Vice Adm Adam M Robinson Jr
36th Surgeon General of the United States Navy and Chief of the Navy’s Bureau of Medicine

Navy medicine is a thriving, global healthcare system fully engaged and integrated in providing high quality healthcare to beneficiaries in wartime and in peacetime. Our highly trained personnel deploy with sailors and Marines worldwide - providing critical mission support aboard ship, in the air, under the sea, and on the battlefield. At the same time, Navy medicine’s military and civilian healthcare professionals are providing care for uniformed services’ family members and retirees at military treatment facilities around the globe. Every day, no matter what the environment, Navy medicine is ready to care for those in need, providing world class care, anytime, anywhere.

As we enter 2011, we find ourselves at an important crossroads for military medicine. The operational tempo of today’s military has been unrelenting. Meeting the increased demand for healthcare providers both in the military and civilian world is a challenge facing us all as we enter the second decade of the 21st century. How we collectively respond to these challenges will likely set the stage for decades to come.

During the long wars in Iraq and Afghanistan, we’ve made incredible advancements in how we care for and treat our heroes and our caregivers. We’ve had the lowest mortality rate amongst trauma victims coming out of the war. The survival rate of combat forces that reach forward resuscitative surgical unit with life threatening injures is now about 95%. As operations in Iraq wind down, we must maintain keen focus on our contributions to Afghanistan and our commitment to our wounded warriors and their families. We must never waver in our support to them for the long haul. We must anticipate caring for them for the rest of this century, when the young sailors and Marines of today mature into our aging heroes of tomorrow.

Additional challenges include working through manning shortfalls for wartime critical specialties and providing more seamless logistical coordination during humanitarian disasters around the globe. Regardless of the challenges ahead, Navy medicine is well-positioned for the future. As I complete my last year as the Navy’s Surgeon General, I am confident that we will overcome any obstacles in our ability to meet our world-wide operational demands and continue our commitment to provide high-quality patient and family centered care to our growing number of beneficiaries. With that spirit of commitment and service in mind, I want to share some insights on what we’ve accomplished in 2010 and my strategic priorities for 2011.

Force Health Protection in Support of Global Operations

The foundation of Navy medicine is force health protection. It’s why we exist. Nowhere is our commitment to force health protection more evident than in our active engagement in military operations overseas in support of Iraq and Afghanistan. Due to the life threatening nature of many injuries, we are seeing increased demand to provide immediate expeditionary combat casualty care before a sailor or Marine is flown out to a field hospital. When seconds count, the Navy medicine team of doctors, nurses, and corpsmen is saving countless lives by providing immediate care from the battlefield. In addition, our deployed chaplains and mental health providers are also working in concert with our sister services to ensure the mental well-being of our troops and civilians alike. Make no mistake, Navy medicine personnel are serving and sometimes dying on the front lines along with the sailors and Marines whose lives are often literally in our hands.

Smart Power in Action

At the same time, our humanitarian assistance/disaster response (HA/DR) missions in direct support of the nation’s maritime strategy are expanding because the medical skills Navy medicine personnel possess are a cornerstone of the Navy’s overall HA/DR response capability. Nowhere has this been more evident than in the USNS Comfort’s mission in Haiti following the January 2010 earthquake. At that time, the USNS Comfort - which is one of the largest trauma hospitals in the United States - was undergoing scheduled maintenance, but we were able to get her underway within 77 hours of the activation order, and started receiving patients while in transit.

Upon arrival, the Comfort became part of the US federal and international effort by working with Haiti’s Ministry of Health, in support of the US Agency for International Development (USAID) and alongside healthcare providers from dozens of nations and non-governmental organizations like the Red Cross, Operation Smile, Project Hope, and so many more concerned people from around the world who joined together. The military/civilian team onboard Comfort treated almost 900 patients, performed almost 850 surgeries, and delivered 10 babies. This was the very first time that the Comfort was at full capacity with all of its 1,000 beds occupied.

The life-saving and life changing service we provided the Haitian people, while simultaneously maintaining the highest standards of patient and family centered care for our people at home, cannot be over emphasized. Our response to the Haitian people shows the selfless character of our nation, and our values of caring for those who are less fortunate. By doing so whether in Haiti or elsewhere, we save lives in the short term, but we also provide the conditions for greater security and stability in the long term. That is SMART power in action. Operation Unified Response illustrates without a doubt that we truly are a “global force for good.”

Navy medicine not only responds to disasters around the world and at home, we conduct proactive humanitarian missions in places as far reaching as Africa through Africa Partnership Station to the Pacific Rim through Pacific Partnership and South America through Continuing Promise. The Navy hospital ship USNS Mercy’s recent deployment in support of Pacific Partnership 2010, now the fifth annual Pacific Fleet proactive humanitarian assistance mission, is strengthening ongoing relationships with host and partner nations in Southeast Asia and Oceania. Our hospital ships are executing our maritime strategy by building the trust and cooperation we need to strengthen our regional alliances and empower partners around the world. With each successful deployment, we increase our interoperability with host and partner nations, non-governmental organizations, and the interagency. To be clear, today’s security mission (no matter what it’s called) must include humanitarian assistance and disaster response, which puts Navy medicine at the forefront of global operations. Often times, we learn just as much from the host country as they do from us.

During recent trips to countries such as Egypt and Vietnam, current partnerships and future partnership possibilities between Navy medicine and host nation countries were evident. Increasing military medical partnerships are strengthening overall military to military relationships which are the cornerstone of overarching bi-lateral relations between allies. So in many ways, Navy medicine is the face of the United States around the world in a very positive way and is providing the foundation for stronger military to military relations. These engagements are mutually beneficial -- not only for the armed forces of both countries but for world health efforts with emerging allies.

Navy Medicine’s Continuum of Care

Patient and family centered care is our core philosophy and approach—it’s our bottom line. Whether we are deployed with our warfighters in harm’s way or serving those who faithfully support our military—our families, and to those who have honorably worn the cloth of our nation – our retirees, we are providing comprehensive medical care for all our beneficiaries, from cradle to grave, wherever they may be and whenever they may need it. Patient and family centered care ensures patient satisfaction, focusing on increased access, coordination of services and safety, while recognizing the vital importance of the family. Navy medicine serves personnel throughout their treatment cycle. For our wounded warriors, we manage every aspect of medicine in their continuum of care to provide a seamless transition from battlefield to bedside to leading productive lives.

One of the key differences between civilian and military medicine is how we execute case management. We make sure we bring the medicine to the patient. We don’t make the patient find the medicine or the doctor. We make sure our sailors, Marines, and their families get the right care, when and where they need it. Our new Medical Home Port initiative is the perfect example of this philosophy.

Medical Home Port is Navy medicine’s patient centered medical home model. In alignment with my strategic goal for patient and family centered care, it will provide a more comprehensive, team-based model of healthcare delivery. This new model will drive out variability by implementing standards for all aspects of primary care services. The Medical Home Port team will ensure that care is all-inclusive and integrated with all other care provided within our healthcare system. Care delivered in Medical Home Port includes, but is not limited to: readiness, prevention, wellness, behavioral health, and disease management. Navy medicine selected eight initial sites (Naval medical centers and family practice teaching hospitals) to garner lessons learned and best practices with the goal of implementing throughout Navy medicine. The ultimate target is to achieve national recognition for Medical Home Port practices through the National Committee for Quality Assurance (NCQA).

Towards this end, having been the Surgeon General for three years now, I have and will continue to stress disease prevention versus disease intervention. Throughout my tenure, I have focused on a more holistic and comprehensive approach with respect to how Navy medicine prioritizes its programs, processes, and our people. Despite shortages in some military medicine specialties, Navy medicine remains committed to serving personnel throughout the treatment cycle, from the cradle to the grave, and continues to manage every aspect of medicine in the continuum of care, providing a seamless transition as wounded warriors progress through levels of treatment.

We are also aggressively working to reduce the stigma surrounding psychological health and operational stress concerns by partnering with our line counterparts in programs such as Navy Operational Stress Control, USMC Combat Operational Stress Control, Families Overcoming Under Stress(FOCUS), Caregiver Occupational Stress Control (CgOSC), and suicide prevention.

Excellence in Research and Development

Navy medicine would not be able to accomplish its mission without a vibrant research and development (R&D) community. The work that our researchers do is having a direct impact on the treatment we are able to provide, from the battlefield to the bedside. Many wounded warriors are walking, talking, and leading productive lives today because of the research and medical advancements in traumatic brain injury and PTSD, wound management, wound repair and reconstruction, as well as extremity and internal hemorrhage control and phantom limb pain in amputees. Our R&D programs are truly force multipliers to Navy medicine’s success and enable us to remain agile in the world-class healthcare we provide to our service members and beneficiaries.

We need to make sure that we include our basic sciences in everything that we do. It’s not about grant money. It’s about the innovation and the creativity that will propel us to go to the next level. Moving to that next level comes from that energetic and creative thinking in our research and development labs and schools. Science and technology, research, and development are the basis from which most of our innovations come.

Navy medicine has made tremendous strides in combat casualty care in the past few years and anticipates further advancements in battlefield medicine in the years to come. The Navy and Marine Corps team have unique operational needs, including expeditionary medicine, undersea medicine, and hypobaric and hyperbaric issues. Due to the nature of wounds we are seeing from Iraq and Afghanistan, Navy medicine is focusing its research on five priority areas to include: traumatic brain injury (TBI) and psychological health treatment and support for both operational forces and home-based families; medical systems support for maritime and expeditionary operations; wound management throughout the continuum of care; hearing protection and restoration; and undersea medicine.

The most recent and innovative example of research and treatment initiatives is the new National Intrepid Center of Excellence (NiCOE) which exemplifies “the convergence of art and science” for traumatic brain injuries and post traumatic stress disorders. This state-of-the-art facility is intended to serve as the vanguard for how to effectively research, diagnose, and treat traumatic brain injuries for wounded warriors.

Navy Medicine Looks to the Future

The pace and demand for Navy medicine personnel is only expected to increase in the coming years as we balance the dual mission of expeditionary medicine in support of those deployed in conflict zones with patient and family centered care for sailors, Marines, and their families. Despite all our success, we must still help the many service members who are returning home from a war zone, some of whom are injured physically or suffering from mild to severe TBI, and others suffering from combat stress or PTSD. How military medicine takes on this challenge will set the stage for decades to come, especially with respect to the quality, accessibility, and reliability of healthcare services in support of veterans and their families.

One of the major initiatives to build and sustain this support is the ongoing transition to the Walter Reed National Military Medical Center onboard the campus of the National Naval Medical Center, Bethesda, MD. We are working with the Joint Task Force—National Capital Region Medical, the lead Department of Defense organization, to ensure that this significant and ambitious project is executed properly and without disruption of services to wounded warriors, joint service members, their families, and other beneficiaries.

In closing, I am very encouraged that women will soon begin their integration into our submarine community. There are extremely capable women who have the motivation, talent, and desire to succeed in the submarine force, just as they have in our surface and aviation communities for decades. As women have increased their percentage of the active duty population, it behooves us to draw on the full range of the talent pool. Integrating women into the submarine force is not only feasible and safe; it is in the best interest of our Navy and our nation.

It is an honor and a privilege to lead the men and women of Navy medicine. Each day reinforces my confidence in what we can accomplish.

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