Skip to main content

Military Health System

Important Notice about Pharmacy Operations

Change Healthcare Cyberattack Impact on MHS Pharmacy Operations. Read the statement to learn more. 

Ultimate Caduceus 2023 Tests Defense Health Agency Readiness in Emergencies

Image of Ultimate Caduceus 2023 Tests Defense Health Agency Readiness in Emergencies. U.S. Air Force flight crews and medical personnel work together to care for simulated patients as they fly to military treatment facilities during Ultimate Caduceus at Joint Base Lewis-McChord, Washington, March 15.The Ultimate Caduceus 2023 exercise provides a valuable training opportunity for the various components of the Department of Defense and the Military Health System to work together alongside other government agencies and our civilian partners as we prepare to support our national defense and respond to any emergency. This is the first time that the Defense Health Agency has participated in a combatant command exercise. Credit: John Wayne List/ Madigan Army Medical Center

For the first time, medical representatives from the Defense Health Agency participated in a combatant command movement exercise, the Ultimate Caduceus 2023 held in March. The objective was to test the Department of Defense’s aeromedical evacuation and critical care transport capabilities.

The U.S. Transportation Command conducts the annual patient movement field training exercise designed to simulate transporting injured troops on a mass scale from one point to another. This exercise simulated movement from outside the continental U.S. to medical facilities in the U.S., and was held at several locations across the U.S.

“Ultimate Caduceus 2023 allowed all partners in the global patient movement enterprise to work together. It also allowed us to exercise our collective preparedness for any crisis throughout the spectrum of competition and conflict,” said U.S. Air Force Brig. Gen. Norman West, the DHA director of staff.

More than 400 joint and total force military and civilian personnel participated in the exercise, including representatives from the U.S. Department of Veterans Affairs, the U.S. Department of Health and Human Services, the DHA, and several other local partners.

“The patient movement exercise was a great opportunity for the DHA to demonstrate more of the capability we provide to support our national defense,” said West.

The exercise took place in several locations: Joint Base Lewis-McChord in Washington; Joint Base Elmendorf-Richardson in Alaska; Boise, Idaho; and Portland, Oregon.

“Ultimate Caduceus assessed the capabilities of and provided field training to aeromedical evacuation and critical care air transport teams, medical staging systems, as well as reception and onward movement functions for global patient movement,” said Joseph Weston, medical emergency manager with DHA’s Madigan Army Medical Center at Joint Base Lewis-McChord.

This exercise was important for the DHA because it was the first time it activated their operations center and the patient management coordination cell, according to Weston.

Movement Scenario and the Madigan Response

Weston was the lead planner for the hospital activities and coordinated with local and regional partners to help with the response, such as the Air Force Reserve’s 446th Aeromedical Staging Squadron also based at JBLM.

The scenario was this: An explosion occurred on the island of Guam and service members were injured. The hospital in Guam would triage and work with USTRANSCOM to expedite transporting them stateside.

“There would be a call to USTRANSCOM saying there were 30 service members that need to be evacuated,” said Weston. “At which point, the DHA operations center worked with USTRANSCOM to identify what was required and stood up the coordination cell.”

According to Weston, the DHA then identified which facility they wanted to handle the injured: Madigan was chosen.

“We got the call with the number we were receiving and then had to plan our response,” said Weston. “We were asked what our capacity was and how many we could take. What we couldn’t handle at Madigan, we looked to our local and regional partners to see what their capacity was.”

The scenario demonstrated a key capability of DHA: it’s ability to utilize the networks of care within the Military Health System and partners.

“The DHA market is a hub. It’s also a spoke. We get the call to take in patients, (and) we push them to wherever they need to go,” said Weston.

Madigan received a time frame and had to ensure they had the capabilities and staff ready for when the injured hit the ground. “We had to be ready within three hours once we received the call that they were on the way,” said Weston.

“We had a number of objectives that we felt went well,” Weston said. “The first was to activate the emergency operation center and implement the National Incident Management System principles. This established command and control to maintain situational assessment and awareness and operational communications—this was a big piece.”

According to Weston, “another objective was the coordination between TRICARE and the DHA with local partners, and to evaluate our processes for activating the Veteran Administration contingency plan, if needed, to push to them.”

Receiving and admitting those injured was another a tactical objective, with the goal to admit aeromedical evacuation patients to the appropriate level of care from the region within one hour of the aircraft arriving. “I think we did well overall,” said Weston.

“The exercise gave our team of professionals at Madigan the chance to test their ability to receive an influx of patients from anywhere in the world, while continuing to provide daily health care to our deserving beneficiaries,” West said.

Ultimate Caduceus 2023 exercise didn’t just test the immediate response, but also what would happen or need to occur on day 30 and day 60.

“The questions we had to answer were how we could create immediate capacity for that initial event, and then how do we start developing sustainable capacity,” said Weston.

The exercise emphasizes interoperability in bringing all elements of the global patient movement enterprise together to ensure combatant commands can move sick and injured patients to appropriate levels of medical care, according to Weston.

“These exercises are key to sustaining the force, while agility and scalability are the cornerstone of the Defense Health Agency’s combat support,” said West.

You also may be interested in...

Report
Aug 1, 2020

MSMR Vol. 27 No. 8 - August 2020

.PDF | 1.06 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Commentary: The limited role of vaccines in the prevention of acute gastroenteritis; Diarrhea and associated illness characteristics and risk factors among British active duty service members at Askari Storm ...

Report
Jul 1, 2020

MSMR Vol. 27 No. 7 - July 2020

.PDF | 1.02 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Hearing conservation measures of effectiveness across the Department of Defense; Alcohol-related emergency department visits, hospitalizations, and co-occurring injuries, active component, U.S. Armed Forces, ...

Report
Jun 1, 2020

MSMR Vol. 27 No. 6 - June 2020

.PDF | 743.79 KB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2019; Hospitalizations, active component, U.S. Armed Forces, 2019; Ambulatory visits, ...

Report
May 1, 2020

MSMR Vol. 27 No. 5 - May 2020

.PDF | 2.34 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2019; Hospitalizations, active component, U.S. Armed Forces, 2019; Ambulatory visits, ...

Report
Apr 22, 2020

MSMR Vol. 27 No. 4 - April 2020

.PDF | 836.99 KB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Commentary: The Warrior Heat- and Exertion-Related Event Collaborative and the Fort Benning Heat Center; Update: Heat illness, active component, U.S. Armed Forces, 2019; Update: Exertional rhabdomyolysis, ...

Report
Apr 2, 2020

MSMR Vol. 27 No. 4 - APR 2020

.PDF | 831.95 KB

As of 1 APR, 186,101 total confirmed COVID-19 cases (3,603 deaths) have been reported in all U.S. states, the District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands. Current hot spots include NY, NJ, LA, CA, GA, FL, SC, and Guam. Confirmed COVID-19 cases are rapidly accelerating in the U.S., an increase ...

Report
Mar 30, 2020

MSMR Vol. 27 No. 3 - March 2020

.PDF | 910.92 KB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Update: Sexually transmitted infections, active component, U.S. Armed Forces, 2011–2019; Incidence of sexually transmitted infections before and after insertion of an intrauterine device or contraceptive ...

Report
Feb 1, 2020

MSMR Vol. 27 No. 2 - February 2020

.PDF | 1.80 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Update: Malaria, U.S. Armed Forces, 2019; Diabetes mellitus and gestational diabetes, active and reserve component service members and dependents, 2008–2018; Increased risk for stress fractures and delayed ...

Report
Jan 1, 2020

MSMR Vol. 27 No. 1 - January 2020

.PDF | 1.09 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Carbon Monoxide Poisoning, Active and Reserve Component Service Members and Non-Service Member Beneficiaries of the Military Health System, U.S. Armed Forces, July 2009–June 2019; Respiratory Pathogen ...

Report
Dec 1, 2019

MSMR Vol. 26 No. 12 - December 2019

.PDF | 3.00 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Editorial: Mitigating the risk of disease from tick-borne encephalitis in U.S. military populations; Tick-borne encephalitis surveillance in U.S. military service members and beneficiaries, 2006–2018; Case ...

Report
Nov 1, 2019

MSMR Vol. 26 No. 11 - November 2019

.PDF | 1.88 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Editorial: Mitigating the risk of disease from tick-borne encephalitis in U.S. military populations; Tick-borne encephalitis surveillance in U.S. military service members and beneficiaries, 2006–2018; Case ...

Report
Oct 1, 2019

MSMR Vol. 26 No. 10 - October 2019

.PDF | 1.25 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Editorial: The Department of Defense/Veterans Affairs Vision Center of Excellence; Absolute and relative morbidity burdens attributable to ocular and vision-related conditions, active component, U.S. Armed ...

Report
Sep 1, 2019

MSMR Vol. 26 No. 9 - September 2019

.PDF | 1.58 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Editorial: The Department of Defense/Veterans Affairs Vision Center of Excellence; Absolute and relative morbidity burdens attributable to ocular and vision-related conditions, active component, U.S. Armed ...

Report
Aug 1, 2019

MSMR Vol. 26 No. 8 - August 2019

.PDF | 10.02 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Modeling Lyme disease host animal habitat suitability, West Point, New York; Incidence, timing, and seasonal patterns of heat illnesses during U.S. Army basic combat training, 2014–2018; Update: Heat illness, ...

Report
Jul 1, 2019

MSMR Vol. 26 No. 7 - July 2019

.PDF | 4.86 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Modeling Lyme disease host animal habitat suitability, West Point, New York; Incidence, timing, and seasonal patterns of heat illnesses during U.S. Army basic combat training, 2014–2018; Update: Heat illness, ...

Last Updated: July 31, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery