Optimizing Health: Standing up the US Army Public Health Command USPHS Scientific and Training Symposium Optimizing Health: Standing up the US Army Public Health Command BG Timothy K. Adams CG, USAPHC (Prov) 21 June 2011 UNCLASSIFIED UNCLASSIFIED

BRIEFING OUTLINE PURPOSE: To provide an overview on the US Army Public Health Command to USPHS Scientific and Training Symposium attendees. Army Medical Command (MEDCOM) Overview MEDCOM Reorganization: 5 Lines of Effort Public Health Command Background Mission Structure Transition timeline Integration Opportunities Public Health Support to Operations in Japan Questions UNCLASSIFIED UNCLASSIFIED

OneStaff The Department of the Army TSG & CG Office of The Surgeon General (OTSG) Pentagon/Falls Church, VA An Army Staff Element Policy and Regulation Represents the Army US Army Medical Command (MEDCOM) Fort Sam Houston, TX Direct Reporting Unit (DRU) Fixed Facility Healthcare Doctrine Training Leader Development Organizations Materiel Personnel Facilities Regional Medical Commands (5) Warrior Transition Command Research & AMEDD Center & School Dental The Department of the Army OneStaff TSG & CG USAMEDCOM DoD Executive Agencies Armed Forces Institute of Pathology DoD Veterinary Services Activity Armed Service Blood Program Office Military Vaccine Program/Vaccine Hlth Care Netwk Armed Forces Health Surveillance Center Medical Research for Prevention, Mitigation and Treatment of Blast Injuries Investigational New Drugs Force Health Protection Military Entrance Processing Command – (MEDICAL) ARSTAF Principal Public Health (Provisional) Development, Policy Direction, Organization, and Overall Management of an Integrated Army-wide Health Service System The Surgeon General is dual hatted as the CG MEDCOM. What has emerged as the template for DRU organization under the Army Campaign Plan has been in place in MEDCOM since 1994. The Surgeon General has executive agency of a number of critical joint organizations as noted on the lower right of the slide. Within MEDCOM there are 11 major subordinate command including, the AMEDD Center and School-the largest school in the Army school system; the Medical Research and Material Command-which conducts over 80% of all DoD Medical research and development; the Center for Health Promotion and Preventive Medicine, Veterinary command, Dental Command, and 6 geographical Regional Medical Commands. WTC Components: WTU BDE – 2 WTU BN – 13 WTU CO – 17 CBWTU - 9 COL Martinson/MCSC/(210)221-6213/Wendy.Martinson@us.army.mil UNCLASSIFIED

Major Subordinate Commands MEDICAL RESEARCH & MATERIEL COMMAND Ft. Detrick WESTERN RMC NORTHERN RMC JBLM MAMC APG PUBLIC HEALTH COMMAND Ft. Belvoir WARRIOR TRANSITION COMMAND Crystal City WAMC SOUTHERN RMC Readiness Division WBAMC CRDAMC DDEAMC Readiness Division Readiness Division FSH BAMC EUROPE RMC PACIFIC RMC Japan Korea AMEDDC&S TAMC FSH Readiness Division DENCOM Readiness Division FSH COL Martinson/MCSC/(210)221-6213/Wendy.Martinson@us.army.mil UNCLASSIFIED 4

OTSG/MEDCOM Personnel AMEDD AT A GLANCE AMEDD Personnel World Wide OTSG/MEDCOM Personnel Beneficiaries 24,631 Total AC Military 40,189 Civilians 8,429 Contractors 2,326 Total NG/RC Military 75,575 Total 4,397 Medical Corps Officers 904 Dental Corps Officers 8,381 Other Officers 35,792 Enlisted 49,474 Total AC 8,429 Contractors 45,883 Civilian 50,301 Total NG/RC 154,087 Total Active/Reserve 10 / 16 Combat Spt Hosp (CSH) 16 / 22 FWD Surg Tm (FSTs) 100 / 0 Other Active Units 0 / 52 Other Army NG Units 0 /129 Other Army AR Units 126/52/167 AC/NG/AR Deployable Units (345 Total) 546K Active Duty (AD) 814K Family Members (FM) (AD) 214K Dependent Survivor 180K Eligible NG/R 264K Family Members of NG/R 714K Retired 825K FM Retired 145K Other 3,702K Total TOE Units MEDCOM Installations Walter Reed Fort Detrick TDA Facilities U.S. Army Medical Center (MEDCEN): MEDCENs are large hospitals organized, staffed and equipped to provide preventive, primary, and specialized (tertiary) care, as well as related dental, medical, and social support services. MEDCENS also provide comprehensive pharmacy services (inpatient, outpatient, clinical, oncology, nuclear), as well as comprehensive laboratory and radiology services. When designated, MEDCENs conduct post graduate medical, dental and allied health education. Bliss, Bragg, Gordon, Hood, Landstuhl, Lewis, Sam Houston, Tripler, Walter Reed U.S. Army Community Hospital: Smaller in scale and scope than MEDCENs, ACHs are hospitals organized, staffed and equipped to provide preventive, primary, and specialized (secondary) care, as well as related dental, medical, pharmacy, lab, radiology and social support services. Knox, Belvoir, Sill, Carson, Polk, Riley, Leonard Wood, Irwin, Wainwright, Jackson, West Point, Campbell, Stewart, Benning, Korea U.S. Army Health Center (AHCE): A MTF that is organized, staffed and equipped to provide preventive, primary, and specialty outpatient services. Also, AHCEs may provide ambulatory services, such as same day surgery, as well as urgent care/emergency services. Although AHCEs may have up to 25 observation beds for care not to exceed 72 hours, unlike MEDCENs and ACHs they are not staffed and equipped to provide inpatient services. Also provides full range of ambulatory (outpatient) pharmacy services and limited laboratory and radiology services. Eustis, Lee, Meade, Leavenworth, Huachuca, Heidelberg, Vicenza U.S. Army Health Clinic (AHC): A MTF that is organized, staffed and equipped to provide preventive, primary, and some specialty outpatient services to eligible personnel. Generally, basic laboratory, radiology, and pharmacy services are offered on-site. Also, AHCL’s may have up to 25 observation beds for care not to exceed 72 hours. Supporting an Installation: Redstone, Rucker, Myer, Drum, Monmouth, Aberdeen, Carlisle, Zama, Dugway (Schofield / Richardson?) U.S. Army Troop Medical Clinic (TMC): A MTF that is organized, staffed and equipped to provide sick call, immunizations, medical examinations, physical profiling, and limited pharmacy and treatment services to eligible personnel. Patients needing additional care may be referred to larger MTFs. U.S. Army Occupational Health Clinic (OHC): A MTF that is organized, staffed and equipped to coordinate and implement the Army’s Occupational Health Program for both military and Federal Government civilian employees. They are equipped to treat occupational illness and injury and provide emergency treatment of non-occupational illness and injury. Also, they provide preventive health services, such as, hearing conservation, occupational vision and industrial hygiene services. Patients needing additional care may be referred to other MTFs or private physicians and dentists. U.S. Army Dental Clinics: We are using 147 as the number of clinics because we are counting stand alone dental clinics and combined medical/dental clinics (111) plus hospital dental clinics (24), as well as SRP/Reception Station/Inprocessing center with DTRs (12) because we actually use all of these facilities to accomplish our mission. If you count only Cat 500 buildings which will include dental clinics in hospitals, the number will be 135. FY10 Execution: Includes DHP O&M, RDTE, MILPERs, BRAC, OMA 9 Medical Centers 17 Army Community Hospitals 7 Army Health Centers 9 Army Health Clinics (supporting an installation) 128 Army Health Clinics 47 Army Troop Medical Clinics 18 Army Occupational Health Clinics 147 Dental Clinics 96 Veterinary Clinics 31 Research and Development Laboratories 32 Prevention Facilities 541 Total Daily Expenditures (All appropriations) $35.13M Total COL Martinson/MCSC/(210)221-6213/Wendy.Martinson@us.army.mil UNCLASSIFIED

Average Day in Direct-Care MEDCOM Outpatient Care Inpatient Care 1,214 Beds Occupied 374 Patients Admitted 41,986 Clinic visits Dental Services 26,620 Procedures 64 Births Veterinary Services 1,961 Veterinary Outpatient Visits and 418 food safety visits 50,420 Laboratory Procedures Clinic Visits, Births, Inpatient Care, Dental, and Veterinary Services data are all from Oct 08 - Jun 09 Laboratory Procedures, Outpatient Pharmancy, Radiology Procedures and Immunizations are all FY08 data 54, 048 Outpatient Pharmacy Prescriptions Medical Logistics Services 150,000 Supply Transactions 1561 Medical Maintenance WOs 12,494 Radiology Procedures Deployments 1,232 Soldiers Deployed 5,879 Immunizations COL Martinson/MCSC/(210)221-6213/Wendy.Martinson@us.army.mil UNCLASSIFIED

MEDCOM Reorganization - 5 Lines of Effort MISSION: USAMEDCOM provisionally realigns and reorganizes the CONUS RMCs NLT 1 OCT 2009 IOT improve span of control, while enhancing support to Soldiers, beneficiaries, Army readiness and transformation; on order executes permanent realignment NLT 1 OCT 2010. ENDSTATE 1 Realign RMCs RMC boundaries are realigned ICW TRO boundaries; the respective levels of command and staff leadership are reorganized to provide the proper span of control; the requisite C2 leaders and structures are in place and projected accordingly; As the MEDCOM improves support to Soldiers, beneficiaries, Army Readiness, and transformation. 2 Staff REORG Command Plan Public Health Command 3 DENCOM Realign 4 5 WTU / AMAP REORG UNCLASSIFIED 7 * Colors group similar / like actions UNCLASSIFIED

Public Health Command Transition US Army Public Health Command (Provisional) UNCLASSIFIED

In the beginning…. Idea: merge VETCOM and CHPPM capabilities, optimize public health support to Army Similar, overlapping missions of mutual interest Inconsistent public health services across the force Feasibility Study conducted by Public Health Command working group, September 2008 Course of Action chosen by TSG, effective 17 July 2009 Integrate select missions of CHPPM and VETCOM Select Level I and II veterinary services (from VETCOM) and preventive medicine missions re-aligned to MTF Initial Operational Capability – 1 October 2010 Full Operational Capability – 1 October 2011 CIP Submitted to MEDCOM US Army Public Health Command (Provisional) UNCLASSIFIED UNCLASSIFIED

Commander’s Intent MEDCOM will reorganize its public health capabilities to: Enhance the health and wellness of Soldiers and military retirees, their Families, and DA Civilian employees Create a single point of accountability and responsibility for public health within the MEDCOM Optimize public health support to the Army Improve the planning and use of Army public health assets across the full spectrum of installations and activities Execute effective Veterinary Service programs across the DoD End State A unified Army public health team that enhances and protects the health, fitness, and well-being of Soldiers, their Families, DA Civilian employees, and military retirees; and executes effective veterinary service programs across the DoD US Army Public Health Command (Provisional) UNCLASSIFIED UNCLASSIFIED

US Army Center for Health Promotion & Preventive Medicine (CHPPM) What We Do: Public Health and Wellness consultants for the Army Expertise in field preventive medicine, environmental and occupational health, health promotion and wellness, epidemiology and disease surveillance, toxicology, laboratory sciences, hazardous and medical waste, drinking water, entomological vectors, radiation sources and health Risk Communication Specialized Facilities: Analytical Chemistry Laboratories Radiochemistry Laboratory Entomology Laboratories Soils Laboratory Molecular Biology Laboratory Serum Repository Toxicology Laboratory Public Health Information Systems Just to give you a brief glimpse of my organization, we are the main public health unit in the Army. CHPPM has the laboratories and the experts to provide any necessary consultative support throughout the world. We are also provide the main links to civilian public health organizations, like CDC, and now, the Homeland Security Agency. Talk to CHPPM about their missions, e.g. Health Promotion Coordinators, etc. US Army Public Health Command (Provisional) UNCLASSIFIED

US Army Veterinary Command (VETCOM) Food Safety/ Defense Sanitation Audits/ Approved Sources Special Events Food Defense Teams Operational Rations/ DFACS/DeCA/AAFES Food and Water Vulnerability Assessments Food and Water Risk Assessments Animal Medicine Military Working Dogs Other Government Owned Animals Privately Owned Animals Human-animal bond program support One Health – One Medicine Public Health Team Zoonotic Disease Surveillance/Prevention Trained Soldiers OIF/OEF/ND/HOA/OCO Humanitarian Assistance/Civil Affairs Special Taskers-Department of State, Secret Service, USDA, COCOMS ALFOODACTS/DSCP ALERTS/VENDOR RECALLS Support over 250 Commissaries worldwide Support over 2000 Dining Facilities worldwide $5.3 Billion Subsistence Inspected Over 2300 MWDs Over 300 Other Government-Owned Animals Over 450,000 Military Family Pets Animal Bite Program US Army Public Health Command (Provisional) UNCLASSIFIED

PHC Transition Team: A3 Working Groups US Army Public Health Command (Provisional) UNCLASSIFIED

PHC CONOPS MEDCOM RMCs RPHC AIPH Regions MTF District PHC Installation CHPPM and VETCOM integrate into the PHC RVCs and CHPPM Subordinate Commands integrate into PHC Regions under the C2 of the PHC RMCs have C2 of installation PVNTMED missions PHC has oversight of level I-III PVNTMED missions through RMCs RMCs will have enterprise oversight and monitoring authority of the level I-II VETSVC Oversight authority infers a level of monitoring, advising, coordination and collaboration needed to execute oversight This slide depicts functional areas MEDCOM RMCs PHC RPHC Regions MTF District Installation PVNTMED VETSVCS AIPH Oversight (PH Missions) RMCs oversee I-II VETSVCs; PHC oversees I-III PVNTMED Coordinate / Collaborate (PH Missions) Monitor (PH Missions) Color Legend – Level of PH Services Major Sub Command Level (V) Strategic Level (V) Regional or Area Level (III and IV) Installation Level (I and II) Red Lt Blue Gold Green UNCLASSIFIED US Army Public Health Command (Provisional)

APHC Strategy Map Alignment to AMEDD BSC September 2010 Vision World-Class Provider of Public Health Services across DA and DoD. Promote health and prevent disease, injury, and disability of Soldiers and military retirees, their Families, and DA Civilian employees; assure effective execution of full spectrum veterinary service for Army and DoD Veterinary missions. Mission Strategic Themes Synchronize Public Health Maximize Value in Health Services Build the Team Balance Innovation with Standardization Optimize Communication and Knowledge Management ENDS SUSTAIN PREPARE RESET TRANSFORM Patient/Customer/ Stakeholder CS 1.0 Minimized Diseases & Injuries of Military Significance CS 2.0 Enhanced Health & Well-Being CS 3.0 Optimized Public Health Programs and Practices CS 4.0 Optimized Animal Care CS 1.0, 2.0, 3.0 CS 1.0, 3.0 CS 1.0, 2.0, 3.0, 5.0 CS 4.0 IP 5.0 Finalize Public Health Command Transition Process IP 6.0 Ensure Effective Public Health Oversight IP 7.0 Ensure Safe DoD Food and Water IP 8.0 Improve Disease & Injury Surveillance and Control Internal Process IP 7.0, 11.0, 12.0 IP 7.0 IP 7.0, 10.0 IP 7.0, 10.0 IP 9.0 Integrate Delivery of Health Promotion and Wellness Services IP 10.0 Minimize Risk from Occupational & Environmental Health Hazards IP 11.0 Enhance Characterization and Analysis of Health Status and Threats WAYS Feedback Adjusts Resourcing Decisions IP 7.0 IP 7.0, 10 .0 IP 7.0 IP 12.0 Ensure High Quality Veterinary Clinical Services IP 13.0 Develop and Enhance Relationships with Key Partners Alignment to AMEDD Strategic Objectives shown in red IP 8.0, 9.0 CS 6.0 , IP 13.0, 14.0 Learning and Growth LG 14.0 Maximize & Sustain Workforce Competencies LG 15.0 Standardize & Document Command Business Practices LG 16.0 Improve Knowledge Management MEANS LG 17.0, 18.0 LG 19.0, 20.0 LG 20.0 Resource R 17.0 Maximize Human Capital R 18.0 Optimize Facilities and Infrastructure R 19.0 Forecast Requirements and Secure Enduring Resources R 23.0 R 22.0 R 21.0 AMEDD Objectives not aligned to PHC objectives are: IP15.0 Leverage Research, Development and Acqusition and IP 16.0 Synchronize Army Medicine to Support Army Stationing & BRAC 15 15 15

PHC Structure, Roles & Responsibilities PHC Headquarters Aberdeen Proving Ground, MD Provide C2 for PHCRs, PHCDs, AIPH, and MWD Center. Provide PH oversight, policy, and promulgation. PHC HQ Public Health Command – Regions Provide C2 of PH Districts. Execute specialized core PH services within AOR. Monitor training, mentoring, and credentialing. Monitor installation level PH mission execution. Senior VCO serve as Veterinary Services Advisor to RMC. NOTE: DoD MWD (VS) Center and Food, Analysis & Diagnostic Laboratory aligned under PHCR-South RPHC PHC Regions PHC AIPH Army Institute of Public Health Aberdeen Proving Ground, MD Provide unique operational and strategic services & expertise. Develop Public Health programs. Provide technical supervision / consultation. Oversee quality assurance / process improvement. Public Health Command -Districts Execute general core PH services. Environmental Health Field Preventive Medicine Veterinary Public Health Provide training and mentoring. Monitor installation level EH, FPM, and Vet mission execution. Provide C2 of installation veterinary missions at CONUS and OCONUS locations. PHC Districts Color Legend: Level of Public Health Services Major Sub Command Level (V) Strategic Level (V) Regional or Area Level (III and IV) Lt Blue Gold Red Vet Branches & Sections US Army Public Health Command (Provisional) UNCLASSIFIED

PHC Organizational Structure IOC CONCEPT Align by technical function (AR 40-5; 40-3) Implement standard PHC organizational structure Regional and District personnel execute operational missions along the functional portfolios. Army Institute of Public Health (IPH) senior managers serve as Portfolio Directors overseeing portfolios for MEDCOM Public Health Develop and analyze PH programs and policy Execute unique low-density PH services Color Legend Major Sub Command Level (HQ) Strategic Level (V) Strategic Portfolio Managers Unique Services Regional or Area Level (III and IV) District Level (III) Lt Blue Green Red Gold Violet Yellow US Army Public Health Command (Provisional) UNCLASSIFIED

PHC Organizational Structure Color Legend Major Sub Command Level (HQ) Strategic Level (V) Strategic Portfolio Shared Services Regional or Area Level (III and IV) District Level (III) Lt Blue Green Red Gold Violet Yellow PHC Organizational Structure FOC CONCEPT Align by technical function (AR 40-5; 40-3) Implement standard PHC organizational structure Regional and District personnel execute operational missions along the functional portfolios. Army Institute of Public Health (IPH) senior managers serve as Portfolio Directors overseeing portfolios for MEDCOM Public Health Develop and analyze PH programs and policy Execute unique low-density PH services US Army Public Health Command (Provisional) UNCLASSIFIED

Personnel Strength as of 1 Mar 2011 3,051 Legacy CHPPM (1,190) Legacy VETCOM (1,861) UNCLASSIFIED US Army Public Health Command (Provisional)

Formal Steps to FOC Command Implementation Plan (CIP) Permanent Order Formal documentation to establish PHC Approved by HQDA, dated 23 May 11 Permanent Order Official documentation of the creation of the USAPHC In staffing Re-designate/Inactivate VETCOM US Army Public Health Command (Provisional) UNCLASSIFIED

PHC Transition Timeline FY 2011+ Phase I (Provisional) Phase II (IOC) 1 OCT 11 – PHC FOC WRMC/SRMC Enterprise Rapid Experiment, Phase II (Monitor) July 11 – Re-designate / Inactivation Ceremonies June 11 – Anticipated Permanent Order May 11 – HQDA Approval of CIP FY 2011 1 Feb 11 – ATTACH CONUS RVCs to PHCRs 19 Jan 11 – PHC OPORD 11-01 (PHC Reorganization) published 1 Jan 11 - DVCs aligned to RVCs along target CONUS regions 1 DEC 10 – MEDCOM approves CIP 1 OCT 10 – PHC IOC; WRMC Enterprise Rapid Experiment, Phase I (Coordinate/Collaborate) 1 AUG 10 – OPCON OCONUS RVCs to PHCRs; OPCON Installation PM assets to MEDDAC-Japan FY 2010 1 MAR 10 – BG Adams briefed on CONPLAN 1 APR 10 –OPCON VETCOM and VETCOM-EUR to PHC (P) 26 FEB 10 – TSG approves CONOPS 19 JAN 10– MEDCOM CofS IPR 1 OCT 09 – Establish PHC(Provisional) per OPORD 10-02 (MEDCOM REORG) FY 2009 28 AUG 09 – PHC TT Project Charter Approved 17 JUL 09 – WARNO 09-59 (Establishment of USAPHC) 3 JUN 09 – TSG selects PHC COA 3a.1 U.S. Army Public Health Command (Provisional) UNCLASSIFIED 21

USAPHC Integration Opportunities Preventive Medicine Veterinary Health Services Disease prevention and control Field preventive medicine Environmental health Health surveillance and epidemiology Laboratory services Health risk assessment Integration Opportunities Emerging Programs Army Wellness Centers NAF Central Fund First Year Graduate Veterinary Education (FYGVE) Community Health Promotion Councils (AR 40-3, AR 40-656, AR 40-657, AR 40-905) Veterinary Medical care for Government- Owned Animals Zoonotic disease surveillance and control Food safety and food defense quality assurance programs Veterinary Medical care for Privately-Owned Animals (AR 40-5) Occupational health Health surveillance and epidemiology Soldier, family, community health, and health promotion Toxicology Laboratory Services Health Risk Communication Zoonotic disease surveillance and control Food safety and food defense quality assurance programs US Army Public Health Command (Provisional) UNCLASSIFIED UNCLASSIFIED

The New Public Health Paradigm Laboratory Animal Veterinarian Sanitary Engineer Veterinary Pathologist Nuclear Medical Science Officer Occupational Health Nurse Health Physicist Geologist Chemist Safety and Occupational Health Specialist Animal Care Specialist Audiologist Chaplain Medical Laboratory Specialist Meteorologist Psychologist Ergonomist Fire Protection Engineer Entomologist Physicist Dietitian Acoustical Engineer Safety Engineer Wildlife Biologist Medical Officer Dental Officer Social Worker Veterinarian Agronomist Optometrist Toxicologist Epidemiologist Electrical Engineer Marine Biologist Mechanical Engineer Physical Therapist Environmental Engineer Community Health Nurse Industrial Hygienist Environmental Law Attorney Clinical Medicine Veterinarian Comparative Medicine Veterinarian Environmental Scientist Preventive Medicine Physician Veterinary Food Inspection Specialist Veterinary Services Food Safety Officer Environmental Protection Specialist U.S. Army Public Health Command (Provisional) UNCLASSIFIED

Ambient Radiation Monitoring Air Water Soil Food/Bottled Water Testing Public Health Support to Operations in Japan Ambient Radiation Monitoring Air Water Soil Food/Bottled Water Testing Support personnel evacuations Veterinary clinical support to Search and Rescue Dogs Support to JSF-J and PACOM US Army Public Health Command (Provisional) UNCLASSIFIED

Questions UNCLASSIFIED U.S. Army Public Health Command (Provisional)