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Combat Support Role of DHA unique within DoD

Okinawa, Japan (June 7, 2019) Hospital corpsmen respond to a simulated patient casualty during a tactical combat casualty care exercise as part of a rigorous Jungle Medicine Course at Jungle Warfare Training Center, Okinawa, Japan. The 10-day course trains Navy medical personnel assigned to Marine forces on jungle survival skills, patient tracking, field medical care, and casualty evacuation techniques. (U.S. Navy photo by Mass Communication Specialist 2nd Class Jeanette Mullinax) Okinawa, Japan (June 7, 2019) Hospital corpsmen respond to a simulated patient casualty during a tactical combat casualty care exercise as part of a rigorous Jungle Medicine Course at Jungle Warfare Training Center, Okinawa, Japan. The 10-day course trains Navy medical personnel assigned to Marine forces on jungle survival skills, patient tracking, field medical care, and casualty evacuation techniques. (U.S. Navy photo by Mass Communication Specialist 2nd Class Jeanette Mullinax)

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Advances in military health care, particularly on the battlefield, have reduced the number of service members killed in action.  “We’ve achieved the highest battlefield survivability rates in history, despite increases in injury severity.” That’s the word from Air Force Maj. Gen. (Dr.) Lee Payne, assistant director for Combat Support at the Defense Health Agency, during a presentation at the annual meeting of the Society of Federal Health Professionals, also known as AMSUS, Dec. 4, in National Harbor, Maryland.

What does “high battlefield survivability” mean? It’s taking seriously the role of being a combat support agency, or CSA, to fulfill combat support functions for joint operating forces and combatant commanders across the full range of military operations. As one of eight CSAs, DHA provides specialized medical capabilities to combatant commands to support or deliver expertise based on operational requirements.

Payne stressed the importance of medical combat support throughout his remarks. According to data published earlier this year in an issue of JAMA Surgery, fatality rates were high during early periods of war in Afghanistan (20.4 percent in 2001) and Iraq (14.5 percent in 2003). Since that time, medical personnel have received improved training in the use of tourniquets and including whole blood for transfusions at the point of injury. Emphasis was also placed on the medical evacuation of patients to higher echelons of care. Such measures have contributed to saving thousands of lives, on and off the battlefield. As a result, Payne explained that battle fatalities were nearly halved in both regions, falling to 8.5 percent in 2011 in Iraq and Afghanistan’s rate decreasing to 10.1 percent in 2017.

Payne said that these statistics validate the work DHA is doing in combat support.

“The Military Health System remains laser-focused on advancing readiness and supporting the warfighter,” Payne said. “These achievements reflect the DHA’s dedication to supporting the services, the Joint Staff, and the combatant commands in building an even stronger military medical enterprise that can provide the comprehensive system of support to enhance operational readiness and deliver the highest quality care for our warfighters on the battlefield.”

For the DHA, fielding the capabilities needed to fulfill its role as the DoD's only medical combat support agency is key to enabling that readiness vision, Payne explained.

Those capabilities include “building the combat support infrastructure to best prepare, protect, and care for our warfighters; advancing world-class operational support capabilities to support the enterprise; and strengthening combat support contributions to support Global Health Engagement priorities,” Payne listed.

Through component organizations, such as the Joint Trauma System, the Armed Services Blood Program, the Armed Forces Medical Examiner System, and the Armed Forces Global Heath Surveillance Branch, DHA ensures combatant commanders, and troops on the ground, have the medical capabilities needed to meet operational requirements.

“DHA's combat support role has grown in recent years,” explained U.S. Southern Command Deputy Command Surgeon Walter Diaz.

One recent addition to DHA’s combat support capabilities has been the initiation of DHA liaison officers (LNO) at each combatant command. The LNOs facilitate communication between the combatant commands and help DHA better understand command needs. DHA currently has 10 LNOs positioned across the combatant commands, Joint Staff, and Centers for Disease Control and Prevention.

“Having a DHA liaison embedded in the surgeon's office has been immensely helpful, improving communication to and from DHA on myriad issues ranging from medical logistics to TRICARE-Latin America support,” Diaz said.

That support has shown measureable benefits, according to U.S. Air Force Col. Ronni Orezzoli, of U.S. Southern Command: “Having a physically embedded DHA LNO on the headquarters staff is absolutely critical since he or she acts as the bridge connecting service members and their families with our HQ, as well as the health care network enterprise. [Their] work directly and positively affects the health and wellness of the force and the overall medical readiness of our units.”

Payne believes DHA’s role as a medically focused combat support agency will become more important as military health care reform initiatives are enacted as a result of congressional action.

“The MHS reforms underway reflect the changes to the military medical enterprise that will build a more integrated, effective system of health and readiness to deliver on the current and future battlefield needs,” Payne said.

Assistant Secretary of Defense for Health Affairs Tom McCaffery reiterated that emphasis, stating, “The MHS must operate as a unified and integrated system. It is an interdependent system in which each component supports the others, a system that relies on each component’s unique contributions to our collective mission to succeed. We know that training our medical force and ensuring our operational force is medically ready is inextricably linked with our system’s delivery of health care."

To find out more about DHA’s role as the nation’s only medical combat support agency, click here.

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