US Army Medical Research & Materiel Command – Understanding the Mission and People

This morning we are going to talk about a
very unique and special Army Organization – the U.S. ARMY MEDICAL RESEARCH & MATERIEL
COMMAND. An organization that has about 7,000 employees. 17% are active duty; 41% are government
civilians; and 42 % are contractors. But this is not what makes USAMRMC unique. These employees
come to work every day knowing they make a difference — They contribute to the wellbeing
of all WARFIGHTERS –their families and other beneficiaries. But this is not what makes
USAMRMC unique. This organization is Army thru and thru; but often looks tri-service.
We work closely with Air Force and the Navy. We collaborate with industry, such as the
Bill and Melinda Gates Foundation, Chart SeQual Technologies, ANP Technologies, Inc., and
Biosentinel, Inc., academia, the University of Penn for example and other government agencies
like NIH. But this is not what makes USAMRMC unique. So, what does make us so unique? Simple:
We impact the Warfighter from the day he or she becomes a recruit until, well sometimes,
for their whole life span. But don’t stop there; we impact the family members. We impact
civilians who benefit from our inventions, our devices, our drugs and vaccines. We impact
third world countries, disaster areas, and we are a catalyst for our economy. This brief
will depict one of our products, the adenovirus vaccine, and show you how many of the organizations
within MRMC contributed to it’s success. Every person at MRMC is Army Strong as we support
the medic in combat the Warfighter, and the Warfighter Family. We are the heartbeat of
Army Medicine. We do the discovery. We are out on the frontiers of science where innovation
and breakthroughs are made. We do the advanced development. We create unique partnerships
built on trust. We do the logistics — Supply chain management. And – We do it better than
anyone! You know what? We are not only Army Strong; We are everywhere! Did you know that
we are on every continent but one? Each and every one of you, each person here, is part
of a team that spans the globe. We have six Army medical research laboratories.;three
medical research detachments and four overseas laboratories. Nothing works without acquisition
and logistics: U.S. Army Medical Materiel Development Activity
U.S. Army Medical Materiel Agency U.S. Army Medical Materiel Centers in Europe
and Korea. Not done yet:
We have forward sites for the prepositioned medical materiel and maintenance divisions
to support: Acquisition
Fielding Sustainment of medical equipment
We have three Executive Agencies The Armed Forces Medical Examiner System
The National Museum of Health & Medicine Defense Center of Excellence for TBI and Psych
Health All of this happens by design. This design
begins with a mission and a vision. The mission tells people what we do. Look at the words:
We are responsive – (To the Warfighter — They need something — we get it there)
We are responsible — (To taxpayers, to our senior leaders, Congress — Most importantly,
we are responsible to the Warfighter) And what do we deliver? Products, some materiel
and some knowledge. The Vision looks to our future:
Trust (Partnerships work because we are trusted) Leaders (We have leaders unlike other leaders.)
Unrelenting service Unsurpassed expertise
Empathy And the relentless pursuit of excellence
Our leaders personify the ARMY VALUES Innovation (Creative, inventive, resourceful)
Global Health ( People and places are better because we were there)
Relationships & Perceptions Before we go on to we should have a talk – much
like the talks all of us have had as parents with our sons and daughters. As youngsters
we all go thru the same stages. I was always on best terms with Mom and Dad whenever I
needed cash or had to borrow the car. My parents were the last ones to meet the latest girlfriend!
I hated it when they were overseeing my homework or housework! So I rebelled and joined the
MILITARY! Talk about oversight! So, are we much different when we refer to Headquarters
when we are in the position of a Subordinate Command? Let’s talk about our relationships.
I used to complain to my Dad: You treat me like a child! He’d look at me and gave me
“THE LOOK!” Of course I was 31 at the time and may have actually deserved THE LOOK. Perception
— They treat us like a subordinate command. If HQ would just leave us alone …Way too
much oversight — Telling us how to do our business. 
Like you, I spent many years in the field anticipating the call from HQ with an urgent
request — a TASKER! First, like you, MRMC is a subordinate command
to US Army Medical Command MEDCOM. It is just the way the Army runs. Like you, we get our
funding taxed. Like you we get help form oversight groups like GAO and DCMA and, like you we
get taskers. A full 80% of the taskers we handle inside HQ without external assistance.
  We defend your money. 
We defend your manpower.  Along with your leaders, we plan strategically
and speak for the entire Command so that there is one voice, one mission, one vision.  We
assimilate the differences, the diversity, the challenges into a cohesive force for the
health and wellbeing of the Warfighting Family and the World.
Diversity — Let’s talk about our people. Like many large organizations, we have an
incredible mix of people who have an endless array of talent and skills, each able to fit
into the huge complex called MRMC. Each day we walk next to people who have made some
of the great discoveries of medical science, others have unique talents for sequencing,
or repairing equipment. Others can write, while others are remarkable teachers. Some
of us love supply chain management, financial analysis, acquisition, and contracting. Some
are experts in quality assurance and quality control. Some have developed procedures to
make sure we have clean rooms when we need them. Some of us know how to raise funds and
create partnerships. And everyone contributes; Each person matters; And we need each and
every one of you. Partnerships – One of our Great Strengths.
Our partnerships fall into three general areas: Government — NIH, the VA, the Navy and Air
Force; Academia — Major universities who are performing cutting edge research (Duke,
Maryland, MIT, UCLA); and Industry — The partners who will commercialize our inventions,
such as InBios, Intercell, and GenVec. They want to partner with us. We do the heavy lifting.
We take the chances and they are better off because they partnered with MRMC! At the same
time, we need these Partners in order to be successful. And this works because we are:
Responsive, Responsible, and Trusted. Our Life Cycle Command requires Different
Kinds of Work as well. The work is just as diverse as the people who make up MRMC. We
talked about the different people and the diversity we see at MRMC. We require this
because we are a full life cycle command. We are a powerhouse of collaboration that
spans the entire life cycle. Outreach programs like GEMS – Gains in the Education of Mathematics
and Sciences (GEMS) Program run by HQ. MRMC is a threat-driven organization. Everything
we do is centered on the Soldier and eliminating medical threats. There are seven categories
of threats that affect our Service Members. The threats of today are not totally unique
from the threats of earlier wars. Yet we have had to adjust to the threats
of today. Combat injuries — They may look
the same, but we know so much more today. Yet they are different. Non-compressible hemorrhaging,
pain management, loss of limbs and TBI. Operational Stressors — We had those in Vietnam as we
do today, but we know so much more about the effects of these stressors. We are addressing
these and coming up with solutions. Endemic diseases — These have been around forever;
and they change our focus with each battle scenario. Addressing the threat is just the
beginning. From threats, we move to Requirements and
the Joint Capabilities Integration & Development System. Once the threat is identified, the
Combat Developer – Identifies the capability gaps we have and documents the requirement
in three documents:  ICD — Initial Capability Document — Fairly
broad  CDD — Capability Development Document – More
specific  CPD — Capability Production Document — Very
specific  This whole process helps us prioritize our
programs. It is a true test of how well we respond to user needs. But the real test
is in execution.
We deliver. The
Warfighter’s wellbeing is worth every penny that comes to this Command. We deliver both
medical knowledge products and medical materiel products.
Next line — We do this thru 3 integrated programs that allow for transitions throughout
the life cycle of development: Research & Development, Development & Acquisition, and Acquisition
& Logistics. These programs actually blend one into the other.
You are going to see this design again when we address PPBE and the Decision Gate process.
Complimenting these programs we have three special programs:   Congressional Special
Interest — with targeted outcomes, The Armed Forces Medical Examiner — Cause of Death,
Identification of Remains, and the National Museum of Health & Medicine – Captures the
History of health and medicine, Provides lessons from the past helping our understanding today,
and Is a catalyst for future researchers and practitioners.
Not only are we a life-cycle Command, but we impact the life of every Warfighter, from
entry, thru deployment, post-deployment, and retirement. We are going to look at the life
of a Soldier and see some examples of where we fin tin to make the Army STRONG.
(COL Raymond Laurel) Good morning, I’ll be teaming up with Dr. Keith Vesely on “Training
and Pre-Deployment.” First, let’s take you to Basic Training so you can see firsthand
who we support from the start. Physical Training — push-ups, sit-ups, 2-mile
run, obstacle courses, immunizations — are all part of basic training and our Command
has a shared mission to establish these standards in building our Nation’s force. The Army is
the Nation’s force for decisive action, both at home and abroad, providing the Joint Force
the ability to prevent conflict, shape the environment, and if prevention fails, win
decisively and dominantly. In order to meet the needs of the Nation in a complex operating
environment, our Army must remain agile and responsive to provide forces that are flexible
to operate across the range of military operations. In support of
the Army’s mission to transform a civilian
to a Warfighter, we team up with other Army activities to produce training policy and
guidelines that provide recommendations to enhance Warfighter capabilities and reduce
health risks. The objective of the medical process in bringing in new recruits is to
screen out applicants who are medically unfit for service and for those fit to serve, enhance
individual performance. We, in this Command, continue this coordinated effort by product
and knowledge improvement for clothing, equipment, nutrition, pharmaceuticals, and other medical
advances by providing design specifications to improve individual Warfighter equipment,
rations, and knowledge products. “Keeping the Promise,” “Fulfill their Trust,”
and “No one left behind” are several of many mottos that refer to the efforts of the Department
of Defense to recover those who became missing while serving our Nation.
During medical in-processing, blood is taken from recruits to register their DNA. The DoD
DNA registry is maintained by the Armed Forces Medical Examiner System (AFMES), a relatively
new component of our Command. This registry enables the Casualty and Mortuary Affairs
mission to provide compassionate, unwavering support to the Families of our Warfighters
who have paid the ultimate price of their profession. This full accounting is in concert
with upholding the Warrior Ethos in never leaving a fallen comrade behind. Operation
Iraqi Freedom is the first US Conflict in which all personnel were accounted in large
part of the ongoing science improvements at AFMES.
Medical in-processing is also a time to begin the process of protecting Warfighters from
the myriad of infectious diseases. Exposure ranges from the training environment, some
of which are a result of the stressful training which they are about to begin… to the deployed
environment on the execution of their mission of serving as our Nation’s interest across
the Globe. Many of these products owe their existence to the ideas and efforts of Army,
Navy and Air Force researchers. As an example of the impact of these efforts and the complexity
of ultimately making one of these products available to Warfighters, we’ll illustrate
the development path for the newest vaccine in our armamentarium, the Adenovirus Types
4 and 7 Vaccines. Adenoviruses, particularly serotype 4 and
7, are one of the primary causes of febrile respiratory disease (FRD). Adenovirus-related
FRD is uniquely relevant to military recruit populations because it causes suffering, disrupts
training, and consumes medical resources, often resulting in recruit re-cycling and
sometimes proving fatal. Eight deaths were attributed to adenovirus infections in Warfighters
from 1999 to 2010. Since the program restarted last year, combined data from the training
installations of the Army, Navy, Air Force, Marines, and Coast Guard indicates that the
vaccine has reduced the incidence of febrile respiratory illness by over 75% and essentially
eliminated the threat posed by adenovirus types 4 and 7.
So, how do we get a product to the Warfighter? Like all product development efforts our Command,
the Adenovirus program had to be managed in accordance with not only regulations from
the Food and Drug Administration (FDA), but also those regulations, directives and processes
of the DoD acquisition system. And also like all USAMRMC development efforts, it could
not be successful without the input of many components of our Command. The Integrated
Product Team (IPT) is a multidisciplinary group of people who are collectively responsible
for delivering a defined product or process. The IPT for Adenovirus Vaccine brought together
many elements of the Command including several key offices in USAMRMC Headquarters in constant
coordination with the Walter Reed Army Institute of Research and the US Army Medical Materiel
Development Activity. Each representative brought a perspective to the team such that
when combined they provide total expertise required to navigate a product through the
complicated development process through the Food and Drug Administration (FDA) and DoD
Acquisition System to s The Walter Reed Army Institute of Research (WRAIR) located at Silver
Spring, Maryland was instrumental in the development of the Adenovirus vaccine. WRAIR conducts
biomedical research that is responsive to DoD and U.S. Army requirements and delivers
lifesaving products including knowledge, technology, and medical materiel that sustain the combat
effectiveness of the Warfighter. WRAIR focuses on research to advance prevention
and treatment of Warfighters for the adverse medical and operational consequences of combat
stress, inadequate sleep, concussion, brain injury, infectious disease, and more through
its Centers of Infectious Disease Research and Military Psychiatry and Neurosciences.
Their Special Foreign Activities include: USAMRU-Kenya
USAMRU-Europe AFRIMS – Thailand
CPHRL-Georgia uccessful licensure and fielding. The US Army Medical Materiel Development Activity
(USAMMDA) located at Fort Detrick, Maryland in close coordination with WRAIR was key in
successfully navigating the Adnenovirus vaccine into development.
USAMMDA is the DoD’s advanced medical materiel development activity for products designed
to protect and preserve the lives of Warfighters. They develop new drugs, vaccines, and medical
devices that enhance readiness, ensures the provision of the highest quality medical care
to the DoD, and maximizes survival of medical casualties on the battlefield.
The US Army Medical Research Acquisition Activity (USAMRAA), as part of the Integrated Product
Team for Adenovirus vaccine closed this product development into a useful and effective combat
multiplier for our Warfighters, so that they can continue their development in becoming
the Nation’s finest military. USAMRAA, also located at Fort Detrick, Maryland is the contracting
element of our Command and provides support to the Command headquarters and its worldwide
network of laboratories and medical logistics organizations. USAMRAA also supports DoD-wide
projects sponsored by the Service Surgeons General, the Office of the Secretary of Defense
(Health Affairs), and numerous Congressionally mandated programs. More importantly, USAMRAA
is our command’s vehicle for implementing the command’s acquisition strategic plan.
The recruit’s schedule includes: marksmanship training, grenadier training, drill and ceremony,
gas chamber orientation, radio and signal communications, survival skill training, force
road marches, combat and bayonet training, combatant hand-to-hand training… The rapid
pace of operations and the need for repeated deployments have a profound effect on the
physiological and psychological health and performance of Warfighters. Our Command’s
physiological health research focuses on developing medical standards, predictive models, and
countermeasures to prevent or mitigate the effects of physiological stressors on the
performance and fitness of Warfighters. These stressors may include inappropriate nutrition,
poor physical fitness, sleep loss, sleep deprivation, fatigue, and burnout.
As you can see, the recruits’ normal training schedule can be described as chaotic. Our
Command’s Military Operational Medicine research program (MOMRP) and the US Army Research Institute
of Environmental Medicine (USARIEM) have been at the forefront in providing information
and input to training doctrine in an effort to reduce injuries to recruits during training.
For example, when training in extreme high temperatures, Warfighters must learn to continually
take-in fluids to prevention dehydration and heat stroke. USARIEM has been instrumental
in determining the appropriate regimens of fluid intake for basic training recruits.
Another method to reduce heat injury perfected at USARIEM is the arm immersion kit as seen
on the bottom-left photo. It looks like a bathtub of water at 50 degrees Fahrenheit.
Heat-stressed Warfighters immerse their arms in the device up to their elbows for up to
3 minutes. This preventative measure cools the Warfighter down. USARIEM and MOMRP have
also conducted extensive studies on other types of training injuries and are continually
seeking to develop new and more effective means of prevention for those injuries so
that sound, healthy and well-trained Warfighters join the fighting force.
The U.S. Army Research Institute of Environmental Medicine (USARIEM) located at Natick, Massachusetts
conducts biomedical research to improve and sustain Warfighter health and performance
under all conditions. USARIEM is internationally recognized as the
DoD’s premier laboratory for Warfighter health and performance research and focuses on environmental
medicine, physiology, physical and cognitive performance, and nutrition research. Military
guidance has been published for operations in heat, cold and high-altitude environments
and nutrition for health and performance. Graduation Day — the day that every basic
training recruit eagerly anticipates. It’s a day to celebrate with visiting parents,
brothers, sisters, boyfriends, girlfriends, and Family. It is here they witness you become
a Soldier, Sailor, Airmen, Marine, and Coast Guardsmen. Thanks to you and your efforts
as a member of our Command, these Warfighers are now a well-trained member of an organization
with a proud tradition of defending this country, its citizens, and our Constitution. Because
of you, they will also now be entering the Warfighter’s life cycle better trained and
better fit to enter into more specialized training with enhanced performance in preparation
for deployments…deployments to new and far-reaching areas…areas for operational, peacekeeping,
and humanitarian missions…and because of your efforts their period of post-deployment
and reintegration back in to the Force are better planned so that we can depend on their
profession to continue to defend our Nation. We’ll see how our Command, the US Army Medical
Research and Materiel Command is instrumental in maintaining the Warfighter’s health during
all of these phases, preventing, diagnosing, and treating disease and injury and rehabilitating
those that are injured and ensuring these medical products are strategically, operationally,
and tactically distributed throughout our global outreach.
I will now be followed by the incomparable-friendly-neighborhood-veterinarian, Dr. Keith Vesely, the Office of the Principal
Assistant for Research and Technology. The medical team is responsible for ensuring
Force readiness, caring for the ill and injured and enhancing the health of those entrusted
to our care. To meet this mission, medical personnel require training above and beyond
what they received in basic training. This slide shows some of the advanced training
courses available. Several courses directly supporting medical personnel are held at Institutes
within MRMC to include USAMRICD and USAMRIID which I will talked about shortly.
Since time is of the essence for wounded warfighters and medics can be very busy, the Combat Livesaver
Course was developed to provide medical training to non-medical soldiers so they can provide
lifesaving measures as a secondary mission to their primary mission. The course provides
a bridge between the self-aid/buddy-aid training given to all soldiers during basic training
and the medical training given to the combat medic
Through their multiple medical logistics training programs, the MRMC Logistics Commands contribute
to the enterprise-wide initiative of educating individuals and units on medical logistics
procedures and medical logistics automation A favorite course of many is the Medical Management
of Chemical and Biological Casualties Course. It is a six-day course held jointly at both
ICD and RIID that provides familiarization with the management of acute chem/bio warfare
injuries in an operational environment. Part of one day involves a field exercise where
the students get to assess volunteer chem/bio casualties positioned on stretchers. I was
a volunteer casualty for several field exercises during my time at ICD. Most fun was filling
your mouth full of chicken noodle soup and waiting for group of students in full MOPP
gear to gather around you was you begin twitching and retching.
USAMRICD — located at Aberdeen Proving Ground (Edgewood Area). Nation’s lead lab for medical
chemical defense. USAMRICD discovers and develops medical countermeasures to chemical warfare
agents for U.S. military and U.S. citizens. They train and educate personnel in the medical
management of chemical casualties such as course I already mentioned. Also, provides
subject matter expertise in developing Defense and National policy and in proper crisis management.
USAMRICD is an active consultant role during wars in Iraq and Afghanistan, questions such
as what to do with dead birds they have found to what is this rash on my hands?
Under USAMRICD is the US Army Center for Environmental Health Research (USACEHR). This organizational
relationship is beneficial to both organizations, because the missions are closely related.
They plan, direct, and conduct research, development, testing and validation for occupational and
environmental health surveillance and environmental health technology in support of Force Health
Protection. Areas of research include Rapid Analysis of Drinking Water for Microbial Contamination
and Biomarker Discovery and Toxicogenomics. Before renovations to the current building,
back when it was called the BRDL Building (Biomedical Research and Development Laboratory),
could always tell they keep tropical fish in the basement as part of their aquatic toxicology.
USAMRIID — located here at Fort Detrick. DoD’s lead lab for medical biological defense
Research leads to medical solutions (therapeutics, vaccines, diagnostics, and information) that
benefit both military personnel and civilians Since we cannot ethically or feasibly expose
humans to chem/bio warfare agents to conduct efficacy or effectiveness studies, the FDA
Animal Rule allows us to test effectiveness of a new countermeasure in animals rather
than people These “pivotal” animal studies must establish
that the product is reasonably likely to produce clinical benefit in humans
In 2008,biosurety or the establishment of systems and procedures to properly safeguard
Biological Select Agents and Toxins (BSAT) became important to RIID as well as the entire
nation. Examples of BSAT shown above
USAMRIID as well as the Safety, Surety and Environmental Office here at Fort Detrick
constantly ensure all the BSAT material at USAMRIID are handled in a safe, secure and
reliable manner. Nation’s military forces may be called to
serve anywhere in the world during times of conflict or in peacetime. Among the threats
our Forces face are injury from combat operations, exposure to chemical or biological warfare
agents, environmental extremes, and endemic diseases not common in the United States.
To provide Warfighters defenses against these hazards and sustain their health is the goal
of USAMRMC. Examples of products currently in the hands
of the warfighter include: JBAIDS
Ruggedized, portable system fielded to all the Services
Capable of rapidly identifying multiple biological agents and other pathogens of operational
concern Anthrax, tularemia, plague and influenza detection
systems are FDA cleared for diagnostic use Being able to test for more common agents
such as influenza allows operators to maintain competency since we are not testing everyday
for anthrax or plague Unique collaborative effort between RIID and
CBMS, the advanced developer of med chem/bio product for DoD
CBMS is located here at Fort Detrick Soman Nerve Agent Pretreatment Pyridostigmine
(SNAPP) or PB Tabs FDA approved as prophylaxis against nerve
agent soman First drug approved under the Animal Rule
I mentioned earlier Collaborative effort between MRICD, and USAMMDA
Antidote Treatment Nerve Agent Autoinjector (ATNAA)
Administered after onset of symptoms of nerve agent toxicity
Since affects CNS, I don’t have to worry – no target organ
FDA-approved ATNAA is two-chambered autoinjector for IM injection of nerve antidotes atropine
and 2-PAM through same needle Replaces the MARK I Nerve Agent Antidote Kit,
same drugs but two autoinjectors Development required collaboration between
ICD and USAMMDA Not all training is done through courses and
not all of USAMRMC’s products are materiel development items or “widgets”
USAMRMC has also been instrumental in the development of medical knowledge products
as shown here These products exist on paper, or in the form
of software, but are not “acquired” in the usual sense of the DoD acquisition process
which you will hear more about later Nevertheless, they are important products
that can be used to disseminate “best practices” for DoD
Examples include: Red, blue and gold management of chem/bio
casualties books which are designed to be carried in the pocket of the ACUs
Textbook of Military Medicine Series which according to my count is up to 18 books. My
favorite is shown here since I am co-author is one of the chapters.
Clinical Practice Guidelines MRMC was instrumental in developing
I believe our efforts to develop these products not only moves military medicine forward but
moves all of medicine forward In addition to the courses I mentioned earlier,
the Medical Training and Health Information Sciences Research Program (or Joint Program
Committee-1) and the Telemedicine and Advanced Technology Research Center (TATRC) are working
together to improve patient safety and quality of care through modeling and simulation-based
technologies/systems as shown in the initiatives above
Combat Casualty Training Initiative: Focus of this initiative is to advance pre-hospital
combat casualty training with an emphasis on the combat medic
Medical Practice Initiative: Focuses on maintenance of military and medical skills over a medical
provider’s health care career A tremendous benefit of Medical Simulation
and Training is its ability to reduce our reliance on live animal training.
TATRC is located at Fort Detrick. It is the lead DoD research center for electronic Health
and mobile Health research initiatives. eHealth research encompasses the use of information
and communication technology, such as computers, mobile phones, communications satellite, patient
monitors, etc., for health services and information. An example would be the electronic health
record system. mHealth is the delivery of healthcare services
via mobile communication devices, such as mobile phones, BlackBerries, and laptops.
Also heavily involved in computational biology or bioinformatics research. Come long way
since I bought my Commodore Colt with “upgraded” hard drive of 20MB and was told all the memory
I would ever need. TATRC also acts as S&T scouts for military
medicine. Constantly looking to support innovative and convergence science efforts to feed the
R&D pipeline. Surprisingly, usually do not require large
investments, with ~$250-300K being the sweet spot for finding new and innovative ideas.
Prior to any deployment, the Warfighter must be prepared at the unit level as well as an
individual Deployment Readiness requires completion of
a set of basic elements for all the Services to protect the health of our deploying Service
members. This includes the basic things such as updating your will and ensuring your bills
will be paid while on deployment. In addition, assessments such as the required Pre-Deployment
Health Assessment are designed to provide comprehensive health surveillance for Service
members affected by deployments and make sure overall Force Health Protection.
Form designed to identify and address health concerns, with specific emphasis on mental
health Allows military personnel to share any concerns
they have prior to deployment Helps health care providers identify issues
and provide medical care before deployment Medical Operational Medicine Research Program
and WRAIR (which you heard about earlier) served as consultants during the development
of form Other examples of products that USAMRMC was
instrumental in developing and fielding and now in the hands of the Warfighter about to
deploy include: Nerve agent autoinjector which I already mentioned
Combat Application Tourniquet (CAT) Life saving tool carried by each Solider to
stop the bleeding quickly Developed using funding from our Combat Casualty
Care Research Program and operations and maintenance (O&M) dollars
Expeditiously selected and tested by the U.S. Army Institute for Surgical Research, or ISR,
and procured and delivered to each Soldier by the U.S. Army Medical Materiel Agency
USAISR is located at Fort Sam Houston in the San Antonio Military Medical Center
Army’s lead lab for combat casualty care medical solutions and products for injured Soldiers
and works closely with the Combat Casualty Care Research Program here at Fort Detrick
When I think of ISR I think of their Burn Center which serves as the sole facility caring
for combat burn casualties, beneficiaries and civilian emergencies within the entire
Department of Defense The Joint Trauma System (JTS) was established
within the ISR to improve trauma care delivery and patient outcomes across the entire continuum
of care to include prevention, point of injury, pre-hospital, patient movement, military treatment
facility acute, subacute, chronic care and life-long rehabilitation
As part of the JTS, the Joint Theater Trauma Registry (JTTR) is the data repository for
trauma-related injuries and leads improved care of wounded warriors through such things
as new clinical practice guidelines I mentioned earlier.
I mentioned the great work that we do for the Individual Warfighter during pre-deployment,
now let’s focus on how we support our Units during pre-deployment. USAMRMC directly supports
the readiness of the US Army through life-cycle logistics to Army Units. Although you will
hear more medical logistics details later, I wanted to mention a key organization here
at Fort Detrick that is a central focal point for deployment readiness, the U.S. Army Medical
Materiel Agency (USAMMA). The U.S. Army Medical Materiel Agency (USAMMA)
manages the fielding and technical inspection of medical equipment and supplies.
These fieldings bring modernized equipment and materiel to our units prior to deployment
to make sure they have the most state-of-the art items to take care of injured or sick
warfighters   USAMMA also manages multiple contingency stock
programs to include Army Prepositioned Stock around the world and those stocks linked to
our national strategic emergency response plans
USAMMA also provides oversight/collaboration on specific materiel projects that are linked
to MRMC Acquisition and Planning, Programming, Budgeting, and Execution (PPBE) processes
(which you will hear more about later) In summary, USAMMA provides strategic, operational,
and even tactical level support to the warfighter. For the deploying unit, USAMMA provides essential
materiel fieldings and logistics solutions, ensuring that they are ready!
Next will be Dawn Rosarius who will talk to you about deployment
MRMC ensures Soldiers are prepared physically and mentally for deployments
All environment — from desert heat to snowy mountains to the rain forest
From humanitarian assistance to combat MRMC has been and continues to be heavily
involved in ensuring our warfighters have the protective equipment and supplies they
need  The Military Infectious Disease Research
Program the Walter Reed Army Institute of Research, or WRAIR, and the U..S Army Medical
Materiel Devel- opment Activity — USAMMDA — develop bed nets used in areas with a heavy
population of insects, to make sure our warfighters are protected from disease
 Working with our Combat Developer, experts from the US Army Institute of Surgical Research
or ISR the US army Medical Materiel Development Activity, and the US Army Medical Materiel
Agency or USAMMA worked together to make sure the best commercially available items were
selected for the Individual First Aid Kit which is now worn by each Soldier and has
essential medical items, such as the CAT and lifesaving bandages.
The Military Operational Medicine Research Program and Congressional Special Interest
funds assist the U.S. Army Institute of Environmental Medicine, or USARIEM, in conducting nutrition
research to determine the impact and effects of the types of food and calorie intake of
a Solider. And, we continue to be on the fore front of
research in providing better protection with the Combat Casualty Care and Military Operational
Medicine Research Programs via the work at the Walter Reed Institute of Research for
Fatigue, sleep, and Traumatic Brain Injury Like the protection to our individual Soldiers,
MRMC also provides a safe working environment for the staff.
The Military Operational Medicine Research Program with the U.S. Army Center for Environmental
Health Research and U.S. Army Medical Materiel Agency are developing the Coliform Analyzer
— a tool to make sure that the Soldier’s drinking water is safe from Coliform bacteria
and E coli. The MRMC has also been essential in developing
and determining the best medical evacuation and care solutions for both ground and air
ambulances, at the U.S. Army Aeromedical Research Lab, the U.S. Army Medical Materiel Agency,
the U.S. Army Medical Materiel Development Activity, and the Telemedicine and Advanced
Technology Research Center. Now how do YOU fit into this process and this
great organization of MRMC? From Research and Development, Development
and Acquisition and Acquisition and Logistics all important along the DoD LCM cycle. For
example, vaccines can take 10-15 years and devices can take about 5 years.
: From Research and Technology, this is typically research of knowledge or materiel solutions
in the discovery through technology development This area is led by Dr. Frazier Glenn, our
Principal Assistant for Research and Technology Funds managed by our Research programs noted
from Military Infectious Disease Research Program to out newest area the Medical Training
and Health Information Sciences Noted is RAD and JPC, a RAD or research Area
Directorate manages the Army funds and typically under the same manager the JPC or Joint Program
Committee — a multiservice team — manages the intramural Defense Health Program/DHP
funding Intramural programs are executed by our Laboratories
noted there and Extramural programs are typically managed by our Execution Management organizations
who include the Clinical Directed Medical Research Program — CDMRP and the Telemedicine
and Advanced Technology Research Center — TATRC. From Acquisition, this is typically for what
DoD calls Programs of Record, from Milestone B through production and deployment, ensuring
products are properly FDA cleared, manufactured, and prepared for the environment
This area is led by Dr. Ken Bertram, our Principal Assistant for Acquisition
Execution is performed by our Project Managers from the Pharmaceutical PM to the Helicopter
MEDEVAC Mission Essential Package PMs who work for USAMMA, USAMMDA, and WRAIR.
Army dollars are managed by the PMs and DHP dollars are managed by our Joint Program Chairs
When products are ready for fielding, we then hand this off to our logisticians.
From logistics, we procure, assemble, field, maintain and sustain our equipment and sets,
kits, and outfits developed for our deploying units.
This area is led by Mr. David Williams, our Deputy for Materiel
Executed by our Log organizations of USAMMA, U.S. Army Medical Materiel Center Europe/USAMMCE,
USA Medical Materiel Center — Korea/USAMMC-K, and the 6th Medical Logistics Management Center.
How Do we Make This Happened As we mentioned — it is You!!
From your early ideas in basic research and technology, through Advanced Development and
Acquisition thru Logistics Lastly, we NEED MONEY….. We all like money
and we all need money to exist, as does MRMC. We talked about the process of obtaining and
spending our funding and making better decisions using Integrated Product Teams
This chart demonstrates how all these sources of money we mentioned flows
It all starts with Congress through the Office of the Secretary of Defense and then, depending
on the type of funds we receive, either through the Defense Threat Reduction Agency if in
support of research at ICD or RIID, Health Affairs for our DHP RDT&E funding and in support
of our logistics agencies, or via the Army for our Army-funded programs; then through
MEDCOM, and finally to us This “funds flow and process” is what we call
our CORE funding We also receive special appropriations directly
from Congress to do research in special areas such as Breast Cancer and Traumatic Brain
Injury — these funds go around the entire process and come directly from Congress. This
is called Congressional Special Interest money and is a large portion of our funds.
Like you and Money, processes are important to make us successful. One of those processes
important for MRMC’s research and development is the Decision Gate Process
This is not something MRMC developed to create more oversight, it is the marriage of existing
Federal and DoD regulations, laws and processes from the DoD Acquisition system and the U.S.
Food and Drug or Environmental Protection agencies
Decision Gate is a streamlined process to support these many laws and regulations. Depending
on the maturity of the product and it’s intended use, it can take several to many years.
This demonstrates how from basic research thru the Acquisition phases and Milestones,
we get a product thru the process and in the hands of the warfighter.
One example of this is the Noise Immune Stethoscope, which was taken thru the various research
phase of Materiel Solution Analysis and Technology Development by the US Army Aeromedical Research
Lab/ USAARL Then, at this triangle — called a Milestone
— Milestone B, it was handed off to our Advanced Development organization — USAMMA who took
the product thru Engineering and Manufacturing Development — ensuring the product was FDA
approved, that it could be manufactured and that is was supportable
It is now being reviewed by the user community and hopefully we will hand it off to our Logisticians
to fully field and sustain it in the near future.
In addition, as part of our research and development processes, like Decision Gate with our DoD
and FDA regulations and laws, we have additional laws and regulations that provide ethical
and regulatory processes to help us be successful with medical R&D.
Our Office of Research Protections at HQ, MRMC helps make sure that any research conducted
on an animals or humans is ethical and done in accordance with all regulatory requirements
Our Division of Regulated Activities and Compliance/DRAC at USAMMDA provides FDA regulatory support
and is the single point of communication w/ the FDA-regulated products
Both organizations are essential in our research and development.
As mentioned earlier, we are an unique organization and a full lifecycle manager
We have two lifecycles within the full lifecycle – product development and product sustainment
Both support the other and are essential for us to develop, procure, and sustain products
for our Soldiers Not all of our products are developed from
the early stages. 95% of products that go to the field are COTS or commercial off of
the shelf items. (COL Dole) The Army Medical Department sustains
the fighting force. The Army Medical Department also inspires the American war-fighter: instilling
confidence when they face dangers because they know they will receive the best possible
protection and care. Media: Click to start the video
Script continues: The medical materiel and medical knowledge delivered by MRMC has been
essential to the positive medical outcomes. In Iraqi and Afghanistan, the military health
system has achieved the highest rate of survival with the lowest medical footprint of any conflict;
90% of total causalities have survived. Follow the wounded Soldier in this scenario
through the evacuation process. Prior to the injury, the Soldier has received
the best possible equipment and training, efforts seeking to prevent or mitigate injury.
Immediately upon injury, the Soldier receive care from their battle-buddy, from the Soldiers
in his squad trained in the Combat Life-Saver program, and from medics integrated into the
unit. You can imagine his buddy opening the Improved First Aid Kit (IFAK) strapped to
the Soldier’s vest or, in a traumatic injury, utilizing the Combat Application Tourniquet
(CAT) to a severed limb. At that moment, it is all reaction and hasty
action. Adding to the Soldier’s strength in that moment are very deliberate and technical
processes from MRMC’s activities. Illustrating this point, the Joint Trauma
Analysis and Prevention of Injury in Combat (JTAPIC) provides data, analysis, and recommendations
to improve design to military equipment. JTAPIC collects and analyzes intelligence and clinical
injury data in order to provide actionable information to the appropriate Program Executive
Office. In this way, MRMC influences the proper design and life-support systems for vehicles
and equipment. JTAPIC has impacted design changes to helmets,
armor, vehicles, and clothing and changes to Tactics, Techniques, and Procedures. The
photos on this slide illustrate vehicle design changes, a very relevant example to the video
of the IED blast video. The experience of the wounded Soldier continues
as the ‘9-line’ call for MEDEVAC brings in medical evacuations.
The medical materiel and medical knowledge delivered by MRMC continue to be an essential
element of the care. The Noise Immune Stethoscope, MEDEVAC Telemedicine, and portable oxygen
generation are illustrated in these photos. The U.S. Army Aeromedical Research Laboratory
(USAARL) located at Fort Rucker, Alabama, the home of Army aviation, provided the research,
testing, and knowledge products that made those innovations possible.
The USAARL’s mission is to preserve and enhance the health, safety, combat effectiveness,
and survivability of the U.S. Army Aviator and the Soldier.
Their five main tasks are listed on this slide. Ultimately, USAARL reduces the health hazards
and improves human performance on Army aviation platforms and vehicles. Their effort ensures
the Soldier safety, health, and optimal human performance is built into our systems.
These are specialized examples of technology solutions, consider that as the life-cycle-manager
for all Class VIII Medical Materiel, MRMC manages and delivers all medical products
— “Healthcare Starts with Medical Logistics” The life-cycle management included three parts;
Research & Technology, Acquisition, and Logistics. It is in the logistics that MRMC provides
direct support to the military units. The medical logistics responsibilities (per
the Joint Health Readiness CONOPS) includes nine capabilities: Medical Supply, Equipment
& Technology, Medical Maintenance, Optical Fabrication, Medical Logistics Services, Blood
Management, Medical Facilities, Medical Contract Management, Assemblage Life Cycle Management.
In 2009, the MRMC Commander was designated by the Army Surgeon General as the senior
leader champion for the Army Medical Logistics Enterprise. This reinforced MRMC role as the
life-cycle-manager for Class VIII materiel and expanded MRMC’s role and responsibility
to influence the entire Army Medical Logistics Enterprise.
There are two elements, first, MRMC executes medical logistics functions through organic
Medical Logistics commands that provide robust and unique capabilities. Second, MRMC develops
and synchronizes medical logistics concept of operations and strategic goals across all
Army activities by leading a collaborative approach with Medical Command, Forces Command,
Defense Logistics Activity, and all other stakeholders.
MRMC has specific leadership responsibility in supply, equipment, maintenance, and assemblage
life cycle management — as well as a significant responsibilities in all nine MEDLOG capabilities
— especially through the logistics commands. Provides medical logistics support to U.S.
Forces Korea and organizations located in the Korean theater.
At USAMMC-K, a MRMC unit, partners with Korean civilian employees, Republic of Korean (ROK)
Army, and the U.S. Army 563rd Medical Logistics Company to provide the full range of medical
logistics support. Their vision includes “Fight & Win Tonight!”, as USAMMC-K is fully integrated
into the Eighth Army contingency plans. Provides medical logistics support to U.S.
Forces Korea and organizations located in the Korean theater.
At USAMMC-K, a MRMC unit, partners with Korean civilian employees, Republic of Korean (ROK)
Army, and the U.S. Army 563rd Medical Logistics Company to provide the full range of medical
logistics support. Their vision includes “Fight & Win Tonight!”, as USAMMC-K is fully integrated
into the Eighth Army contingency plans. The 6th Medical Logistics Management Center
(MLMC) is a deployable FORCES COMMAND unit under the administrative control of MRMC.
The 6th MLMC provides strategic medical logistics resources — to plan and execute expeditionary
centralized medical materiel management. A unique capability that has proven invaluable
during expeditionary missions such as theater openings, and disaster relief operations such
as the relief mission in Haiti and Hurricane Sandy.
The 6th MLMC provides two deployable teams — these teams have been on constant deployed
rotations to Camp As Sayliyah Qatar throughout the Operation Iraqi Freedom and Operation
Enduring Freedom, continuing today in Operation New Dawn. In Qatar, the 6th MLMC provide leadership
to the U.S. Army Medical Materiel Center — Southwest Asia (USAMMC-SWA) (Provisional), the TLAMM
for Central Command providing direct logistics support to hundreds of joint and interagency
customers. MRMC provides the full range of logistics
support as part of the complete Life Cycle Management of medical materiel; MRMC is the
champion for the Medical Logistics enterprise; and MRMC units and personnel provide direct
support, including deployed logistics teams, to all Army units and to Joint forces.
I will be followed by (LTC Fobbs) as MRMC continues to impact the Soldiers experience
after deployment (LTC Fobbs) Increasing numbers of Service
members are surviving with extreme trauma to the extremities and head due to advances
in trauma care. VIDEO  The Clinical and Rehabilitative Medicine
Research Program (CRMRP) seeks more effective ways to treat wounded Soldiers.
 The program has multiple initiatives to achieve its goals, including improving prosthetic
function, enhancing rehabilitative care, repairing damaged eyes, improving pain management, improving
limb/organ transplant success, and creating full functioning limbs/organs.
 The CRMRP focuses on definitive and rehabilitative care innovations require to reset the nation’s
wounded warriors, in terms of duty performance and quality of life. The CRMRP is the lead
for program development and oversight of the Armed Forces Institute of Regenerative Medicine,
or AFIRM, which is a multi-institutional, interdisciplinary network working to develop
advanced treatment options for severely wounded service members.
The wounds of battle are often hidden. Close calls and seeing buddies killed in action
are traumatic. No one is immune.  The Military Operational Medicine Research
Program supports the ongoing research and development plan at Walter Reed Army Institute
of Research for post traumatic stress and other psychological health issues that impact
our warriors. Their goal is to develop better, standardized
clinical practice guidelines that can be provided to the Defense Centers of Excellence and implemented
throughout our military treatment facilities. Military Operational Medicine Research Program
as well as WRAIR develops and manages resilience training programs such as BattleMind that
offer strength-based, positive psychology tools to aid Soldiers, Leaders and Families
who must face the daily challenges of military life. 
The information provided within this training is targeted to all phases of the Soldier deployment
cycle, life cycle, and support system.  Here is an early example of a product used
to assist warriors returning from deployment. The Army places strong focus on cognitive
assessment for its Service members.  As follow-on to the Pre-Deployment Health
Assessment discussed earlier, the Army requires deployed military and civilian personnel to
complete a post-deployment health assessment immediately after return to home station and
post deployment health reassessment 90-180 days following return.
 The assessments are designed to identify and address health concerns, with specific
emphasis on mental health, that have emerged over time since deployment. We have covered
how MRMC takes care of the Warfighter in the field, but also important is that MRMC supports
the family in many ways. Of particular note resilience training and suicide prevention
training. Many programs are of interest to Congress. As was mentioned earlier, Congressional
Special Interest funding has assisting in keeping Breast Cancer and prostate cancer
research moving forward.  The Nation recognizes MRMC’s capability
to manage extremely high budget research programs. Therefore, — CDMRP manages Congressional
Special Interest funded medical research programs in areas directed by Congress.
 In the 20 years since MRMC received its first breast cancer money, CDMRP has received
over 100 different CSI appropriations for other diseases to include ovarian and lung
cancer, psychological health, traumatic brain injury as well as orthopaedic and spinal cord
injury. In recent years, CDMRP has become an Execution
Manager for the Joint Program Committees core programs.
 Another of our organizations that has national and international reach is… The Armed Forces
Medical Examiner operates a system that provides comprehensive services in forensic pathology,
forensic toxicology, DNA technology and identification, and mortality surveillance for the Department
of Defense.  A Tri-service organization, the AFMES is
the only Medical Examiner Operation at the Federal Level and is an Executive Agency.
They are responsible for determining cause and manner of death in all cases of suspicious
or unnatural death for US Service members and persons of interest to the US government.
 They work closely with the investigative arm of each branch of the military to include
forensic investigation of crime scenes. And upon request an AFME team consisting of a
forensic pathologist, forensic anthropologist, investigator, and photographer can deploy
to incident site for recovery, identification, re-association and return of fallen warriors
to the families. With so many historic medical events occurring, it is critical that significant
innovations in medicine be captured… The National Museum of Health and Medicine has
case studies and records about disease, injury treatment and healthcare in the military since
1862. This includes vaccine research and trials, brain surgery and artificial organs.
  NMHM celebrated its 150th anniversary on May
21, 2012 (the exact date of its founding in 1862) with a formal ribbon-cutting and public
open house, attended by more than 1000 people from the across the entire Washington, D.C.
metropolitan area.  
The Museum’s long history allows for a vast collection of materials used for ongoing research
and development. It also serves as a repository for current products and technologies.
  The Museum held its 25th annual Forensic Anthropology
course in June 2012. The course was held at the Office of the Chief Medical Examiner in
Baltimore, Maryland, and drew participants from national and international organizations
of military and civilian professionals.  
Each year during brain awareness week, the museum educates nearly 1,000 local middle
school students on TBI. The museum also provides a welcoming and comfortable space for Soldiers
and their families to discuss topics related to Traumatic Brain Injury and post traumatic
stress disorder.  
The stress-free environment of the museum reflects the care and concern shown for our
warriors and the medical innovations developed to care for our military. It enables family
members to gain a sense of the medical community’s involvement in Soldiers’ lives across a linear
time spectrum. We all understand that health for our warriors does not stop once the Soldier
leaves active duty… The Department of Defense and the Department of Veterans Affairs provide
health care and benefits to the same population at different times in their lives.
 For this reason it is critical that DoD and VA share data, resources, and coordinate
and collaborate on medical care and medical research initiatives.
 MRMC works with the VA on many clinical trials and consortia studies focusing on regenerative
medicine (AFIRM), traumatic brain injury, post traumatic stress, suicide, Alzheimer’s,
Gulf War Illness and the Millennium Cohort Study, which examines the health-related effects
of deployment on military personnel and Veterans.  This overview only scrapes the surface of
the service, support and products MRMC develops and distributes to make sure our warriors
stay Army Strong, Aim High, and are always faithful from initial entry to retirement and beyond. Any questions or comments?