Army Medical Research and Development Infrastructure Planning Proceedings of a Workshop (2021) / Chapter Skim
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Pages 34-54
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From page 34... ...
Multi-Domain Operations and Battlefield Accessibility Committee member Ann Salamone introduced the multi-domain operations and battlefield accessibility theme, emphasizing that innovative and disruptive technology must be developed to address potential 2035 conditions, such as lack of airspace control, degraded communications and electronic equipment, and inability and need to rapidly transport injured soldiers. This requires prioritizing investments toward highly flexible and adaptable medical capabilities.
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From page 35... ...
Multi-domain operations only amplify the need to enable young soldiers to make critical decisions better and faster. Committee member Ruzena Bajcsy noted that in under developed countries, the battles are not only military versus military, but also within the environment of the local population, so it is necessary to take into account actions like helping the noncombatants.
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From page 36... ...
She asked the participants not to completely ignore the important benefits of low-consumption energy devices. Committee member Mary Ann Spott observed that given many great and innovative things to consider, there has to be a balance of technology and clinical care, without sacrificing the quality of care for advancing technology.
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From page 37... ...
Serious consideration should be given to technology being wrapped into autonomous systems, not just current robotics for doctors, but also autonomous systems that can help medical personnel on the ground. There is a need, irrespective of bandwidth in future conflicts, to determine a casualty's status and how best to assess them -- whether there are not just a couple casualties, but tens of thousands, or perhaps even more.
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From page 38... ...
Regarding requirements, Kester noted for the future that he understood there will be no cessation of existing and new medical threats to the force -- challenges that necessitate a strong Army medical R&D enterprise. He mentioned that Lane and Bertram spoke to the point that without a credible organization, one cannot address these threats.
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From page 39... ...
He reiterated that the charge to the panel suggested exploring whether an internal military laboratory system is needed to sustain capabilities for the future, like the MDO environment. Teyhen asserted that existing funds can be leveraged to get after those priorities.
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From page 40... ...
BOARD member Jim Bagian commented on priorities and observed that a dislocation between what the people in the field believe they need and what people back in the research area are supporting. As with the Combat Trauma Care10 workshop, similar themes include the same lament that there is a gap in the field's needs, measuring those needs, and tying those needs to what is in the research pipeline.
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From page 41... ...
It is incredibly powerful to understand how to come up with that family of countermeasures to really help prevent, for example, malaria. Teyhen provided another illustration where translational research is helpful, with tourniquets.
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From page 42... ...
Clements noted that the "acquisition" theme title encompasses a number of the topics that were discussed by different speakers and that acquisition programs will develop in relation to priorities. He reflected on a comment that funding for medical research was almost a rounding error in the larger Army budget, and it was often seen as a place to retract funding if a medical research deliverable milestone had not been met.
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From page 43... ...
Barish gave an Air Force example, which could be useful to the Army, which involved training 30 to 40 trauma teams that then go onto the battlefield with good results. Another Air Force example included a funded graduate medical education and a trauma fellowship.
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From page 44... ...
AFC's desire is to conduct research at the speed of relevance to provide a timely solution to war ghters. After fi looking at Army research efforts on an important medical issue, the question should be, Who could help answer that need faster?
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From page 45... ...
When current incidents signaled the need for it, management was ready for telemedicine and buy-in was immediate. Johnson gave another example of industry foundation money and French Army connections to help fight malaria death as a nongovernment foundation investment without a return on investment.
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From page 46... ...
Bienvenue suggested looking at program management from the perspective of those executing externally to the Army and government, as well as internal program management for efficiency. Both Bienvenue and Spott commented on the administrative burden on researchers, a known problem across many different agencies, as mentioned by Ling, Kaminski, Quake, and Ingber.
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From page 47... ...
Spott added an important note that unless one has the documentation, one cannot collect the data, referring to Kotwal's need for more pre-hospital data in order to continue combat trauma care tudies. Regarding SARS-CoV-2 shifts, Spott commented on a need for s data-egistration capability, which would require pausing work on the r combat trauma care registry and pivoting the platform to accept coronavirus data.
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From page 48... ...
Bajcsy offered an example of an implanted microchip needing a high level of security to protect critical organs like the lungs or heart, because the functioning of a microchip could be vulnerable to these types of threats, and with lethal results. Sepúlveda observed data and information enterprise responsibilities have shifted from top level positions of chief information officers to chief data officers.
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From page 49... ...
Nevertheless, medical R&D organization integration within the larger Army was suboptimal; medical research ownership implies that attention must be placed on the importance of military R&D career-path assignments and effective talent management. 11 National Academies of Sciences, Engineering, and Medicine, 2016, A National T rauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury, Washington, DC: The National Academies Press, https://doi.
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From page 50... ...
Line Leadership Bienvenue emphasized similarities with the combat trauma care workshop12 results, particularly the focus on line leadership. Kester suggested that senior research leaders (flag rank and Pentagon level)
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From page 51... ...
Comparing civilian to military researchers, he noted that civilian scientists have continuity of programs, specific missions, and accomplish critical mission-related objectives, whereas military personnel in those structures rotate frequently, without the same level of support as civilians, and have no clearly defined research path nor military operational specialty code for research. Clements observed that for some physicians in the military treatment facilities, the situation is even worse; their research is not supported by dedicated time or funds, and they are still expected to see a full patient load.
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From page 52... ...
The processes are overly bureaucratic, priorities are constantly shifting, and it is not at all suited to an agile research organization. Sepúlveda said it was a learning experience for him to gain insight into the complicated nature of the medical enterprise, along with the complexity of integration and collaboration.
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From page 53... ...
Kester noted the workshop had proceeded under the assumption that the Army medical infrastructure discussed is going to exist going forward, but if DHA takes over, that is a new world with tri-service implications for medical R&D. In response, Dertzbaugh noted that the current National Defense Authorization Act (P.L.
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