Integrating Across Military Medical Research & Development

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Jonathan S. Miller, Ph.D., J.D., Acting Civilian Deputy, Principal Assistant for Research & Technology, US Army Medical Research and Development Command12 June 2019

The views expressed in this presentation are those of the author and may not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

Responsively and responsibly create, develop, deliver, and sustain

medical capabilities for the Warfighter

Lead the advancement of military medicine

MISSION VISION

Mission and Vision

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Medical Research & Development Command

Focused on materiel and knowledge-basedmedical solutions to:

• Improve downrange health delivery

• Increase and sustain Warfighter readiness

• Enhance recovery, rehabilitation, or reintegration

COLLABORATIVE COMMAND

WE SAVE LIVES

• Improve fitness, health, protection, and resilience

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DoD and Service Medical Requirements

Medical Research and Technology

Medical Product Development and

Systems Management (~PEO)

Medical Knowledge and Materiel for the Warfighter

Why is Army Medicine Involved?

Select, modify, and procure commercial medical materiel solutions, when appropriate, or we partner to developWe take the lead in Research and Development when:

• The issue is unique to the Military• Blast injuries

• Industry/academia lack interest• Endemic diseases in specific

area of responsibility (AOR)• Military needs a timely solution• Directed by Congress

To: Increase Warfighter readiness; Improve fitness, health, protection, and resilience; Improve downrange health delivery; Enhance recovery,

rehabilitation, or reintegrationUNCLASSIFIED 4

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Combat InjuriesHemorrhageHead TraumaBlast InjuryLung InjuryBurns

Mental & Physical StressPhysical PerformanceMusculoskeletal InjuriesCognitive PerformanceMental HealthPost-Traumatic StressSuicide

Endemic DiseasesParasitic DiseasesBacterial DiseasesViral Diseases

Battle SequelaeLoss of limbsLoss of tissueLoss of visionPain

Environmental HazardsHeat and ColdAltitudeToxic Industrial Chemicals

Systems HazardsDirected EnergyNoise

Nuclear, Chemical & Biological Warfare AgentsChemical Warfare AgentsBiological Warfare AgentsNuclear/Radiological

Threats to Service Member Readiness

Program Area Directorates (Science & Technology [S&T])

Military Infectious Diseases Research Program (MIDRP) – COL Wendy Sammons-Jackson

• Vaccines & drugs to prevent parasitic diseases (malaria)• Vaccines to prevent diarrheal diseases• Vaccines to prevent viral diseases (dengue, hanta)• HIV countermeasures (congressional mandate)• Prevent & treat combat wound infections• Protection from disease carrying arthropod vectors• Countermeasures against emerging infectious diseases

Combat Casualty Care Research Program (CCCRP) – Col Michael Davis

• Hemorrhage control and resuscitation• Traumatic brain injury care• Blood and blood products far forward• Burn injury and organ support• Tactical CCC interventions• Extremity and maxillofacial trauma treatment• Prolonged field care

Military Operational Medicine Research Program (MOMRP) – CDR Christopher Steele

• Musculoskeletal Injury • Blunt, Blast, & Accelerative Injury • Behavioral Health, Wellness & Resilience • Psychiatry & Clinical Psychology Disorders• Health, Readiness & Performance in Austere Enviros• Fatigue, Cognitive Health & Performance • Human Operator Health & Performance in Complex Systems • Environmental Toxicant Exposure• Performance Nutrition & Weight Balance • Directed Energy Health Hazards • Biomedical Aspects of Human Perf Opt & Enhance

Clinical & Rehabilitative Medicine Research Program (CRMRP) – Tony Gover

• Rehabilitation of neuromusculoskeletal injuries• Regenerative medicine and transplants• Sensory Systems (Vision, Hearing and Balance)• Battlefield, acute and chronic pain management

Medical Simulation and Information Sciences Research Program (MSISRP) – Mr. David Thompson

• Medical simulation• Health information technology and informatics• Medical capabilities to support disbursed operations

Program Area Directorates (PADs) – Functions• Manage programs; do not execute programs

(do not perform research and technology)• Fund intramural and extramural research and technology• Responsible for both the problem set and the solution set• Devise a research strategy (program) and fund research and

technology that fit the program• Collaborate with industry, academia and professional societies

Program Coordinating Offices• CBRN Defense Coordinating Office• DoD Blast Injury Research Program Coordinating Office• Joint Trauma Analysis and Prevention of Injury in Combat

PA(R&T) Fort Detrick, MD

Acting Principal Assistant for Research & Technology

Dr. Mark DertzbaughFt Detrick

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Laboratory Competencies

U.S. Army Research Institute of Environmental Medicine

USAMRIIDFt. Detrick, MD

U.S. Army Medical Research Institute of Infectious Diseases

Walter Reed Army Institute of Research Infectious Diseases:

Parasitic, Bacterial, Viral Vector Control TBI Neurotrauma & Brain Dysfunction Psychiatry & Clinical Psychology Disorders Fatigue, Cognitive Health & Performance Behavioral Health, Wellness, & Resilience Blunt, Blast, & Accelerative Injury Human Performance Optimization/

Enhancement – Psychological

WRAIRForest Glen, MD

USARIEMNatick, MA

TATRCFt. Detrick, MD

Telemedicine and Advanced Technology Research Center

Bacterial Diseases Viral Diseases Biological Toxins

TeleHealth Health Information Technology Medical Simulation

& Training Systems Medical Intelligent Systems

Musculoskeletal Injury Performance Nutrition & Weight Balance Human Performance Optimization/

Enhancement – Physiological

U.S. Army Institute of Surgical Research

USAISRFt. Sam Houston, TX

Hemorrhage, Shock, & Coagulopathy of Trauma Pain Pre-Hospital Tactical Combat Casualty Care Critical Care Delivery Endovascular Hemorrhage Control Prolonged Field Care Medical Aspects of Directed Energy Maxillofacial Trauma Extremity Trauma Ocular Trauma Burn Injury

U.S. Army Medical Research Institute of Chemical Defense

USAMRICDAberdeen PG, MD

Traditional & Emerging Chemical Threats Biological Toxins

USACEHRFt. Detrick, MD

U.S. Army Center for Environmental Health Research Environmental Toxicant Exposure Systems Biology

U.S. Army Aeromedical Research Laboratory

USAARLFt. Rucker, AL

Human Operator Health & Performance in Complex Systems Blunt, Blast & Accelerative Injury En Route Care Environment Crew Survival in Military Helicopters

& Combat Vehicles Medical Aspects of Directed Energy Human Performance Optimization/

Enhancement – Cognitive

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USAMRDC / Defense Health AgencyScience & Technology Interfaces

DirectorDHA J9, R&D Directorate

(Deputy Commander USAMRMC)

USAMRDC Board of DirectorsLab Commanders, PADs, Deputies,

and External Stakeholders

Commanding GeneralUSAMRDC

PAD IIPTProgram Managers, Lab

Representatives,External Stakeholders, and SMEs

Scientific SteeringCommittees

Lab and Other SMEs

Principal Assistant for Research & Technology/

Principal Assistant for Acquisition

Program Area Director (PAD)/Joint Program

Committee Chair

Capability Area Manager/Working Group

Chair

ASA(ALT) (Funding)AMEDD C&S (Requirements)

DHA (Funding)Joint Staff (Requirements)

USAMRDCStaff Support

Interagency Support Agreement (ISA) USAMRDC and DHA

Overarching IPTMedical R&D Flag Officer

Group (FOG) Components, JSS, DHA J9

Director, and DHA CAE

Integrating IPT

Working IPT

Joint Program Committees Program Managers,

External Stakeholders, and SMEs

Working GroupsProgram Managers, Lab

and Other SMEs

Staff Guidance & O

versightExecution

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QUESTIONS

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Program Area Directorates – Key Objectives

1. Improving Military Medical Simulation Establish a DoD integrated and federated Medical Simulation Enterprise (MSE) through:• Introducing Medical Health System (MHS) wide

standardized simulation with Joint Evacuation and Transport Simulation (JETS)

• Development of far-forward medical simulation capabilities through Point of Injury and Trauma Simulation (POINTS)

• Enabling a medically ready Force and ready Medical Force through Warfighter Preparation, Resilience, Enhancement, and Protection (WarPREP) efforts

2. Health Information Technology and Informatics

• Technology tools for data capture, movement, and transfer to the right provider and the right patient at the right time: Theater/Operational Medicine Reach

• Technology tools to improve actionable medical decisions from disparate data sources: Theater/Operational Medicine Agility

3. Provide Medical Capabilities to SupportDisbursed Operations

• Autonomous and Unmanned Medical Capability• Virtual Health• Medical Robotics

Medical Simulation and Information Sciences

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Program Area Directorates – Key Objectives

1. Protect the Warfighter against Infectious Disease Threats• Develop vaccines to prevent malaria, dengue,

diarrheal diseases (ETEC, Shigella, Campylobacter), hanta virus and HIV

• Develop drugs to prevent and treat malaria

2. Prevent, Treat, & Manage Combat Wound Infections• Develop tools to detect, identify and characterize

drug-resistant organisms causing wound infections• Develop novel therapeutics/delivery technologies

against wound infection pathogens & biofilms

3. Prevent & Control Disease Carrying Arthropod Vectors• Discover and develop control measures and tools to

prevent diseases transmitted by medically relevant arthropod vectors, e.g., mosquitoes, ticks, sandflies, & mites

4. Counter Emerging Infectious Diseases• Leverage international research infrastructure and

extensive infectious disease core capabilities & expertise to respond to emerging infectious disease threats

Infectious Diseases Military Operational Medicine1. Environmental Health & Protection

• Provide policy, training, planning tools, knowledge products, decision aids, mission planning tools, and materiel solutions to enhance readiness, sustain health, and optimize operational effectiveness when exposed to multi-environmental stressors

2. Injury Prevention & Reduction• Develop strategies and interventions to reduce the risk of

musculoskeletal injury (55K/yr not fit for duty)• Validate medical standards to optimize Human Operators

health and performance in complex systems

3. Physiological Health & Performance• Develop assessments/interventions to mitigate cognitive

deficits posed by operationally-induced sleep loss• Identify nutritional approaches tailored to specific

mission requirements • Discover novel biomedical approaches to optimize and

enhance Soldier performance

4. Psychological Health & Resilience• Support enhanced Service member and Family

psychological health & resilience• Identify PTSD biomarkers and develop pharmaceutical

interventions• Develop and refine suicide prevention

strategiesUNCLASSIFIEDName, Title, Email 11

Program Area Directorates – Key Objectives

Combat Casualty Care Clinical & Rehabilitative Medicine1. Reduce combat deaths and improve

functional outcome• Point of injury through definitive surgery• Prolonged Care in support of the MDB• Self, buddy, medic, PA, nurse, and physician care

2. Identify and develop medical techniques and materiel for early interventions• Decision support• Devices, drugs, and knowledge products• Focused empiricism for rapid impact• Rapid translation though integration with the Joint

Trauma System CoE

3. Translate Military-relevant basic and preclinical trauma research into clinical practice

• Stop bleeding, resuscitate, restore mangled extremities, treat burns, extracorporeal organ support, treat TBI

1. Rehabilitate NeuromusculoskeletalInjuries

• Service Related NMS Injury Rehabilitation• Prosthetics and Orthotics

2. Manage Pain• Battlefield• Chronic

3. Regenerate, Repair, Restore Injured Tissue

• Muscle, Nerve, Bone, Skin, Vascular Tissue

• Mechanisms of wound healing and scarring

4. Restore Sensory Systems• Novel Interventions

• Diagnostics• Treatments• Sensory simulation

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