US aeromedical evacuation has changed. Forward-based units or helicopters are still the primary link from the battlefield during the “golden hour” that follows major trauma. Once a patient has been stabilized, however, more advanced care at more advanced facilities may be needed. For several decades, the USA had a fleet of dedicated aircraft, the last being its DC-9 derived C-9A “Florence Nightningale” fleet. In its place is a new approach devised by USAF Lt. Gen. Paul K. Carlton Jr., the Air Force surgeon general until 2002. The idea is that every USAF Air Mobility Command aircraft can become an aeromedical aircraft, as newly arrived aircraft on the tarmac are loaded with about 800 pounds of gear and supplies per patient and diverted to hospitals like Landstuhl in Germany. Instead of waiting for days to stabilize a patient, outbound flights are sometimes coordinated while a patient is still in surgery. The result? Lower average cargo volume and weight statistics for US transport aircraft missions, and a 90% survival rate for troops injured in current operations. In Operation Desert Storm in 1991, the rate was about 75%.

On to the next step in quality improvement, which could have significant implications for civilian disasters as well. USAF aircraft without organic litter systems rely on the patient support pallet (PSP), whose weight and bulk make it heavily reliant on cargo handling equipment for loading and unloading. This assumes the PSP is even present with the evacuation crew, of course; if not, additional stops will be required to pick up the equipment. In an age of rising fuel prices, those side-trips get very expensive, and time is always of the essence.

Enter the Air Mobility Battlelab. They were established in 2001, and will deactivate in September 2008 as part of a USAF cost-savings initiative. Before they go, however, they’re developing an idea that might solve these problems…

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Brain injuries have become a focus of study and controversy received during the current war. This is partly the result of improved detection and understanding of maladies whose symptoms are sometimes subtle, and can be mistaken for purely psychological maladies. It is also partly the result of enemies whose primary tactical approach is land mine warfare. When these go off, they have a tendency to throw vehicles around pretty hard. Being slammed against the top or side of one’s vehicle leads to concussions, and sometimes to brain injuries. US veterans have been pushing for more work and funding in this area in order to help soldiers who have encountered this hazard, and to improve the future design of equipment and vehicles.

Henry M. “Scoop” Jackson was a US Senator [D-WA], who was known as one of the most consistent supporters of a powerful US military and a strong anti-communist foreign policy within his party. He was also known as a smart lawmaker who authored the National Environmental Policy Act, was a key player in the grant of statehood to Alaska and Hawaii, strongly supported the US submarine fleet, and sought his party’s nomination for President in 1972 & 1976. With the shift of USS Ohio and three other ballistic missile submarines to SSGN special forces and conventional strike roles, the lead sub of the US Trident fleet is now the SSBN 730 Henry M Jackson based in Bangor, WA. His legacy is also continued by the The Henry M. Jackson Foundation for the Advancement of Military Medicines...

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Carothers Construction Inc. in Water Valley, MS received a $10.1 million firm-fixed-price contract for construction of a diagnostic imaging center radiology oncology clinic at Keesler Air Force Base. This project will provide an elevated one-story steel frame and concrete addition on pile foundation, with a concrete slab, concrete and glass exterior, a modified bitumen roof, and all mechanical and electrical systems. The facility will be an adequately sized, efficient, modern, hurricane-protected Diagnostic Imaging Center for the Radiation Oncology Clinic to serve the eligible personnel in the Biloxi/Gulfport MS area, with a connector to the existing hospital.

Work will be performed in Biloxi, MS, and is expected to be complete by September 2009. This contract was competitively procured via the Naval Facilities Engineering Command e-solicitation website, with 5 proposals received by the Naval Facilities Engineering Command, Southeast in Jacksonville, FL (N69450-08-C-0758).

DID has covered the USA’s Base Realignment and Closure process before, a fairly unique effort whereby a commission draws up a list of bases to be closed, and the Congress must vote yes or no to the entire list. The result is that it becomes much harder (but not impossible) for Congressmen to protect each base, and easier to create a basing system whose priorities are shifted toward military rather than political needs.

The 2005 BRAC Commission’s recommendation to realign and consolidate facilities in the USA’s National Capital Region, in order to meet the medical and security needs of the 21st century, includes the realignment of all tertiary medical services currently located at Walter Reed Army Medical Center in Washington, DC to the National Naval Medical Center in Bethesda, MD. The new joint operational medical facility will be named the Walter Reed National Military Medical Center, and will be staffed by personnel from the Navy, Army and Air Force. The existing Walter Reed main installation is mandated to close by 2011, according to the BRAC law.

DID thought this was an interesting BRAC initiative to cover going forward as a Spotlight article… and then the controversies hit. In their aftermath, the first contract has now been issued for construction of the new facility. DID chronicles the contracts – and the controversies – in this DII public-access article…


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A Pentagon DefenseLINK story recently touted the progress of prosthetic limb development, fueled by a combination of combat need and the steadily advancing capabilities inherent in modern electronics and robotics. Army Col. Geoff Ling manages DARPA’s Revolutionizing Prosthetics programs.

For instance, researchers at Dean Kamen’s DEKA Research and Development Corp. in Manchester, NH (inventors of the Segway, the stair-climbing iBot wheelchair, and those PowerSwim fins that I want), have developed a “strap-and-go-arm” that requires no surgery, just 1-2 hours of training. The process of picking up a pen, key, coffee cup, or power drill obviously differs. Embedded electronics in DEKA’s arm enable the wearer to activate a switch with a foot or chin, to cycle through 5 different gripping actions to match the task at hand. One tester who lost his arm at the shoulder was reportedly able to field strip and reassemble an M-16 rifle using the prosthesis, which comes in 3 models: [1] amputees who have lost a complete arm, [2] amputations above the elbow, and [3] amputations below the elbow. See a picture here.

The Department of Veterans Affairs, National Institutes of Health and the Food and Drug Administration have all shown interest in the program, and are expected to join forces with the Defense Department in the months ahead, and getting a governmental agreement in place will be a big step forward to getting the devices mass-produced. Meanwhile, Johns Hopkins University is working on a device that connects into the peripheral and central nervous system under Revolutionizing Prosthetics 2009; a Phase 2 contract is expected in the coming months. Read “Defense Agency Makes Big Advances in Prosthetics Research” for more, and see also WIRED’s feature on the JHU project: “The World’s Most Advanced Bionic Arm.”

Troops require medication of all kinds as a way of managing chronic conditions, handling the wear and ills that are a constant risk on military deployments, et. al. Unsurprisingly, militaries tend to buy in bulk, often through middle-men offering wholesale margins on a wide variety of treatments. Recent days have seen over $3 billion in contracts issued, many of which are option periods from an original award. AmerisourceBergen seems to be the big winner.

Unless otherwise noted, the Defense Supply Center Philadelphia in Philadelphia, PA issued the contracts.

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Sept 14/07: The GM/ GDLS Defense Group L.L.C. Joint Venture in Sterling Heights, Mich. Received a $37.9 million delivery order for 33 Stryker M1133 Medical Evacuation (MEDEVAC) Vehicles, as part of a $5.68 billion firm-fixed-price contract for the Stryker family of vehicles. The 8×8 wheeled M1133 provides mobile protection for up to 6 patients and a medical team.

The DoD release says that work will be performed in Sterling Heights, Mich. (60%), and London, Ontario, Canada (40%), but General Dynamics’ release adds Anniston, Ala. And Lima, Ohio as work sites. Work is expected to be complete by Jan. 31, 2010. Bids were solicited via the World Wide Web on April 6, 2006, and 17 bids were received by the U.S. Army Tank-Automotive and Armaments Command in Warren, Mich. (DAAE07-00-D-M051).

The Wisconsin Physicians Service Insurance Corp. of Madison, WI received the follow-on TRICARE Dual Eligible Fiscal Intermediary Contract. It covers claims processing, customer service and administrative services for individuals who are eligible for both TRICARE (the US military health benefits program) and Medicare (the US public health benefits program). Future medical costs are a serious long term issue for both programs, but this move simply covers administrative necessities.

The contract includes a 12-month base period and 6 more 12-month option periods, for a total of 7 years if all options are exercised. The base period for transition is August 1, 2007 – June 30, 2008, and delivery for the TDEFIC for claims processing, customer service and administrative services will begin on July 1, 2008 if option 1 is exercised. The estimated delivery order value through the Option 1 period is $92.7 million.

This contract was competitively procured via the TRICARE Management Activity e-solicitation Web site, with 2 offers received by the Department of Defense TRICARE Management Activity (H94002-07-0001).

Caddell Construction Company Inc. in Montgomery, AL won a $73.8 million firm-fixed-price contract for Construction of a Clinic and Demolition of a Hospital at MacDill Air Force Base, FL. Work is expected to be complete by Aug. 9, 2009. Bids were solicited via the World Wide Web on Aug. 10, 2007, and 3 bids were received by the U.S. Army Corps of Engineers in Mobile, AL (W91278-07-C-0037).

Science Applications International Corp. (SAIC) in San Diego, CA received a $9.1 million one-year follow-on contract under previously awarded indefinite-delivery/indefinite-quantity, cost-reimbursement contract (N66001-04-D-2504) to exercise an option to provide support for the Naval Health Research Center (NHRC), San Diego, to include studies of symptoms, morbidity, hospitalizations, reproductive outcomes, mortality, and other health-related issues among service members and Department of Defense beneficiary populations.

The The Henry M. Jackson Foundation for the Advancement of Military Medicine has also received awards under this contract for this purpose; the original 2-year contract included three 1-year options, and this award represents exercising of the 2nd option year. The cumulative potential value of the contract, if the third option is exercised, is $45 million. Work will be performed in San Diego, CA (90%) and at NHRC Detachment at Wright Patterson Air Force Base in Ohio (10%), and is expected to be complete July 2008. The Space and Naval Warfare Systems Center in San Diego, CA issued the contract.