BAMC Site Visit Slides.pptx

Brooke Army Medical Center Command Overview

COL Mark Stackle BAMC Commander

Trauma Mission

3% mortality - Multidisciplinary care to ensure maximal functional recovery

Life-saving damage control surgery staged to complex reconstructive surgery

TCCC from point of injury to hospital evaluation & stabilization

Patient injury severity at BAMC matches combat injuries

Inpatient Ward

Advanced Virtual Support for Operational Forces to improve remote casualty triage & treatment

Inpatient Ward

Army Virtual Medical Center

Prolonged Field Care

Surgery

Field Hospital

Emergency Department

Point of Injury

Battalion Aid Station

Improvised Explosive Device

UNCLASSIFIED

Medically Ready Force… Ready Medical Force

Inpatient Volume & Complexity

Overall MHS CMI = 0.92 Workload adjusted for Genesis MTFs Average Daily Patients vs. Case Mix Index 12-month data period ending FY 21.06

Slide 3 has not been updated with a more current chart on Inpatient Volume and Complexity. BOD reached out to MEDCOM in JUN 22 to ask for an update, but they have not been able to provide an update to date.

Brooke Army Medical Center - People

1,861 Contractors

253,668 Eligible Beneficiaries

117 Volunteers

266 D Det Students

2,953 DoD Civilians / 65 DA Civilians

1,353 Air Force

1,487 Army Staff / 196 MTOE Assigned Personnel (MAP)

Beneficiaries Data (Data Period: Rolling 12 Months: MAR 2022-FEB 2023):

Available from: https://fmis.health.mil/app/business-intelligence/reports/qlik/sense 253,668 Total Eligible Beneficiaries (includes those enrolled to our market partner the 59th Medical Wing)

BAMC FY24 Target Prime Enrollment = 58,429

All Other Categories (As of 23 May 23):

Contractors decrease of 327 since JUN 22 GS Civilians increase of 93 since JUN 22 Volunteers decrease of 108 since JUN 22 Air Force increase of 15 since JUN 22 Army decrease in 30 since JUN 22 MAP assigned increase of 35 since JUN 22 Students decrease of 261 since JUN 22

Why We Exist… Army Virtual Medical Center Field Hospital

From the Foxhole to the Fixed Facility Healthcare Readiness

Mission, Vision, & Values

MISSION

Enable total force readiness and health, Ensure globally responsive premier healthcare teams that deliver high-quality care, while Empowering and caring for our People.

VISION

To be the pinnacle of readiness, training and innovative healthcare – Anytime, Anywhere - Always!

VALUES

UNCLASSIFIED

Compassion & Empathy Collaboration & Teamwork Dignity & Respect Committed to Excellence Integrity

DHA Mission Statement: The Defense Health Agency supports our Nation by improving health and building readiness -- making extraordinary experiences ordinary and exceptional outcomes routine.

Army Mission Statement: Our Purpose remains constant: To deploy, fight, and win our Nation’s wars by providing ready, prompt, and sustained land dominance by Army forces across the full spectrum of conflict as part of the Joint Force.

MEDCOM Mission Statement: Provide ready and sustained health services support and force health protection in support of the Total Force to enable readiness and to conserve the fighting strength while caring for our People and their Families.

MRC,W Mission Statement: Provide regionally ready, globally responsive medical forces, health service support, and force health protection to conserve the fighting strength; enable the readiness and health of the Army and designated activities; integrate and liaise at echelon for the provision of health service support and force health protection to the Total Army. Provide Command and Control to Medical Department Activities (MEDDAC), Medical Centers (MEDCEN), Dental Health Commands (DHC), Public Health Commands (PHC), and Soldier Recovery Units (SRU).

History 1879 – First treatment of patients in temporary hospital buildings 1886 – First hospital built on Fort Sam Houston – 84 beds 1937 – Construction completed for new Station Hospital (BLDG 1000) – 418 beds 1942 – Station Hospital re-designated as Brooke General Hospital 1946 – Establishment of Brooke Army Medical Center, which included Brooke General Hospital, the Medical Field Service School (now MEDCoE), and the U.S. Army Surgical Research Unit (now USAISR) 1996 – Current BAMC (BLDG 3600) opens -450 beds 1996 – San Antonio Uniformed Services Health Education Consortium (SAUSHEC) established 2005 – Base Realignment Closure Act (BRAC) consolidated all inpatient care from Wilford Hall to BAMC 2007 – Civilian-funded Center for the Intrepid (CFI) rehabilitation center opened 2011 – Consolidated Tower (BLDG 3608) with expanded Level I Trauma Center opens – 425 beds 2021 – San Antonio Market established within the Defense Health Agency

BAMC was far more than the hospital alone but it also resided with a relatively small areas on FSHTX. It included all of the annexes with hundreds of more beds. But some reports, Brooke Hospital Center expanded to 7,800 beds by 1945 as casualties returned from WWII.

Bldg 2792 was Annex II; Bldg 2791 was Annex III (there were ultimately 5 annex buildings many convalescent wards.

two changes occurred over the last 10 years that may have decreased beds in Bldg 3600:

We remodeled Ward 7W for the IOP circa 2013 and I have lost track of the net change to bed count. Fairly confident that we lost beds in the process since 2W, 3W, 4W, and 6W had 30 beds each and 7W now only has 12.

We also created Rehab space on 4W and I need to check on the space allocated for that also.

USAISR ORIGINS:

The Institute of Surgical Research (USAISR), originally named the Surgical Research Unit, was established in 1943 at Halloran General Hospital, Staten Island, New York.

Its mission was to evaluate the role of newly discovered antibiotics in the treatment of war wounds. In 1947, the Institute, with its 12 assigned personnel, moved to Brooke General Hospital, Brooke Army Medical Center, Fort Sam Houston, Texas. At that time, in addition to the study of antibiotics, the Institute was also charged with the study of innovative new surgical techniques and developments. Then in 1949, due to concern regarding the large number of possible casualties generated by nuclear weapons, the Institute’s mission was further expanded to include the study of thermal injury. The advent of improved grafting procedures and continued use of antibiotics in new applications grew with this mission.

BRAC:

More than 10 years ago, on Sept. 15, 2005, President George W. Bush signed a letter approving the Base Realignment and Closure Commission's recommendations.

In the beginning, the 2005 BRAC initiative received mixed reviews from military and civilians in San Antonio, but Army Medicine and Brooke Army Medical Center grew significantly with the directed changes. The BRAC initiative called for the consolidation of all inpatient military healthcare services in San Antonio to one location. Construction projects included a new 760,000-square-foot consolidated tower, renovations to nearly half the original hospital structure, a 5,000-space parking garage, central energy plant and the Fort Sam Houston Primary Care Clinic at a total cost of about $802.3 million.

Overview

CPT Moreno Primary Care Clinic

Brooke Army Medical Center

Schertz Medical Home

Patient Centered Extended Hours

Increased Convenience Center for the Intrepid

Corpus Christi Health Clinic

Westover Medical Home

Taylor Burk Clinic

McWethy Troop Medical Clinic

Enhanced Access Virtual Medical Center

Overview:

The San Antonio Market is responsible for $1.1B combined Army/Air Force budget with a staff of 13K across BAMC and Wilford Hall Ambulatory Surgical Center (USAF), to include 10 stand-alone clinics covering 100 specialty services. The 959th Medical Group falls under BAMC. Of the 10 Deputy Commanders, 7 are Army, 2 Air Force, and 1 Civilian. Of the 8 Senior Enlisted Advisors, 6 are Army and 1 Air Force. Care oversight includes Air Force Basic training and nearly all DoD AIT training for medical personnel.

Integrated Comprehensive Services Unique Capabilities Level I Trauma Center Extracorporeal Membrane Oxygenation (ECMO) and Acute Lung Rescue Flight Team Center for the Intrepid (CFI) USAISR Burn Center with Burn Flight Team Allogenic Bone Marrow Transplant Center 35 Primary & Specialty Care Services 32 Sub-Specialty Clinics Simulation Center Accredited through both American College of Surgeons (ACS) and the Society for Simulation in Healthcare (SSH) 28 Main Operating Rooms plus dedicated suites for OB, Oral Maxillo-Facial Surgery & Burn Can expand up to 483 beds to meet Role IV mission 3 million sq. ft. clinical/admin space (41 buildings) 4 Fisher Houses

BAMC has an average of 68 ICU and 234 ICW staffed beds (as of OCT 22)

Multi-D Behavioral Health Psychiatry/Psychology/Social Work Services, Intensive Outpatient PTSD & Addictions Medicine (AM), Residential AM & Acute Inpatient

Daily Encounters (FY23Q2)

Inpatient Census

3,800 Outpatient Visits

Inpatient Admissions

Trauma Activations

Emergency Room Visits

4,494 Lab Procedures

Surgical Procedures

4,052 Prescriptions

ECMO

Radiology Studies

JAN 2023 – MAR 2023

Training Platform Annual Stats - Forging Premier Medical Leaders of a Globally Ready Force

35 GME and 22 GAHE Programs

100% of Army CC/ER RN training

Ed/Training Agreement Cmte~45 students

98% first time board pass rate

100% of Army EMT-P training (Combat/Flight)

Largest DoD graduate health education site

404 USAF, 306 USA, 8 USN GME/GAHE trainees

59TRS/AETC

691 trainees (10 courses)

1141 METC trainees (17 courses)

Medic sustainment 350 trainees

764 MEDCoE trainees (15 courses)

* 823 medical student rotations

>529,000 nurse precepting hours

Nurse Transition Program 252 RNs (USA/USAF)

MUC/Leadership GME/GAHE curriculum

105 FTEs dedicated to Ed/Tng DoD’s only Level 1 Trauma and Burn Center, providing MHS opportunities to achieve full complement of KSAs, ICTLs, CMRPs.

BAMC is the DoD’s only Leve I Trauma and Burn Center, which provides learners from all Services the opportunity to achieve a full complement of KSAs, ICTLs, CMRPs, and Readiness Repetitions. BAMC currently manages 35 Graduate Medical Education, 22 Graduate Allied Health Education programs for officers and has agreements in place to train up to 691 59TRS/AETC students (10 courses), 1,141 METC trainees (17 courses), 764 MEDCoE trainees (15 courses), and up to 350 medic sustainment trainees per year. This size and scope of our academic mission requires significant manpower to maintain with over 529,000 precept hours required for nursing and phase II medical enlisted training for all 3 services. In Academic Year 2022-2023, BAMC trained 614 medical students, 228 nurses, 104 allied health providers, and 1,011 enlisted service members from across the Army, Navy, Air Force, and Coast Guard per year.

2,104 Total Learners by Service (AY JUN 2022-JUN 2023) = 734 USAF, 985 USA, 383 USN, and 3 USCG:

- GME = 369 USAF, 244 USA, 1 USN

- GAHE = 35 USAF, 62 USA, 7 USN

- Officer Nurses = 80 USAF, 148 USN

- Enlisted LPNs = 108 USA

- Enlisted Students = 250 USAF, 423 USA, 3 USCG, 227 USN

Decrease in GME Programs occurred in 2022:

EM research fellowship went away Psychiatry and nephrology programs technically belong to UTHSA

Decrease in GAHE Programs occurred in 2022:

Dietary internship no longer offered at BAMC Clinical psychology no longer offered at BAMC

4 x ERSAs (as of 28 APR 23):

Christus Alamo Heights–Multispecialty Methodist Hospital—Multispecialty Christus Children’s Hospital—Multispecialty Christus Physicians ASC—Multispecialty

Total BAMC Nursing preceptor Hours June 2022- June 2023: 137,405 preceptor hours

AETC = Air Education and Training Command GME = graduate medical education GAHE – graduate allied health education CC/ER = critical care/emergency room METC = medical education and training campus MEDCoE = Medical Center of Excellence MUC = military unique curriculum

Education and Training Agreement Committee (ETAC) reviews requests from individuals (military, GS, civilian) who desire to complete clinical rotations in support of personal educational goals. These rotations are multidisciplinary, i.e. could be nursing, pharmacy, PT, OT, SW, RT, dietetics, optometry at the bachelors/masters/doctorate level.

Local Military-Civilian Partnership BAMC & STRAC the model MIL-CIV partnership that replicates Joint, Interagency, Intergovernmental, Multinational (JIIM) environment in Large Scale Combat Operations (LSCO)

Regional emergency/disaster response execution & training as a healthcare system

Regional trauma system lessons lead to consolidated gains in forward resuscitation/surgery, prolonged field care, and definitive care that improve combat casualty care

Local trauma research improving care of the wounded on the battlefield and local South Texas population Tourniquets; Whole blood; preventing/treating infection from trauma; blunt trauma stabilization; nerve regeneration; combat casualty rehabilitation

BAMC provides COVID-19 DSCA to San Antonio by continuing regional trauma care and maintaining ability to expand trauma capacity in support of local partners.

BAMC is DOD’s leading edge to Zero Preventable Deaths on the battlefield and at home.

Contingency:

Coordinates and executes contingency operations (i.e., pandemic, trauma, and burn) for both DoD and SW Texas civilian care. A member of the SW Texas Region Advisory Council (STRAC), provides trauma and ECMO care regionally for a 22-county region extending over 26,000 square miles with a population of near 2.5 million people and internationally to all military Services. Works with US Army South and US Army North on contingency planning. Supported DoD's efforts with COVID-19, Afghan immigration support, and efforts supporting Ukraine. In the last year, we have deployed 81 Soldiers, and 217 Airmen to support 33 both CONUS and OCONUS missions.

In support of foreign military forces, we had 5 OCONUS deployments to 5 locations with 14 Army, 217 Air Force, and 0 DoD-Civilian personnel.

Local Partnerships University of Texas Health Science Center University Hospital System 59th Medical Wing (Lackland AFB) Wilford Hall Ambulatory Surgical Center Randolph AFB Clinic Medical Research and Development Command Institute of Surgical Research Battlefield Health and Trauma Research Institute Burn Center Medical Education and Training Campus U.S. Army Medical Center of Excellence South Texas Veterans Health Care System VA Polytrauma Rehabilitation Center Southwest Texas Regional Advisory Council on Trauma 108 Training Affiliation Agreements 4 External Resource Sharing Agreements

Wilford Hall Ambulatory Surgical Center

Medical Education & Training Campus

VA Polytrauma Rehabilitation Center

Battlefield Health Trauma

Army Medical Center of Excellence

4 x ERSAs (as of 28 MAR 23):

Christus Alamo Heights–Multispecialty Methodist Hospital—Multispecialty Christus Children’s Hospital—Multispecialty Christus Physicians ASC—Multispecialty

Center for the Intrepid (CFI) More than 2,772 patients seen at the CFI in 10 years Complex Extremity Trauma due to explosive mechanisms and burns Amputees and Limb Salvage Patients Sports injuries / Trauma patients Intrepid Dynamic Exoskeletal Orthosis (IDEO) More extramural funding than at height of the conflict Special Operations Performance and Recovery (SPaR) Only DoD Prosthetic & Orthotic Fabrication Shop - ships to APOs in combat zones Enhances operational readiness for all services returning to duty

BAMC CFI has treated 609 out of the total of 1,727 (35%) OEF/OIF/OND/OIR/OFS amputee patients treated in all Military Treatment Facilities (MTFs) (unique patients seen from CY2013 to CY2023)

Acquisition Matters:

As the institutional official, overseas a joint institutional review board supporting Army, Navy, and Air Force medical research. Supports the DoD's only burn unit focused on testing and developing treatments for battlefield burn-care and the Naval Medical Research Unit-San Antonio on the grounds of BAMC. Overseas a research program with ~$8.8M extramural funds.

Questions

Other Important Notes

Allied Nations:

As DoD's largest medical platform, we support critical care of warriors from allied nations and training of their medical staff. Operations and deployments (JUN 22- JUN 23)included Sinai, Djibouti (Horn of Africa), Iraq, Syria, Kosovo, Kuwait, Qatar, Guatemala, Honduras, El Salvador, Ghana, Estonia, Germany, Taiwan, Senegal , Romania, Bulgaria, Burundi, Serbia, and Cuba. Medical Readiness Exercises supported operations in SOUTHCOM and AFRICOM AO for global health and security support operations.

Military Health System Support:

We have supported multiple MTFs with backfill support (75 PAX) ISO 15 locations across MRC, West, MRC, East, MRC, Europe and MRC, Pacific.

National Military Strategy:

Patient movement exercises drove casualty planning focusing on limited strategic air and Role IV receiving facilities for LSCO casualties to include distribution to civilian hospitals. Directly supported EUCOM and INDOPACOM planning.

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