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Military Health System experts discuss COVID-19 innovations

Four men wearing masks, holding COVID-19 Airway Management Isolation Chamber Raul Martinez, Robert Serrano, Tim Ahlstrom, and Kevin Waller, maintenance workers with Fort Bliss Directorate of Plans Training Mobilization and Security, volunteered to construct 40 COVID-19 Airway Management Isolation Chambers (CAMICs) for William Beaumont Army Medical Center, in the hopes that it will help save a patient who may have the novel coronavirus disease known as COVID-19. CAMICs have already been used in over 100 surgical procedures within the MHS. (Photo by Amabilia Payen, William Beaumont Army Medical Center)

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Rapid innovation serves as a cornerstone of the Military Health System, allowing for advances that improve the health and safety of service members and beneficiaries, according to Dr. Paul Cordts, chief medical officer at the Defense Health Agency in Falls Church, Virginia. Cordts and three other medical experts discussed the medical innovations resulting from the COVID-19 national emergency at a health innovation virtual roundtable Monday, July 27.

Necessity is often the mother of invention, which was the case with development of the COVID-19 Airway Management Isolation Chamber, or CAMIC. 

“With reports of COVID-19 wreaking havoc in New York City in mid-March and the looming shortage of PPE and so many unknowns at that time, we were really looking for additional ways to protect health care workers, especially during surgical and clinical procedures,” said Army Maj. (Dr.) Steven Hong, assistant professor of surgery at the Uniformed Services University of the Health Sciences (USU) and chief of head and neck surgical oncology and reconstructive surgery at Walter Reed National Military Medical Center in Bethesda, Maryland. 

Three surgeons in hospital room wearing masks
Lt. Col. Eric Weber (far right), chief medical officer, William Beaumont Army Medical Center, and his colleagues demonstrate how to effectively use the COVID-19 Airway Management Isolation Chamber (CAMIC), a device that serves as a barrier protecting healthcare workers from aerosolized droplets by capturing and removing viral particles emitted from the patient, May 19, at WBAMC’s surgical room. (Photo by Amabilia Payen, William Beaumont Army Medical Center)

After putting in a collective 2,000 hours, Hong and his colleagues at WRNMMC and other agencies within the Department of Defense developed a barrier device constructed by draping a large clear plastic bag over a box-like frame made from PVC piping. The CAMIC, when placed over the head, neck, and shoulders of the patient during surgery, protects staff from airborne particles. The invention received emergency-use authorization by the Food and Drug Administration in May and has already been used in over 100 medical procedures within the MHS. 

The current COVID-19 crisis also provided an opportunity for the MHS to leverage both new and existing digital technologies, said Dr. Simon Pincus, director, Connected Health Branch, Defense Health Agency in Tacoma, Washington. In response to the demand for information in a quickly changing clinical environment when treating viral diseases, researchers at the Connected Health Branch created the Antimicrobial Stewardship application to provide up-to-date guidelines for infectious diseases, including COVID-19. 

They also curated a resource toolkit to prevent burnout among health care staff as a result of compassion fatigue and secondary traumatic stress from caring for patients. The Provider Resilience mobile app addresses an issue often seen in war among health care providers, but is also now appearing in the war against COVID-19. 

“When you’re in combat, you’re not going home from the trauma that you see, you’re actually potentially at risk in being a victim of trauma,” Pincus said. “This is kind of similar to COVID-19 where the providers are on the front lines and the health care teams taking care of patients are also at risk with the same outcome … so one of the innovations we pivoted was a provider resilience suite of self-care.”

More than its innovations, however, the MHS itself is pioneering because of its uniqueness to any other system in the world, said Air Force Col. (Dr.) Todd Rasmussen, professor of surgery, associate dean of research, Uniformed Services University of the Health Sciences in Bethesda, Maryland. 

“In broad strokes, because we are a global health system, we have providers and labs and beneficiaries around the world,” he said, noting the unique ability of the system to partner with civilian medicine and other elements of the government and private industry. 

A substantial research investment within the DoD to steward funds toward requirements also sets the MHS apart. “Medical appropriation that comes to the Department of Defense is applied to the health, readiness, recovery, and care of mostly the war fighters but [also] all of our beneficiaries,” he explained. “If we say the requirement of 2020 is COVID-19, the DoD is able to pretty naturally then shift the focus of that requirements-driven medical research into the pandemic and pandemic-related topics, just like it did in the early 2000s when the priorities, or the requirements, were for hemorrhage control and resuscitation, limb salvage and such,” he added.

During the wars in Afghanistan and Iraq, the Joint Trauma System and its trauma registry allowed for the sharing of real-time data that led to innovations in blood transfusion and life-saving techniques. The trauma registry informed the build of the COVID-19 registry, providing real-time data to evaluate and adjust clinical practice, therapies, and other guidelines, explained Cordts.

“We went to the JTS because they had a registry that allowed us to gather real-world data; they have a global network of performance improvement and care improvement where we discuss … the care of—and how best to diagnose and treat—patients with COVID-19,” added Rasmussen. 

The implementation of the DoD’s new electronic health record MHS GENESIS has also helped clinicians adjust workflow and adapt in triaging in-person clinic visits with virtual visits during the pandemic, said Cordts. 

“We're taking a very careful look at virtual health, the safety and efficacy of virtual health, and trying to learn what we can about where virtual health appears to be most beneficial for our patients in terms of improving their access, but also on improving the quality and safety of the care they receive virtually,” Corts added.

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DoD COVID-19 Practice Management Guide Version 5

Technical Document
7/30/2020

This Practice Management Guide does not supersede DoD Policy. It is based upon the best information available at the time of publication. It is designed to provide information and assist decision making. It is not intended to define a standard of care and should not be construed as one. Neither should it be interpreted as prescribing an exclusive course of management. It was developed by experts in this field. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of this guideline is responsible for evaluating the appropriateness of applying it in the setting of any particular clinical situation. The Practice Management Guide is not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions within this guide does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor.

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