Attachment 18.2 59th requirement deep dive.pdf

59th Medical Wing Scope and Background

BACKGROUND: The 59th Medical Wing (59 MDW) is a forward operating Air Force

Medical Service (AFMS) Execution Platform in support of the Headquarters United

States Air Force Surgeon General (HQ USAF/SG). The 59MDW, Science and

Technology (ST) office advises and conducts clinical and translational research under the guidance of the Air Force Surgeon General (AF/SG), the Secretary of the Air Force

(SAF), Air Force Chief of Staff, and the Office of Assistant Secretary of Defense for

Health Affairs (ASD/HA) on matters pertaining to the medical aspects of the Air

Expeditionary Force and the health of Air Force (AF) personnel and beneficiaries. In order to support the required research, the ST office requires support from a Technical

Clinical Research Team (TCRT) and the TCRT team supports a global mission for the

Air Force research program.

Additionally, the ST office supports the San Antonio Military Health System (SAMHS), which is comprised of the 59th MDW/Wilford Hall (AF), San Antonio Military Medical

Center (SAMMC) (Army/BAMC), Joint Base San Antonio (JBSA), each with a robust

Clinical Investigations Program and Clinical Research mission. These sites conduct translational research in the areas of emergency medical care, combat casualty care, force health protection, restorative medicine, clinical and rehabilitative medicine all with multiple centers of excellence (i.e., diabetes, eye, hearing, advanced molecular detection), and specialty centers (i.e., burn management and transport, cardio-vascular, extracorporeal life support and critical care transport, maternal and neonatal intensive care, pain management). The ST office continues to facilitate development of innovations for advancing the care and rehabilitation of the combat wounded and support for Food and Drug Administration (FDA) regulated trials supporting activities

Enterprise-Wide.

Expeditionary Medicine

EM research and technology development encompass interests in Expeditionary

Logistics and Expeditionary Casualty Care. These focus areas are further defined and discussed in the subsequent sections.

The overall aim is to enhance or improve expeditionary medical care during contingency operations including: improvement of expeditionary equipment capability enhancements by addressing needs related to platform capability sustainability (energy, supplies and materials); miniaturization of equipment to reduce logistics footprint, technology identification; development and/or validation of next-generation critical humanitarian/disaster relief equipment/material sets; deployed casualty care optimization and improvements; and field identification, diagnosis and treatment of emerging threat Directed Energy Weapons (DEW) injuries. This research aims to address issues related to care in the expeditionary setting and the inherent challenges in those missions. The funding for EM Research and Development is intended to address unique AF operational needs, with the possibility of collateral benefit to other

Department of Defense entities.

Force Health Protection Direct Energy

Various forms of Direct Energy are a threat that U.S. Air Force and other military operators will encounter on the modern battlefield. As DE incidents become more frequent in both domestic and foreign areas, the threat to Air Force and other military operators increase. Research is required to develop technologies that "detect to warn" and "detect to protect" to allow operators to be aware of the hazards and take appropriate actions to prevent or minimize exposure and associated adverse health effects. Exposure evaluation allows correct interventions and reduces uncertainty in treatment protocols. Also, medical decisions concerning treatment needs can be made as far forward as possible (i.e., minimizing the need for medical evacuation out of a theater of operations).

Human Performance

Human Performance encompasses research and technology development interests in

Cognitive Performance and Fatigue Management, Physiological Performance and

Targeted Conditioning, Operational and Environmental Challenges to Performance, Training for Optimal Performance of AF Medical Personnel and Personnel Selection for

Performance. These focus areas are further defined and discussed in the subsequent sections. The overall aims of AFMS Human Performance research are to enhance, optimize and maintain personnel performance in carrying out their assigned missions

Operational Medicine

Psychological Health/Resilience:

In this time of persistently high operations tempo, in-garrison health care staff is tasked with providing quality care even in the face of staffing shortages due to deployments, budget cuts and inability to hire personnel for temporary positions. To meet staffing shortages, members of the

Air Force Reserves and Air National Guard are often activated and deployed for extended periods of time to locations in the very area in which they live and work as civilians. These prolonged deployments are sources of stress to these Airmen. Research is needed to assess these specific populations for sources of stress, as well as their resiliency and resilience enablers. In addition to Reservists and Guardsmen, active duty members that staff medical treatment facilities during periods of minimal manning need to be assessed for stressors and resilience enablers.

Obesity:

This focus area seeks research and technology development to identify and treat the scope of the obesity in AFMS beneficiaries. This research also seeks to assess the activity levels and physical functional capabilities of AFMS beneficiaries. Once the scope of the problem has been identified, the information will be utilized to drive research to explore and identify effective treatment programs specific to AFMS beneficiaries. As this information is being gathered, translational research is needed to support development and enhancement of currently successful patient educational programs that promote healthy lifestyles to treat obesity and prevent development of chronic diseases such as diabetes mellitus and cardiovascular disease.

Autism:

This focus area seeks to continue development of an Autism Spectrum Disorder Registry of families from Wright-Patterson Air Force Base and Central Ohio with the goal of collaborating with other military Medical Treatment Facilities to provide psychological testing. These efforts will increase the number of studies affected in the registry for increased statistical power for molecular studies, and will continue research to identify autism susceptibility variants in candidate genes by direct sequencing and screening for regulatory variation by measuring Allelic mRNA Expression Imbalance (AEI) and altered gene splicing.

In addition, this focus area will explore the use of telemedicine to deliver Autism healthcare services with the potential to: improve access to care; improve patient compliance with specialty referral; and broadening the scope of patients and families who can be effectively managed.

Current AFMS staffing constraints, limited AFMS system capabilities, and a mobile patient population requires a medical infrastructure capable of meeting unique provider and patient circumstances. Using telemedicine for Autism will improve the impact of existing resources, especially in rural and underserved communities.

Enroute Care

Enroute care seeks to enhance the Air Force Medical Service (AFMS) ability to rapidly but safely transport patients from point of injury to definitive care while reducing footprint and variability and improving efficiency. AFMS seeks to maximize technological advancements and groundbreaking clinical research to match care during transport with state of the art ground medicine throughout the continuum.

Research is needed to address knowledge gaps during patient transport and staging.

The knowledge gained will be used to ensure that the best care is provided to our wounded/ill service members as they are moved through the system.

Research/technology development is also needed on non-invasive and specific methods for assessing trauma resuscitation and timing of interventions and transport.

Clinical research is needed to complement critical care and routine patient transport technology development.

EC Thrust Area focus is on continuum of care during transport of patients from point of injury to point of definitive care. Key areas include: Aeromedical Evacuation, Patient

Staging and Critical Care Air Transport equipment and treatment research. The three broad areas of research include: