pizza brief june 2010 final
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UNCLASSIFIED//FOUO
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Navy Medicine Medical Engagement
RADM Tom Cullison, MC, USNDeputy Surgeon General of the Navy
18 June 2010
This brief is classified UNCLASS/FOUO
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Leadership - OrganizationExecutive Leadership
Surgeon General
BUMED
Chief of Naval Operations OPNAV
Navy Medicine National Capital
Area
NHC AnnapolisNNMC BethesdaNHC Patuxent RiverNHC Quantico
Navy MedicineSupport
Command
NMPTE BethesdaNMIMC BethesdaNMLC Fort DetrickNEHC NorfolkNMRC Bethesda
Navy Medicine East
NH BeaufortNH Camp LejeuneNH CharlestonNH Cherry PointNH Corpus ChristiNH Great LakesNH Guantanamo BayNH JacksonvilleUSNH NaplesNHC New EnglandNH PensacolaNMC PortsmouthUSNH RotaUSNH SigonellaEPMU Norfolk
Navy Medicine West
NH BremertonNH Camp PendletonUSNH GuamNHC HawaiiNH LemooreNH Oak HarborUSNH OkinawaNMC San DiegoNH Twenty-nine PalmsUSNH YokosukaEPMU Pearl HarborEPMU San Diego RESEARCH AND DEVELOPMENT
Naval Medical Research Center, Bethesda, MDNaval Health Research Center, San Diego, CANaval Submarine Medical Research Lab, Groton, CTNaval Aerospace Medical Research Lab, Pensacola, FLNaval Health Research Center Environmental Health Effects Lab, Dayton, OHNaval Health Research Center Directed Energy Bioeffects, San Antonio, TXNaval Institute for Dental and Biomedical Research, Great Lakes, ILNavy Medical Research Unit 2, Jakarta, IndonesiaNavy Medical Research Unit 3, Cairo, EgyptNavy Medical Research Center Detachment, Lima, Peru
Fleet Forces Command Surgeon
The Medical Officer of the Marine Corps
POLICY
EXECUTION
Reference: Office of the Navy Surgeon General
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Navy Medical Community
OperationalMedicine
OperationalMedicine
InformationManagement Information
Management
Education & TrainingEducation & Training
Research & DevelopmentResearch & Development
Environmental & Preventive Medicine
Environmental & Preventive Medicine
3 Medical Centers 16 Military Treatment Facilities (hospitals)189 Health Clinics (includes dental facilities)
*Over 29 million square feet
3 Medical Centers 16 Military Treatment Facilities (hospitals)189 Health Clinics (includes dental facilities)
*Over 29 million square feet
2 Hospital Ships2 Hospital Ships 10 Fleet Hospitals 10 Fleet Hospitals
Reference: Office of the Navy Surgeon General
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Readiness MissionBenefit Mission
Force Health Protection
OperationalFleet and
Fleet MarineForces
Casualty Receiving
and Treatment
Ships and
Medical Battalions
Fleet Hospitals
& EMFs
TRICARENetwork
HospitalsShips
&Soft Power
US OverseasHospitals Hospitals
Navy Medicine’s Dual MissionThe Readiness Health Care Continuum
Navy Medicine
Reference: Office of the Navy Surgeon General
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Marines and Navy MedicineA Special Bond
Photo: Department of the Navy/Department of Defense collection
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Navy Medicine’s Priorities
• Future Force- Readiness• Graduate Health Education • Quality Care/Customer Service • Prevention/Wellness• Medical Research• Patient and Family Centered Care/Value• Casualty Care• Recruitment/Retention• VA Integration• External Communication• Internal Communication
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UNCLASSIFIED//FOUO 7Reference: Office of the Navy Surgeon General
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Patient and Family Centered Care
Photo: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUO 9Photo: Department of the Navy/Department of Defense collection
Marine Corps Recruit Depot, San Diego, CA
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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NM East Military Treatment FacilityNM West Military Treatment FacilityNM NCA Military Treatment FacilityNM Support Command Activity
Fixed Assets Worldwide in support of the Warfighter
Prepared 5 Mar 10
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EMF-KuwaitFDPMU-Kuwait
OEF USMCUS Role 3UK Role 3FDPMU2 x FSE3 x FST
EMF-Djibouti
EMF-GTMO
LRMC
2 x AST
ContinuingPromise
PacificPartnership
OIF USMC
AfricaPartnership
Station
Deployed Forces Providing the Dual Mission of Navy Medicine
Prepared 5 Mar 10
Enduring missions Recurring missions Emergent missions
JTF-Haiti
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As of 7 Dec 09
NUMBERS IN PARENTHESES = BSO 18 REQUIREMENTS
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Average Joint IA Requirements (718)
//// EMF Kuwait (287) //// EMF Kuwait (238) ////
EMF Djibouti (31) //// EMF Djibouti (31) ////EMF Djib (31)
Average USMC HSAP Requirements (426)
LRMC 292 (277 RC / 15 AC) //// LRMC 292 (269 RC / 23 AC)
PP09 USNS R. E. BYRD (26)
EMF GTMO (115) //// EMF GTMO (115) EMF GTMO (115) ////
FDPMU-K (15) //// FDPMU-K (16)
//// INDICATES TRANSITION PERIOD WHERE FORCES DEPLOY/REDEPLOY
UK BAS (43)/CAN KAF (48) ////UK BAS (48)/US KAF (151)
CP09 T-AH USNS COMFORT (358)
CY 09 BSO-18 Support Requirements2009
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Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Average Joint IA Requirements (718)
//// EMF Kuwait (207) //// EMF Kuwait (207) ///
EMF Djibouti (31) //// EMF Djibouti (31) ////EMF Djib (31)
Average USMC HSAP Requirements (426)
LRMC 292 (269 RC/ 23 AC) //// LRMC 292 (274 RC / 18 AC)
PP10 T-AH USNS MERCY (398)
EMF GTMO (115) //// EMF GTMO (115) EMF GTMO (115) ////
///// FDPMU-K (15) /// FDPMU-K (16)
//// INDICATES TRANSITION PERIOD WHERE FORCES DEPLOY/REDEPLOY
UNCLASSIFIED//FOUO
As of 7 Dec 09
///// UK BAS (43)/US KAF (151) //// UK BAS (48)/US KAF (151)
NUMBERS IN PARENTHESES = BSO 18 REQUIREMENTS
CP10 USS WASP (66)
CY 10 BSO-18 Support Requirements2010
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0
500
1000
1500
2000
2500
3000
3500
4000
4500
1Q F
Y03
3Q F
Y03
1Q F
Y04
3Q F
Y04
1Q F
Y05
3Q F
Y05
1Q F
Y06
3Q F
Y06
1Q F
Y07
3Q F
Y07
1Q F
Y08
3Q F
Y08
1Q F
Y09
3Q F
Y09
1Q F
Y10
3Q F
Y10
1Q F
Y11
3Q F
Y11
1Q F
Y11
3Q F
Y11
BSO-18 RESERVES
MERCYBOXER
KEARSARGE
COMFORTDUBUQUE
OEF
OIFEMF-KLRMC
COMFORTPELELIU
OIFEMF-KLRMC
OIFEMF-KLRMC
OIF/OEFEMF-KLRMC
MERCYLHA/LPD
OIF/OEFEMF-KLRMC
COMFORTLHA/LPD
OIF/OEFEMF-KLRMC
MERCYLHA/LPD
OIF
OIF 2
OIF 4-6TSUNAMI
KATRINA
BSO-18 OPERATIONAL SUPPORTHistorical and Projected (AC/RC)
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Navy Medicine at Home
Navy Medicine DeployedPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUO 23Photo: Department of the Navy/Department of Defense collection
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Operation Iraqi Freedom
Photo: Department of the Navy/Department of Defense collection
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Operation Enduring Freedom
Photo: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
Guantanamo Bay, Cuba
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JTF GTMO Det
Provides task-organized theater hospitalization (Level III) Medical, General and Ortho Surgical, Dental care, Prev Med, 24/7 ER, Mental Health Services, and Mass Casualty support to personnel at all Detainee Camps, Detention Hospital, Detainee Mental Health Services, Optometry, Internal Medicine, Pharmacy, Physical Therapy, Prosthetic services, and Special Care Unit. In addition to Detainee care, JTF GTMO provides both general and mental healthcare services to all JTF active duty service member population.
Photo: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
Djibouti
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
Afghanistan
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The Continuum of Care
Forward Resuscitative Care (Level II)
Forward Definitive Care (Landstuhl) (Level IV)
Theater level care (Level III)
Corpsman in the Field(Level I)
Restorative-Rehabilitative Care (Level V)
Photo: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Office of the Army Surgeon General (86th CSH)
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Office of the Air Force Surgeon General
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collectionPhoto: Office of the Air Force Surgeon General
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In 2006, JFCOM tasked the Navy with providing medical staffing in support of the Army's Landstuhl Regional Medical Center (LRMC), Germany. Since then, the Navy Medical Augmentation Det has continued to augment LRMC with Navy medical personnel in support of wounded OEF/OIF warfighters. Currently, the Navy augmentation staff includes; 292 Navy medical personnel (260 reservist/32 active).
Landstuhl Regional Medical Det, Germany
Photo: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
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National Naval Medical Center
Photo: Department of the Navy/Department of Defense collection
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GuamHawaii
Okinawa
Landstuhl
USMC Wounded Warrior Regiment-- Single Command with Strategic Reach --
CampLejeune
CampPendleton
Quantico
WWR services the Total Force –
Active Duty / Reserve / Retired / Former Marines
Level of EffortCurrent (Mil / Civ): 212Contractor Support: 24Future Total: 361
WW RegimentWW Battalions
Patient Affairs Team (PAT)/VA Liaisons
District Injured Support Cells (DISC)
WW Company
Reference: Wounded Warrior Regiment Command Brief
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Navy Safe Harbor – Strategic ReachWounded, Ill, and Injured (WII)
BETHESDA / WRAMC (2)
BAMC (2)
SAN DIEGO (2)AT-LARGE WEST (1)
TAMPA (1)
PALO ALTO (1)
JACKSONVILLE (1)
PORTSMOUTH/RICHMOND (1)
MILLINGTON TN (2)
WASHINGTON DC (12)AT-LARGE EAST (1)
BREMERTON (1)
GREAT LAKES / MINNEAPOLIS (1)
VA POLY TRAUMA CENTER
MILITARY TREATMENT FACILITY
SAFE HARBOR HEADQUARTERS STAFF
NAVY OPERATONAL SUPPORT CENTER
NATIONAL NETWORK OF NAVY OPERATIONAL SUPPORT CENTERS
Reference: Navy Safe Harbor Program Command Brief
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USNS MERCY (T-AH 19) anchored off the coast of Chuuk, Federated States of Micronesia
PACIFIC PARTNERSHIP
UNCLASSIFIED//FOUO
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PACIFIC PARTNERSHIP 2007-2009
San DiegoSan Diego
Dili, TL12-25 Jul
Dili, TL12-25 Jul
Singapore2-7 July
Singapore2-7 July Port Moresby, PP
4-17 AugPort Moresby, PP
4-17 Aug
Pearl Harbor8-10 May15-18 Sep
Pearl Harbor8-10 May15-18 Sep
Chuuk State, FM22 Aug-1 Sep
Chuuk State, FM22 Aug-1 Sep
Nha Trang, VM19-29 June
Nha Trang, VM19-29 June
Manila, RP15-17 JuneManila, RP15-17 June
Samar, RP14 June
Samar, RP14 June
Guam20-24 May
3-7 Sep
Guam20-24 May
3-7 Sep
Darwin, AS27-31 Jul
Darwin, AS27-31 Jul
Majuro, RMI27 Aug-7SepMajuro, RMI27 Aug-7Sep
Da Nang, VM14-24 July
Da Nang, VM14-24 July
I/P Manila, RP17-18 June
I/P Manila, RP17-18 June
Bicol Region, RP20 June – 8 JulyBicol Region, RP20 June – 8 July JOA OPS
14 June – 11 JulyJOA OPS
14 June – 11 July
Pearl Harbor29 May – I June
12-15 Sept
Pearl Harbor29 May – I June
12-15 Sept
San DiegoSan Diego
Soloman Islands18-24 Aug
Soloman Islands18-24 Aug
Madang, PNG6-16 Aug
Madang, PNG6-16 Aug
I/P Singapore27-30 July
I/P Singapore27-30 July
Cotobato, RP29 May-12 June
Cotobato, RP29 May-12 June
Solomon Islands30 July – 12 AugSolomon Islands30 July – 12 Aug
Tonga22 Aug – 2 Sept
Tonga22 Aug – 2 Sept
Samoa5 – 16 Sept
Samoa5 – 16 Sept
Kiribati1 – 14 July
Kiribati1 – 14 July
New Caledonia
16 – 19 Aug
New Caledonia
16 – 19 Aug
Cairns23 – 26 July
Cairns23 – 26 July
Pearl Harbor 8-9 June
24-25 Sept
Pearl Harbor 8-9 June
24-25 Sept
San DiegoSan Diego
Marshall Islands
17 - 28 June
Marshall Islands
17 - 28 JuneGuam9-11 June
Guam9-11 June
UNCLASSIFIED//FOUO
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Eye surgery aboard USNS MERCY: Republic of the Philippines
Photo: Department of the Navy/Department of Defense collection
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A young patient onboard USNS MERCY walks for the first time in seven years after surgery on his leg: Republic of the Philippines
Photo: Department of the Navy/Department of Defense collection
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UNCLASSIFIED//FOUOThe U.S. Navy Amphibious Assault Ship USS Kearsage (LHD 3)
CONTINUING PROMISE
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Port Au Prince, Haiti9-20 Apr
Port Au Prince, Haiti9-20 Apr
Santo Domingo,Dominican Republic
21 Apr – 2 May
Santo Domingo,Dominican Republic
21 Apr – 2 May
St Johns, Antigua5-16 May
St Johns, Antigua5-16 May
Norfolk, VANorfolk, VA
Miami, FL 4-6 AprFt. Lauderdale, FL 26-28 Jul
Miami, FL 4-6 AprFt. Lauderdale, FL 26-28 Jul
La Union, El Salvador21 Jun – 2 Jul
La Union, El Salvador21 Jun – 2 Jul
Corinto, Nicaragua3-14 Jul
Corinto, Nicaragua3-14 Jul
VBN, Panama18-21 Jul
VBN, Panama18-21 Jul
Colon, Panama24 May-2 Jun
Colon, Panama24 May-2 Jun
Tumaco, Columbia6-17 Jun
Tumaco, Columbia6-17 Jun
Cartagena, Columbia20-23 May
Cartagena, Columbia20-23 May
53
Port Au Prince, HaitiPort Au Prince, Haiti
Belize City, BelizeBelize City, Belize
Manta, EcuadorManta, Ecuador
Buenaventura, Colombia
Buenaventura, Colombia
Acajutia, El Salvador
Acajutia, El Salvador
Corinto, NicaraguaCorinto,
Nicaragua
Salaverry, PeruSalaverry, Peru
Puerto Barrios, Guatemala
Puerto Barrios, Guatemala
Colon, PanamaColon, Panama
Port of Spain, Trinidad
Port of Spain, Trinidad
Georgetown, Guyana
Georgetown, Guyana
Paramaribo, Suriname
Paramaribo, Suriname
Norfolk, VA Norfolk, VA
CONTINUING PROMISE 2007 & 2009
UNCLASSIFIED//FOUO
UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
Cooperative Surgery with Dominican medical staff on board the USS Kearsarge: CARIBBEAN SEA
UNCLASSIFIED//FOUO
UNCLASSIFIED//FOUOPhoto: Department of the Navy/Department of Defense collection
Operation Smile patient after successful surgery onboard the USS Kearsarge: Puerto Cabezas, Nicaragua
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Cooperation Afloat Readiness and Training (CARAT) Program
3. Malaysia
6. Brunei
4. Thailand1. Philippines
5. IndonesiaNaval Engagement Activities
2. Singapore
CARAT 2009
Philippines 20 May - 30 May
Singapore 05 Jun - 18 Jun
Malaysia 22 Jun - 02 Jul
Thailand 08 Jul - 16 Jul
Indonesia 21 Jul - 25 Jul
Brunei 03 Aug - 10 Aug
SEACAT 17 Aug - 20 Aug
Exercise Observers
Vietnam Singapore
Cambodia SEACAT
Indonesia SEACAT
Photo: Department of the Navy/Department of Defense collection
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Eastern Europe &
Central Asia10
Caribbean &Latin America
14
Africa46
Asia &Southeast Asia
9
Funding Source
PEPFAR DHP
Middle East 3
DoD Global Fight Against HIV82 Countries Benefited by DoD Activities
(As of FY09)
Photo: Department of the Navy/Department of Defense collection
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7,779 Health care
workers trained
278counseling and testing centers
supported
26,800 individuals
currently on ARVs
353 counseling and testing centers
supported
42,350Troops &
families on palliative care
597,374reached with prevention messages
233,684counseled and
tested
4,728peer educators
trained
78laboratories
equipped and supported
FY 2009 DHAPP Program Accomplishments
Photo: Department of the Navy/Department of Defense collection
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NAMRU-3 AOR2005-9
Influenza
Active DutyHIV/BBPVector studies
Active Programs/PartnersAFI/HFV
Program
NAMRU-3
Ghana Detachment
Afghanistan Satellite Lab
Meningitis
Rotavirus
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OPERATION UNIFIED RESPONSE: HAITI 2010
Photo: Department of the Navy/Department of Defense collection
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USS Carl Vinson / Carrier Air Wing (CVW) 17
14 Ja
n 10
18 Ja
n 10
19 Ja
n 10
20 Ja
n 10
22 J
an 10
23 J
an 1
0
24 J
an 1
026
Jan
10
USS Bataan / 22nd Marine Expeditionary Unit
USNS Comfort
Fleet Antiterrorism Security Team
24th Marine Expeditionary Unit
Navy Forward Deployed Preventive Medicine Unit
USNS Lummus
Photo: Department of the Navy/Department of Defense collection
Operation Unified Response
*Specialty Surge Packages and Non-Governmental Organization Fills Throughout
USS Nassau
12 Jan 10
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USS CARL VINSON
62
• Treated 60 American and Haitian Patients
• Performed 12 Surgeries• Provided Neonatal Care to Infant
Born Onboard the USS Mohawk (USCG)
Photo: Department of the Navy/Department of Defense collection
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USS BATAAN
• Major/Trauma Surgeries: 21• Minor Surgeries: 77• 90% Orthopedic Related• 10% General Procedures
63Photo: Department of the Navy/Department of Defense collection
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On Station in Record Time• 76.5 hrs from notification to sail (5 day norm)• 1st patient via helo before ship anchored PaP• Treated ~1000 earthquake patients• 843 major surgeries
“Largest single orthopedic trauma center in the
hemisphere”
THE FACE OF OUR NATIONAL RESPONSE!
USNS Comfort (T-AH 20)
Photo: Department of the Navy/Department of Defense collection
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Non-Governmental Organizations
• Non-Governmental Organizations expand mission capabilities onboard COMFORT:– American College of Surgeons– Johns Hopkins University– National Nurses United– Operation Smile– Orthopedic Trauma Association– Project HOPE– UCLA– University of Michigan– American Red Cross
Photo: Department of the Navy/Department of Defense collection
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Retention: Top 10 Reasons Sailors Stay and Leave
Number Reasons to Stay113,317 Your medical benefits
109,358 Your dental benefits
99,409 Value of your benefits
94,020 Leave amounts
91,623 Availability of Navy Exchange
90,485 Availability of commissary
87,759 Education benefits offered
82,978 Interest in my current job
80,717 Availability of MWR programs
77,949 Advancement/Promotion
opportunities
Number Reasons to Leave
70,732 Being Selected for an IA
62,903 The red tape
55,545 Separation from family/friends
50,350 Time Away from Home
49,074 Morale in your unit
46,325 Communication within the unit
44,094 Appropriateness of awards
43,764 Administration of award
system in my unit
42,894 # of personnel to do the job
41,728 Time spent training away from
home
66
Zone A Argus Survey Data / ALL NAVY
Data as of Aug 09
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Medical Corps Health Professions Scholarship Program (HPSP)
Note: FY08 –FY10 Data include both HPSP and Health Services Collegiate Program
FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY100
50
100
150
200
250
300
350
400
Goal
Accessions
FY10 as of Apr 10; Additional 96 in process
371 net under-recruiting of HPSP from 2004-2007. Goal met FY08 and FY09On track to fully meet goal in FY10
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Loss Rates FY02-FY09
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
MC 8.7% 9.2% 10.6% 10.4% 9.6% 10.2% 8.2% 8.8%
DC 12.2% 11.7% 10.6% 12.9% 14.4% 14.7% 10.8% 8.5%
MSC 6.9% 7.3% 9.1% 10.2% 10.2% 9.4% 9.0% 9.0%
NC 7.6% 8.4% 9.5% 9.7% 11.4% 9.9% 9.2% 8.9%
FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09
Source: BUMIS Sep 2009
Medical Department Officer Loss Rates
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Parent Services and Med Dept Comparisons
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
550,000
600,000
FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 TD
Ser
vice
s E
nd
Str
eng
th
Army Navy Marine Corps Air Force Navy&MC combined
Marine Corps
Air Force
Navy
Army
Navy & Marine Corps Combined
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Medical Department Officer Communities
0
50
100
150
200
250
300
TOP HIGH DEMAN/LOW DENSITY PERSONNEL CURRENTLY DEPLOYED
Community Manning Personnel Deployed Operational Billets
PA EM Gen Surg CC Nurse Psychiatry Clinical Psych
Community Manning 180 136 176 283 93 106
Personnel Deployed 22 23 27 69 16 11
Operational Billets 54 23 32 19 10 29
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UNCLASSIFIED//FOUO 71Loss Rate (%)
0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00%
Psych Nurse
Nurse Anesthetist
Pediatric Nurse Practitioner
Perioperative Nursing
Family Nurse Practitioner
Critical Care Nurse
Entomologist
Env Hlth Officer
Psychologist
Physician Assistant
Anesthesiologist
Emerg Physician
Psychiatrist
General Surgeon
5 year average annual loss rate 2005-2009 FY09 loss rate
Medical Department Officer Corps Critical Wartime Specialty Manning
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