Integrating Across Military Medical Research & Development
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Jonathan S. Miller, Ph.D., J.D., Acting Civilian Deputy, Principal Assistant for Research & Technology, US Army Medical Research and Development Command12 June 2019
The views expressed in this presentation are those of the author and may not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
Responsively and responsibly create, develop, deliver, and sustain
medical capabilities for the Warfighter
Lead the advancement of military medicine
MISSION VISION
Mission and Vision
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Medical Research & Development Command
Focused on materiel and knowledge-basedmedical solutions to:
• Improve downrange health delivery
• Increase and sustain Warfighter readiness
• Enhance recovery, rehabilitation, or reintegration
COLLABORATIVE COMMAND
WE SAVE LIVES
• Improve fitness, health, protection, and resilience
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DoD and Service Medical Requirements
Medical Research and Technology
Medical Product Development and
Systems Management (~PEO)
Medical Knowledge and Materiel for the Warfighter
Why is Army Medicine Involved?
Select, modify, and procure commercial medical materiel solutions, when appropriate, or we partner to developWe take the lead in Research and Development when:
• The issue is unique to the Military• Blast injuries
• Industry/academia lack interest• Endemic diseases in specific
area of responsibility (AOR)• Military needs a timely solution• Directed by Congress
To: Increase Warfighter readiness; Improve fitness, health, protection, and resilience; Improve downrange health delivery; Enhance recovery,
rehabilitation, or reintegrationUNCLASSIFIED 4
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Combat InjuriesHemorrhageHead TraumaBlast InjuryLung InjuryBurns
Mental & Physical StressPhysical PerformanceMusculoskeletal InjuriesCognitive PerformanceMental HealthPost-Traumatic StressSuicide
Endemic DiseasesParasitic DiseasesBacterial DiseasesViral Diseases
Battle SequelaeLoss of limbsLoss of tissueLoss of visionPain
Environmental HazardsHeat and ColdAltitudeToxic Industrial Chemicals
Systems HazardsDirected EnergyNoise
Nuclear, Chemical & Biological Warfare AgentsChemical Warfare AgentsBiological Warfare AgentsNuclear/Radiological
Threats to Service Member Readiness
Program Area Directorates (Science & Technology [S&T])
Military Infectious Diseases Research Program (MIDRP) – COL Wendy Sammons-Jackson
• Vaccines & drugs to prevent parasitic diseases (malaria)• Vaccines to prevent diarrheal diseases• Vaccines to prevent viral diseases (dengue, hanta)• HIV countermeasures (congressional mandate)• Prevent & treat combat wound infections• Protection from disease carrying arthropod vectors• Countermeasures against emerging infectious diseases
Combat Casualty Care Research Program (CCCRP) – Col Michael Davis
• Hemorrhage control and resuscitation• Traumatic brain injury care• Blood and blood products far forward• Burn injury and organ support• Tactical CCC interventions• Extremity and maxillofacial trauma treatment• Prolonged field care
Military Operational Medicine Research Program (MOMRP) – CDR Christopher Steele
• Musculoskeletal Injury • Blunt, Blast, & Accelerative Injury • Behavioral Health, Wellness & Resilience • Psychiatry & Clinical Psychology Disorders• Health, Readiness & Performance in Austere Enviros• Fatigue, Cognitive Health & Performance • Human Operator Health & Performance in Complex Systems • Environmental Toxicant Exposure• Performance Nutrition & Weight Balance • Directed Energy Health Hazards • Biomedical Aspects of Human Perf Opt & Enhance
Clinical & Rehabilitative Medicine Research Program (CRMRP) – Tony Gover
• Rehabilitation of neuromusculoskeletal injuries• Regenerative medicine and transplants• Sensory Systems (Vision, Hearing and Balance)• Battlefield, acute and chronic pain management
Medical Simulation and Information Sciences Research Program (MSISRP) – Mr. David Thompson
• Medical simulation• Health information technology and informatics• Medical capabilities to support disbursed operations
Program Area Directorates (PADs) – Functions• Manage programs; do not execute programs
(do not perform research and technology)• Fund intramural and extramural research and technology• Responsible for both the problem set and the solution set• Devise a research strategy (program) and fund research and
technology that fit the program• Collaborate with industry, academia and professional societies
Program Coordinating Offices• CBRN Defense Coordinating Office• DoD Blast Injury Research Program Coordinating Office• Joint Trauma Analysis and Prevention of Injury in Combat
PA(R&T) Fort Detrick, MD
Acting Principal Assistant for Research & Technology
Dr. Mark DertzbaughFt Detrick
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Laboratory Competencies
U.S. Army Research Institute of Environmental Medicine
USAMRIIDFt. Detrick, MD
U.S. Army Medical Research Institute of Infectious Diseases
Walter Reed Army Institute of Research Infectious Diseases:
Parasitic, Bacterial, Viral Vector Control TBI Neurotrauma & Brain Dysfunction Psychiatry & Clinical Psychology Disorders Fatigue, Cognitive Health & Performance Behavioral Health, Wellness, & Resilience Blunt, Blast, & Accelerative Injury Human Performance Optimization/
Enhancement – Psychological
WRAIRForest Glen, MD
USARIEMNatick, MA
TATRCFt. Detrick, MD
Telemedicine and Advanced Technology Research Center
Bacterial Diseases Viral Diseases Biological Toxins
TeleHealth Health Information Technology Medical Simulation
& Training Systems Medical Intelligent Systems
Musculoskeletal Injury Performance Nutrition & Weight Balance Human Performance Optimization/
Enhancement – Physiological
U.S. Army Institute of Surgical Research
USAISRFt. Sam Houston, TX
Hemorrhage, Shock, & Coagulopathy of Trauma Pain Pre-Hospital Tactical Combat Casualty Care Critical Care Delivery Endovascular Hemorrhage Control Prolonged Field Care Medical Aspects of Directed Energy Maxillofacial Trauma Extremity Trauma Ocular Trauma Burn Injury
U.S. Army Medical Research Institute of Chemical Defense
USAMRICDAberdeen PG, MD
Traditional & Emerging Chemical Threats Biological Toxins
USACEHRFt. Detrick, MD
U.S. Army Center for Environmental Health Research Environmental Toxicant Exposure Systems Biology
U.S. Army Aeromedical Research Laboratory
USAARLFt. Rucker, AL
Human Operator Health & Performance in Complex Systems Blunt, Blast & Accelerative Injury En Route Care Environment Crew Survival in Military Helicopters
& Combat Vehicles Medical Aspects of Directed Energy Human Performance Optimization/
Enhancement – Cognitive
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USAMRDC / Defense Health AgencyScience & Technology Interfaces
DirectorDHA J9, R&D Directorate
(Deputy Commander USAMRMC)
USAMRDC Board of DirectorsLab Commanders, PADs, Deputies,
and External Stakeholders
Commanding GeneralUSAMRDC
PAD IIPTProgram Managers, Lab
Representatives,External Stakeholders, and SMEs
Scientific SteeringCommittees
Lab and Other SMEs
Principal Assistant for Research & Technology/
Principal Assistant for Acquisition
Program Area Director (PAD)/Joint Program
Committee Chair
Capability Area Manager/Working Group
Chair
ASA(ALT) (Funding)AMEDD C&S (Requirements)
DHA (Funding)Joint Staff (Requirements)
USAMRDCStaff Support
Interagency Support Agreement (ISA) USAMRDC and DHA
Overarching IPTMedical R&D Flag Officer
Group (FOG) Components, JSS, DHA J9
Director, and DHA CAE
Integrating IPT
Working IPT
Joint Program Committees Program Managers,
External Stakeholders, and SMEs
Working GroupsProgram Managers, Lab
and Other SMEs
Staff Guidance & O
versightExecution
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Program Area Directorates – Key Objectives
1. Improving Military Medical Simulation Establish a DoD integrated and federated Medical Simulation Enterprise (MSE) through:• Introducing Medical Health System (MHS) wide
standardized simulation with Joint Evacuation and Transport Simulation (JETS)
• Development of far-forward medical simulation capabilities through Point of Injury and Trauma Simulation (POINTS)
• Enabling a medically ready Force and ready Medical Force through Warfighter Preparation, Resilience, Enhancement, and Protection (WarPREP) efforts
2. Health Information Technology and Informatics
• Technology tools for data capture, movement, and transfer to the right provider and the right patient at the right time: Theater/Operational Medicine Reach
• Technology tools to improve actionable medical decisions from disparate data sources: Theater/Operational Medicine Agility
3. Provide Medical Capabilities to SupportDisbursed Operations
• Autonomous and Unmanned Medical Capability• Virtual Health• Medical Robotics
Medical Simulation and Information Sciences
UNCLASSIFIEDName, Title, Email 10
Program Area Directorates – Key Objectives
1. Protect the Warfighter against Infectious Disease Threats• Develop vaccines to prevent malaria, dengue,
diarrheal diseases (ETEC, Shigella, Campylobacter), hanta virus and HIV
• Develop drugs to prevent and treat malaria
2. Prevent, Treat, & Manage Combat Wound Infections• Develop tools to detect, identify and characterize
drug-resistant organisms causing wound infections• Develop novel therapeutics/delivery technologies
against wound infection pathogens & biofilms
3. Prevent & Control Disease Carrying Arthropod Vectors• Discover and develop control measures and tools to
prevent diseases transmitted by medically relevant arthropod vectors, e.g., mosquitoes, ticks, sandflies, & mites
4. Counter Emerging Infectious Diseases• Leverage international research infrastructure and
extensive infectious disease core capabilities & expertise to respond to emerging infectious disease threats
Infectious Diseases Military Operational Medicine1. Environmental Health & Protection
• Provide policy, training, planning tools, knowledge products, decision aids, mission planning tools, and materiel solutions to enhance readiness, sustain health, and optimize operational effectiveness when exposed to multi-environmental stressors
2. Injury Prevention & Reduction• Develop strategies and interventions to reduce the risk of
musculoskeletal injury (55K/yr not fit for duty)• Validate medical standards to optimize Human Operators
health and performance in complex systems
3. Physiological Health & Performance• Develop assessments/interventions to mitigate cognitive
deficits posed by operationally-induced sleep loss• Identify nutritional approaches tailored to specific
mission requirements • Discover novel biomedical approaches to optimize and
enhance Soldier performance
4. Psychological Health & Resilience• Support enhanced Service member and Family
psychological health & resilience• Identify PTSD biomarkers and develop pharmaceutical
interventions• Develop and refine suicide prevention
strategiesUNCLASSIFIEDName, Title, Email 11
Program Area Directorates – Key Objectives
Combat Casualty Care Clinical & Rehabilitative Medicine1. Reduce combat deaths and improve
functional outcome• Point of injury through definitive surgery• Prolonged Care in support of the MDB• Self, buddy, medic, PA, nurse, and physician care
2. Identify and develop medical techniques and materiel for early interventions• Decision support• Devices, drugs, and knowledge products• Focused empiricism for rapid impact• Rapid translation though integration with the Joint
Trauma System CoE
3. Translate Military-relevant basic and preclinical trauma research into clinical practice
• Stop bleeding, resuscitate, restore mangled extremities, treat burns, extracorporeal organ support, treat TBI
1. Rehabilitate NeuromusculoskeletalInjuries
• Service Related NMS Injury Rehabilitation• Prosthetics and Orthotics
2. Manage Pain• Battlefield• Chronic
3. Regenerate, Repair, Restore Injured Tissue
• Muscle, Nerve, Bone, Skin, Vascular Tissue
• Mechanisms of wound healing and scarring
4. Restore Sensory Systems• Novel Interventions
• Diagnostics• Treatments• Sensory simulation
UNCLASSIFIEDName, Title, Email 12