Defense Medical Materiel Program Office

The Defense Medical Materiel Program Office (DMMPO) is established as an operating entity under the US Department of Defense (DoD) TRICARE Management Activity (TMA) effective 1 July 2009

Theater Trauma Management:

Theater trauma management helps track casualty information from Iraq and Afghanistan to give senior leaders the concrete information they need as they make decisions about everything from what protective gear troops will use to how to better deliver combat casualty care.

Joint Theater Trauma System:

Medical lessons learned from Vietnam and previous military conflicts led to the development of civilian trauma systems in the United States. Operation Iraqi Freedom represents the first protracted, large-scale, armed conflict since the advent of civilian trauma systems in which to evaluate a similar paradigm on the battlefield.

Collaborative efforts between the joint military forces of the United States initiated development of a theater trauma system in May 2004. Formal implementation of the system occurred in November 2004, the collaborative effort of the three Surgeons General of the U.S. military, the United States Army Institute of Surgical Research, and the American College of Surgeons Committee on Trauma. One trauma surgeon (Trauma System Director) and a team of six trauma nurse coordinators were deployed to theater to evaluate trauma system component issues. Demographic, mechanistic, physiologic, diagnostic, therapeutic, and outcome data were gathered for 4,700 injured patients using the Joint Theater Trauma Registry. Interview and survey methods were utilized to evaluate logistic aspects of the system.

System implementation identified more than 30 systemic issues requiring policy development, research, education, evaluation of medical resource allocation, and alterations in clinical care. Among the issues were transfer of casualties from point of injury to the most appropriate level of care, trauma clinical practice guidelines, standard forms, prophylactic antibiotic regimens, morbidity/mortality reporting, on-line medical evacuation regulation, improved data capture for the trauma registry, and implementation of a performance improvement program.

In conclusion the implementation of a theater trauma system demonstrated numerous opportunities to improve the outcome of soldiers wounded on the battlefield.

Joint Theater Trauma Registry:

Theater trauma management track casualty information from Iraq and Afghanistan to give senior leaders the concrete information they need as they make decisions about everything from what protective gear troops will use to how to better deliver combat casualty care.

Trauma medical professions use the Joint Theater Trauma Registry as a tool to capture details about wounds received and the medical care provided from combat support hospitals, aboard ships and aircraft, and throughout the course of their treatment, as well as the results. This shows medical care providers what treatments were most effective as they apply those lessons learned to other patients with similar wounds.

Additional information is located on DefenseLink and in the Trauma System Development in a Theater of War: Experiences from Operation Iraqi Freedom and Operation Enduring Freedom.

Enroute Care Policies and Programs:

Department of Defense doctrine is to move injured or ill soldiers, sailors, airmen, and Marines to appropriate medical facilities as early as possible. This begins with the movement of casualties from the point of injury or casualty collection point to forward resuscitative care facilities for life and limb saving treatment. Patients can then be moved to other facilities within theater if they require additional care to stabilize them for rapid evacuation. Casualties may be collected at aeromedical staging facilities at airfields and moved out of theater for definitive care, including back to U.S. Medical Treatment Facilities (MTFs).

Blast Injury Management:

Blast injury occurs as the result of the detonation of high explosives, including vehicle-borne and person-borne explosive devices, rocket-propelled grenades, and improvised explosive devices (IEDs). The Department of Defense program on Medical Research for Prevention, Mitigation, and Treatment of Blast Injuries uses a taxonomy to characterize such injuries. Primary blast injury is the result of blast overpressure (BOP) resulting in direct tissue damage from the shock wave coupling into the body. Secondary blast injury is produced by primary fragments originating from the exploding device (preformed and natural [unformed] casing fragments and other projectiles deliberately introduced into the device to enhance the fragment threat) and secondary fragments, which are projectiles from the environment (debris, vehicular metal, etc.). Tertiary blast injury is the displacement of the body or part of the body by the BOP causing acceleration/deceleration to the body or its parts, which may subsequently strike hard objects causing typical blunt injury (translational injury), avulsion (separation) of limbs, stripping of soft tissues, skin speckling with explosive product residue and building structural collapse with crush and blunt injuries, and crush syndrome development. Quaternary blast injury is the result of other "explosive products" effects-heat (radiant and convective) and toxic toxidromes from fuel, metals, etc.-causing burn and inhalation injury. Last, quinary blast injury refers to the clinical consequences of "post detonation environmental contaminants" including bacteria (deliberate and commensal, with or without sepsis), radiation (dirty bombs), and tissue reactions to fuel and metals.

Traumatic Brain Injury (TBI) Management:

A common misconception is that having a brain injury is the same as being brain damaged. That is not necessarily the case. People's injuries can range from mild to moderate to severe. There are mild and moderate kinds of traumatic brain injury that result in temporary disability and impairment. Traumatic brain injury (TBI) is caused by a blow or a jolt to the head or a penetrating head injury that disrupts the function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from "mild," i.e., a brief change in mental status or consciousness to "severe," i.e., an extended period of unconsciousness or amnesia after the injury. The number of people with TBI who are not seen by medical professionals or who receive no care is unknown.

People with mild to moderate brain injuries can experience a variety of difficulties. They may have physical symptoms such as headache, dizziness/vertigo, balance problems and sleep disturbance. They may have cognitive symptoms including short-term memory deficits, poor concentration, or being more easily distracted and have difficulty making simple decisions. They may also have changes in their mood that make them feel different than they did before their injury. The most common mood changes that people with brain injury experience are increased irritability, sad mood, lack of motivation and increased anxiety.

One of the confusing and often deceptive things about brain injuries is that they are not visible to the eye. When a patient breaks an arm or suffers a burn, there are visible signs of their injuries which signal to others that the person has been hurt. Oftentimes when people hit their heads in motor vehicle accidents or are able to grow hair over scars on their heads there are no visual cues to others that the person may have suffered a concussion or mild brain injury. While scars and visible injuries may be uncomfortable to patients and may make them feel self-conscious, they do serve to communicate something to others who interact with them. They serve to signal that a person may be in pain, may be fatigued, and may be irritable. They signal that the person has been hurt and may not be their 'usual self' in many different kinds of ways.

Additional information is located on the Defense and Veteran Brain Injury Center (DVBIC) Web site or call 1-800-870-9244.

Forward Resuscitative Care:

Joint doctrine (JP 4-02) defines FRS as the urgent initial surgery required to render Patients transportable for further evacuation to medical treatment facilities staffed and equipped to provide for their care. FRS is performed on patients with signs and symptoms of initial airway compromise, difficulty breathing, and circulatory shock, and who do not respond to initial emergency treatment and advanced trauma management procedures. The basic notion is to reduce the mortality of those who would have died without prompt surgical intervention.

Combat Operational Stress:

DoD recognizes that combat service and operational deployments create stress. Effective identification, risk communication, and treatment across the deployment cycle for Service members and their families are very important. Education, training, and outreach are important components of support and reintegration training upon return from deployment is provided across all Services. In addition, a myriad of support services are provided for families of deployed members. Combat and operational stress teams are provided jointly to support military members and commanders in theater.

For information on Combat Stress visit the Deployment Health Clinical Center. To reduce stigma, increase early intervention, and improve support services to both military members and their families, Military One Source has been established. This program offers counseling for the entire family for any adjustment issues that present during or post-deployment. It is available online, by phone, or in face-to-face counseling sessions.

A continuum of standardized health assessments conducted across the deployment cycle provides consistent periodic screenings to help identify health concerns early so they can be resolved well ahead of the deployment window.

To improve the identification process and facilitate access to treatment, a Post-Deployment Health Re-Assessment was implemented at the 3-6 month period after return from deployment. To expand our continuum of care, we have implemented a robust mental health awareness and education program including a Mental Health Self Assessment Program for military members and their families. This program allows phone-based, web-based, and in-person voluntary, anonymous self assessment, educational products, and referral to counseling and healthcare benefits.

The DoD continues to work with the Institute of Medicine (IOM) and the Department of Veterans Affairs (VA) to develop clinical practice guidelines that provide for evidence-based treatment of the most prevalent mental health problems, including depression, acute stress/PTSD, substance use disorder, and medically unexplained symptoms. These partnerships expand availability of mental health services to Reserve Component Service members. FHP&R continues to explore the issues surrounding combat stress and endeavors to provide the correct identification, diagnostic and treatment regimens possible.

Resources:

Air Force:
http://www.afcrossroads.com/famseparation/ret_educat_materials.cfm

Navy:
http://www-nehc.med.navy.mil/prevmed/MLongDepl04.doc

Army:
Military One Source
For Army Leaders

Marines:
http://www.usmc-mccs.org/cosc/63619-usmc.pdf

Coast Guard:
http://www.uscg.mil/hq/reserve/magazine/mag2001/FAMGUIDE/index.htm

Stress and Reintegration:
Deployment Health Family Readiness Library

• Acute Stress Disorder


• Evidence Based Management of PTSD


• Helping National Guard and Reserve Reenter the Workplace


• Post Deployment Health Care for Reserve Component Members


• Reintegration Roadmap


• Returning to Family Life After Deployment

Rehabilitative Care:

Rehabilitative Care is dedicated to providing clinical care and administrative processes to transition Service members from the military to the civilian world. It provides support to military service members as they maximize their function and either return to duty or transition to civilian life. Rehabilitation Care plays a critical role in the assessment, management, and disposition of the injured combatants with musculoskeletal injuries.