Could you really do your job? We went away from that, and we're bring our focus back to it. We think it's important because it builds skills, builds condence and shows people we're going the extra mile to develop our medics and all the 68 series MOS." These changes and discussions are designed to create a seamless career path for the Army Medicine Soldiers currently enlisted and those who will join the force in the future, said Gragg. "For the young PFC, this is seamless to you. What this does is secure a future for you to be able to grow and be a future leader in Army Medicine, without you having to try and put in the eort to nd the right job," said Gragg. "The right career path will be designed for you. All you have to do is perform your mission phenomenally and you will be rewarded with exceptional leadership along the way." "This is all based o our experience, the current picture, and what we see Army Medicine doing in the future," said Regional Health Command-Atlantic Command Sgt. Maj. Matthew Brady. "We understand as we make these decisions and recommendations now they will likely change in the future one way or ano ther or could become a hybrid of what we're looking at now." "It's important for all Soldiers at all levels to communicate up the chain how they see things and their recommendations," said Bra dy. "We should always be improving and a part of that is for them to voice their recommenda tions for change." "We are going to put the Soldier back in Army Medicine and Soldier-medics," said Gra gg. "Our job is to ensure they're Soldiers rst and Soldiers who are medically trained." By Courtney Dock, Army Medicine Public AairsARMY MEDICINE COMMAND SERGEANT MAJOR HOSTS TALENT MANAGEMENT SUMMIT 22


university of Hawaii cadets, across the Pacic region took part in the German Armed Forces Prociency Badge competition and were tested over the course of three days with a 100 meter swim while wearing the Army Combat Uniform, basic tness test encompassing a sprint, ex arm hang (chin-up test) and a 1,000 meter run. Competitors also had to pass a pistol qualication, which included ring an M9 in a prone position, kneeling position and standing position, as well as enduring a ruck march, carrying a 33 pound ruck sack, in order to earn gold, silver or bronze badges. As the nal tally came in, a total of 326 ser vice members met the rigorous challenge, thus earning the badge, with a medal count of 15 bronze, 210 silver and 101 gold. "The service members who competed for the GAFPB are a shining example of the strength of our nation," stated Sgt. Maj. Larry Reyes, acting senior enlisted advisor, RHC-P. "I am especially proud of the team of RHC-P Soldiers and support sta who put forth their very best in the competition and to host this event, as they carry on the tradition of Army excellence, representing the Army's number one priority, readiness." The competition is also a time to partner to gether with German allies, who travel across the country in support of the event. "Any time we can come shoulder to shoulder with our international partners, we not only strengthen our longstanding alliance, but enhance our Soldier skills," said Reyes. "Both of those are a win, no matter how many participants walk away with a badge." Reyes also added that this year's competition is the largest held to date. Service members from across Hawaii vied for the honor to wear a decoration of the Ger man Armed Forces. The competition, hosted by Regional Health Command-Pacic (RHC-P) with the assistance of the Schoeld Barracks 303D Ordnance Batta lion (Explosive Ordnance Disposal), took place April 30 through May 4, 2018. The German Armed Forces Prociency Badge (GAFPB), or as referred to in German as Ab zeichen fr Leistungen im Truppendienst, is a decoration of the German Armed Forces, autho rized for wear by the U.S. military, and awarded to Soldiers of all ranks. The GAFPB is one of the few approved foreign awards, and according to program leads, is one of the most sought aer awards to achieve. During the three-day event, 567 Soldiers, Ma rines, Sailors, Airmen, Coast Guardsmen, and RHC-P hosts rigorous German Armed Forces By Ana Allen, Tripler Army Medical CenterMEDICAL READINESS 23


The Mediterranean diet is based on the traditional diets and lifestyles of people from countries surrounding the Mediterranean Sea, such as Italy and Greece. Since the early 1960s, researchers have noted that these people are exceptionally healthy compared to Americans and have a low risk of many chronic diseases, such as heart disease and diabetes. Numerous studies over the years have shown the Mediterranean diet helps prevent heart attacks and strokes, protects against cancer, helps with weight loss and even helps peo ple live longer. There is no one right or wrong way to follow a Mediterranean diet. Remember: there are many countries around the Mediterranean Sea and the people living there dont all eat the same things. Consider this a general guideline, not something written in stone. The foods and ingredients can be modied to t individual needs and preferences. Its even great for children. The Mediterranean diet includes a variety of fruits, vegetables, whole grains, beans, sh and healthy fats. Nutrients from these foods help support optimal growth and development while also promoting a healthy weight. If you'd like for you and your family to enjoy the healthful benets of the Mediterranean Diet, these easy steps can help you get started: Build a strong base Fruits, vegetables and whole grains are the foundation of the Mediterranean diet, delivering a wide variety of vitamins and minerals, carbohydrates for energy and ber for smoo th digestion. Instead of making meat the main event, use plant-based foods as the foundation for hearty meals such as pasta with vegeta bles, minestrone soup or stir-fried veggies over brown rice. Learn to love beans You won't nd much red meat or even chicken in this diet, but there are plenty of beans also called legumes and lentils. Beans are naturally low in fat and loaded with protein, ber and healthy carbohydrates. Beans are also high in potassium, magnesium and iron. Add a variety of beans to your diet by tossing chickpeas, soy or kidney beans into salads; add peas or lentils to cooked rice; or mash seaso ned pinto beans into a cheesy quesadilla. Look toward the sea Fish and seafood plays a starring role in the Mediterranean diet. They are a top sour ce of brainand heart-healthy omega-3 fatty acids, plus theyre packed with protein. Sea food cooks fast, making it perfect for quick meals such as grilled shrimp tossed into pasta marinara, or tuna stirred into whole-wheat couscous. Stop fearing fat Monounsaturated fats from olive oil, nuts and seeds are an important part of the Mediterranean diet. In addition to making olive oil your go-to cooking oil, toss pine nuts or sliced almonds into sauted green beans, spinach or asparagus. Make your own trail mix using dried fruits, whole-grain cereals, nuts and seeds ... a great activity for children. Dip it Children (and adults) love to eat foods they can dip. Dunking veggies into Mediterranean-inspired spreads such as hummus, tzatziki a creamy yogurt dip or baba ghanoush, made from sesame and eggplant, sneaks in a serving of vegetables and keeps the wee ones happy. Live it Finally, the Mediterranean lifestyle is almost as important as the diet if you want to gain all of the protective health benets. This includes regular physical activity, getting plenty of sleep, sharing your meals with friends and family, and enjoying life.Live for a living with Mediterranean diet monthBy Maj. Julie Hess, MS, RD, Chief, Nutrition Care Division, Eisenhower Army Medical CenterHEALTH 25


cluding three 248-bed CSHs and one 240-bed Hospital Center of Class VIII medical materiel. Typically, units request smaller "slices," such as specic medical sets, of an MMRP CSH or eld hospital/detachment as a component of a hospital center, based on approved requirements. What's not included: The MMRP does not include potency and dated materiel with a shelf life of 60 months and less. How to request it: OTSG is the release autho rity. Supply Bulletin 8-75-S7 provides a template (Appendix C) that units can complete and then route through their higher headquarters. Once OTSG has advised USAMMA of approved relea se, USAMMA will deploy a Medical Logistics Support Team (MLST). The MLST will conduct a thorough quality assurance check required to prepare the approved bed conguration for inventory and ship to the gaining unit. Unit Deployment Packages (UDP) Potency and dated (P&D) items create unique logistical challenges for units. These items can be costly and have a limited shelf life. While units are expected to maintain their unit ba sic load of medical P&D materiel, lessons lear ned from previous conicts indicate that many units may have P&D shortages. To ensure units have the medical resources they need when called to support a contingency, the Oce of the Surgeon General and USAMMA developed the Centrally Managed Medical P&D Materiel Program. The term "unit deployment package" is used within the program to describe a unit's basic load of medical P&D materiel with a shelf life of 60 months and less. This program can provide early deploying Echelon Above Brigade medical units, that are deploying from state-side home stations, with their basic load of medical P&D materiel with a shelf life of 60 months and less. Strategies for providing this materiel include acquiring and positioning medical materiel at various stateside and overseas locations, or using multiple prime vendors. What's included: A UDP consists of medical and non-medical potency and dated materiel with Medical Unit Assemblage Group Codes (MUAG) 1, 4-9, A, B, D, E, G-I, and N and a shelf life code (SLC) of 60 months and less (Type I NSNs SLC A-H, J-N, P-S and Type II NSNs SLC 1-9). Active Component, Reserve Component Today's Army faces complex, worldwide threats that set the conditions for varied missions in numerous environments -all under continuing budget reform. Being able to medically support Soldiers anywhere in the world at any given time demands a commitment to readiness -all the time. Readiness determines the Army's ability to ght and win our Nation's wars; it is the capability of forces to conduct the full range of military operations to defeat all enemies regardless of the threats they pose. To ensure the highest level of readiness, Army Medicine created several medical ma teriel contingency programs, including the Medical Materiel Readiness Program; the Centrally Managed Medical Potency and Da ted Materiel Program with Unit Deployment Packages; and the Medical Chemical Defense Materiel contingency stock. These programs are operationally managed by sta at the U.S. Army Medical Materiel Agency, a subordinate organization of the U.S. Army Medical Resear ch and Materiel Command. Each of these Army Medicine contingency programs oer specic medical capabilities that can be leveraged individually or combined to support a variety of operational requirements, aording today's Army with greater logistical exibility and medical materiel readiness. Medical Materiel Readiness Program (MMRP) Combat Support Hospitals (CSHs) provide unmatched Role 3 combat health support with a 98 percent survivability rate over the past decade--the highest in the history of American warfare. To ensure CSH capability in a contingency, Army Medicine developed the MMRP in 2007. While this program was originally develo ped as a result of the Reserve Component Hospital Decrement program, none of the assets within the MMRP are earmarked to a specic unit. Rather, MMRP focuses on making sure that four centrally-managed, fully modernized CSHs are maintained at a maximum state of readiness for any approved medical unit -active or reserve. A team of biomedical equipment specialists service the MMRP maintenance-signicant equipment year-round at Sierra Army Depot in Herlong, California. They complete one hospital per quarter, so that three CSHs are ready at all times. What's included: The current program consists of four Role 3 hospital congurations, in-Army Surgeon General's Contingency Programs By Ellen Crown, U.S. Army Medical Materiel Agency Public AairsMEDICAL READINESS 26


Medical Chemical Defense Materiel (MCDM) To protect our Soldiers from deadly threa ts, Army Medicine sustains an initial issue inventory of consumable medical counter measures against a variety of Chemical, Biological, Radiological and Nuclear (CBRN) warfare agents. These assets are maintained for Soldiers and military working dogs that deploy in support of geographic combatant commands theater-strategic and operational requirements. Additionally, Army Medicine sustains the initial issue of potency and da ted CBRN items for the Medical Equipment Set (MES) Chemical Agent, Patient Treatment [Line Item Number (LIN) M23673]. These CBRN warfare agents provide deploying medical units with the capability to treat and protect themselves and other chemical casualties. What's included: Initial issue MCDM for Soldiers, military working dogs, and the Chemical Agent Patient Treatment MES are maintained under three separate projects: DH1 Initial issue MCDM for Deployable Force Packages DH5 -Potency and Dated MCDM for the MES, Chemical Agent Patient Treatment (LIN M23673) Y3R1 Initial issue MCDM for Defense CBRN Response Force For a full description of what is available in each project, read Supply Bulletin 8-75S7, chapter 5. What's not included: Non-potency and dated materiel, such as equipment, are not included. How to request it: OTSG is the release authority. The one exception to this rule is during installation or local emergency situa tions where access to MCDM is critical to lifesaving treatment of casualties. In that emer gency, the storing military treatment facility commander may authorize release of MCDM for that purpose. Instructions for requesting an MCDM project are available in SB 8-75-S7, chapter 5, paragraph 7. In collaboration with the Army Prepositio ned Stock program, OTSG's contingency pro grams are designed to help meet the needs of deploying units and contribute to the Army's ability to rapidly deploy power worldwide. To access USAMMA Supply Bulletins and learn more about Army Medicine's contingency programs, visit:http://www.usamma.amedd. and National Guard early deployments in Echelon Above Brigade units will receive Type I and II medical and non-medical UDP items (MUAG 1) with a shelf 60 months and less ba sed on the initial 31-day declared contingency Time Phased Force Deployment List (TPFDL) requirement and available funding. While the Centrally Managed Medical P&D Materiel Pro gram will provide materiel to those Echelon Above Brigade medical units deploying on or before day 31 of a declared contingency, units must keep in mind that the TPFDL is a exib le and uctuating schedule. Should a unit with an initial deployment date sooner than day 31 suddenly nd itself deploying beyond day 31, that unit will be deleted from OTSG's list of units scheduled to receive a UDP. Therefore, units must plan appropriately. What's not included: Non-potency and dated materiel, such as equipment, are not included. How to request it: OTSG is the release autho rity. Supply Bulletin 8-75-S7 provides a template (Appendix B) that units can complete and then route through their higher headquarters. Pending OTSG approval, USAMMA will coordinate procurement and shipment. SOLDIERS HELPING SOLDIERSARMY MEDICAL COMMAND BLOOD DRIVE16 MAY 2018MEDCOM Soldiers and Civilians participated in a blood drive May 16, 2018 at the AMEDD Center and School on Joint Base San Antonio. Forty donors were screened for a collection of 35 units all donated to the Brooke Army Medical Center. Some of the plasma will be stored and shipped overseas to CENTCOM/AFRICOM. This blood donation resulted in $14,000 worth of potential cost avoidance. To nd a Armed Forces Blood Program blood drive near you, visit: http://www.militaryblood. (U.S. Army photos by Sta Sgt. Amy Klugg)27


Years of hard work, leadership, focus, and discipline led to a career milestone for ve Fort Campbell non-commissioned ocers recently with their induction to the Sergeant Audie Murphy Club, May 10. Blancheld Army Community Hospital NCOs, Sgt. 1st Class Ivan Tanna, Sta Sgt. Sha neka Brown, Sta Sgt. Cory Hudson, Sta Sgt. Eric Serrano and 101st Airborne Division Ar tillery Brigade NCO Sta Sgt. Tamika Wilcox from 3rd Battalion, 320th Field Artillery Regiment, 101st Airborne Division Artillery Brigade Red Knights were inducted into the SAMC, a professional organization of NCOs who exemplify Army leadership, during a ceremony on post. The motto of the club is, You will lead from the front. During his remarks, fellow SAMC member and guest speaker Command Sgt. Maj. Christopher Earle, Blanchelds senior enlisted leader, shared the meaning of the BACH NCOS REALIZE GOAL WITH INDUCTION TO SERGEANT AUDIE MURPHY CLUBclub motto and how he saw the NCOs inducted exemplify the motto. It means that NCOs who are part of this club accept challenges, because we all know if something does not challenge you, it does not change you. Leading from the front also means willing to do what many wont do or cant do and it also means moving outside your perceived comfort zone and inspiring others to follow in your footsteps, said Earle. The command sergeant major used Staff Sgt. Brown as an example. Brown, who passed her SAMC board late last year, was the first NCO at Blanchfield in a number of years to be selected for membership. Under Ear les guidance and with the support of other SAMC members, Brown did the leg work to have an opportunity to go before a SAMC board. It was a rigorous process and involved a lot of coordination. Candidates endure a lengthy four-part selection board process where board members look at the number of Soldiers the NCO super vises and accomplishments under the NCOs leadership, military and civilian education, community service and the NCOs contribution to Army combat readiness. Other NCOs took notice as Brown went through the board process and were inspired in the subsequent quarters to follow her lead, resulting in the induction of ve NCOs to the SAMC, today. Inspirational leadership is contagious. These ve NCOs have inspired others to step outside the box by their proven example. The NCOs before you join an elite club of NCOs who represent only 10 percent of the NCOs in our Army. The values of our club are loyalty, caring, discipline and professionalism. Each of these NCOs represent these values on a daily basis, said Earle. Brown said she is immensely proud and ho nored to join the organization named for one of Americas most decorated combat Soldiers. Selection to the Sergeant Audie Murphy Club is an overwhelming feeling of joy, accomplish-BY MARIA YAGER, BLANCHFIELD ARMY COMMUNITY HOSPITAL PUBLIC AFFAIRS SAMC medallion. (U.S. Army photo by Maria Yager). 28 28


ment and validation by achieving a long-term goal, said Brown, who set her sights on joining the organization when she was a specialist in Yongsan, Korea. During this time, my rst ser geant, whom I highly respected, was a member and she inspired me to research the history and purpose of this prestigious club. Brown learned that Murphy was one of the highest decorated Soldiers in American history. He earned a battleeld commission for his courage and leadership. He was awarded the Medal of Honor for his actions in France during World War II and his eorts continue to help Soldiers to this day. [Murphy] suered battle fatigue, which is now called PTSD and he petitioned the gover nment to increase the study of the impact that combat experiences had on veterans, said Brown. We have made great advancements on PTSD because of the awareness he brought to the issue. The Sergeant Audie Murphy Club was estab lished in 1986 and expanded Army-wide in 1994. Members conduct charity work for the homeless, help the elderly, assist the handicapped, and work to provide a better life for everyone in the community. The club recognizes NCOs who signicantly contribute to the development of a professional NCO Corps and a combat ready Army. Awardees exemplify leadership, cha racterized by personal concern for the needs, training, development and welfare of Soldiers as well as concern for the families of Soldiers. Members are selected based on demonstrated leadership, professionalism and overall general military knowledge. During the induction ceremony, Soldiers who served under these NCOs gave testimonials of their NCOs leadership, support and guidance. Sgt. 1st Class Tanna was my first NCO in the Army. He has taught me a lot about self-discipline and ways to become a leader in the future, said Blanchfield Soldier Spc. Shane Sheffield. Under Tannas guidance, Sheffield performed his job and assumed greater responsibility and experience resulting in the Soldiers promotion before his peers. Sheffield said Tannas actions inspired him and set the example of what leadership is in the Army. Club guidance states that each sergeant is responsible for the training and welfare of their Soldiers, constantly displaying a positive attitude at work and is an upstanding citizen. NCOs seeking to join the Sergeant Audie Murphy Club must serve as leaders of cha racter, competence and commitment and be an example for subordinates, peers and superiors alike. The board also evaluates how the NCO may have handled disciplining of Soldiers in adverse cases such as Absent Without Leave, Driving While Intoxicated and Uniform Code of Military Justice violations. In the final phase of the selection board, candidates must complete a written exam, essay, and oral board. U.S. Army Medical Command Soldiers can learn more about the SAMC in MEDCOM Regulation 215-2. 29 29


said Jackson. "Practical sessions allow for the students to practice skills in developing life-saving treatment techniques." This additional medical knowledge further allows the Iraqi medical sta to join in the ght against ISIS by enhancing their eectiveness on the battleeld. "[MARCH] spans their capability to push out into battleeld operations when they know their ability to care for the wounded is elevated to a level that aeromedical evacua tion can do," said Hite. "They have the capa bility and training to provide point-of-injury care to evacuate Soldiers from there back to a hospital setting in a short amount of time." The course came with its challenges to include language barriers and the slight dierences between U.S. and U.K. treatment and assessment methods. However, learning different methods can be benecial and enhance preferred techniques, according to Jack son. These techniques were tested during the student's nal training event. The culminating training exercise was comprised of a scenario where students provided point-of-injury care and medevac care while ying on the Eurocopter to a multi-trauma ca sualty mannequin under stress inoculation. The premise of stress inoculation is that ex posure to dierent stressors and sensory inputs to include: fake blood, smoke grenades, and noise from a nearby aircra, will prevent medics from being easily distracted and overwhelmed during a real-world medical crisis. "Students should be able to perform basic functions the same regardless of the environment they are in," said Campbell. Seven Iraqi students assigned to the Iraqi army aviation graduated from phase one of the aeromedical evacuation course May 3, with ho pes of continuing the additional phases in the near future. Medical providers from the 449th Combat Aviation Brigade facilitated a 10-day aeromedical evacuation training course with Iraqi nur ses April 22 May 3 at Camp Taji, Iraq. The concept of the program was to use the train-the-trainer model, where the 449th CAB medical sta provided information on medical evacuation principles and tactical combat ca sualty care to the Iraqi nurses so they are able to self-sustain and teach courses in the future. "Battleeld trauma research shows that uncontrolled blood loss is the leading cause of death in 90 percent of the potential survivable battleeld cases, which makes this training necessary," said the 449th CAB Aeromedical phy sician assistant, Capt. Jonathan Campbell. The primary instructors, Campbell and the brigade surgeon, Lt. Col. Wes Hite, began the course by assessing the medical knowledge of the students with a written exam. Co-written with an Iraqi ight surgeon, the test gave the instructors a starting point for teaching the class and guided which lessons needed to go more in depth. "A lot of their knowledge was from a nur sing standpoint or hospital-based care," said Hite. "We have been able to provide them a dierent way of looking at point-of-injury care, that additional minutes to hours that take pla ce with battleeld trauma." Hite and Campbell presented the majority of the material to the students in the class and stressed the basics. Their teaching techniques were designed to address the most likely injuries that will result in battleeld death in the appropriate order. "The biggest key points emphasized throughout the course was the M.A.R.C.H. algorithm, which is a technique used to treat for massive hemorrhage, airway, respiratory trauma, circulation and hypothermia," said Campbell. The United Kingdom Training Team 1, Ar mored Medical Regiment medic instructor Sta Sgt. Natalie Jackson, helped support the course and stressed the importance of understanding anatomy and physiology and the ability to recognize normal and abnormal signs with casualties. "It was important to deliver the course at the right level across a range of trade qualications, ensuring the basic principles and treatment techniques were fully understood," U.S. Army, Iraqi forces train in combat medical By Capt. Briana Mcfarland, Army National GuardMEDICAL READINESS Briana McFarland) 30


M y P late C r o s sw o rd P u z z l e A c r o s s 1 U s e t h e M y a s a g u i de. 2 A p p l e s o r a n g e s a n d ba n a n a s t i n t o t h i s f o o d g r ou p 5 i s s we e t s m o o t h f o o d c o m e s i n m a n y d i e r e n t a v o r s a n d i s a g r e a t w a y t o g e t c a l c i u m f o r you r b one s 7. a r e a n o r a n g e v e g e t a b l e 8. T r y f a t f r e e o r l o w f o o d s w h e n you c a n 9 U s e w h o l e-g r ain f o r you r s a n d w i c h es. 1 1 C h e d d a r s w i s s m o z z a r e l l a m o n t e r e y j a c k a r e e x a m p l es. 1 4 F i t s i n t o t h e g r a i n s g r o u p o f MyP late. G oe s g r e a t w i t h s tir f r y 1 5. M y Plate i s a t o h e l p you e a t a v a r i e t y o f f o o d s f o r a h e a l t h y b o d y 1 7. S p a g h e t t i i s a t y p e o f D o w n 1 C h i c ke n a n d t u r ke y a r e e x a m p l e s o f 2 E a t a v a r i e t y o f f r o m a l l o f t h e g r ou p s 3 B rocco l i a n d g r e e n b e a n s a r e e x a m p l e s o f a 4 ese a r e a g r e a t s ou r c e o f p r o tei n a n d c a n b e m i xe d w i t h c e r e a l a n d d r i e d f r u i t f o r a n o n-t h e g o sna c k 6 P i n t o k i d n ey b l a c k r e f r i e d t her e a r e l o t s o f d i e r e n t k i n d s a n d t h e y c a n b e e a ten l o t s o f di e r e n t wa y s 1 0 V ege t a b l e o r o l i v e a r e o e n u s e d f o r c o o k i n g a n d a r e p a r t o f a h e a l t h f u l d i e t 1 1 i s m a k e s a q u i c k a n d e a s y r e a d y -t o e a t b r e a k f a s t w i t h f r u i t a n d m ilk 12. Y ou c a n h a r d b o i l s c r a m b l e f r y o r p o a c h t h ese o r e a t t h e m a s a n o m e l e t H o w d o you l i k e you r ? 1 3 S a l m o n a n d t r ou t a r e e x a mpl e s o f 1 6 L e a n i s a n e x c e l len t s ou r c e o f p r o t e i n i r o n a n d z i n c U s e t he w o r d s f r o m My P late t o h e l p y ou c o m p l e te t h i s p u z z l e 1 2. 3 4 6 8 9 1 0 1 1 1 4 1 2. 1 3 1 5 1 6. 1 7 5 7 .. Adapted from Find answers at:

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