Creating a revolution in map training
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Creating a Revolution in MAP Training. Briefing for BUMED Readiness Conference 20 Apr 04 CAPT Gerry Cox, MC, USN Director, Medical Programs, HQMC. Creating (R)Evolution in MAP Training. Briefing for BUMED Readiness Conference 20 Apr 04 CAPT Gerry Cox, MC, USN

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Creating a Revolution in MAP Training

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Creating a Revolutionin MAP Training

Briefing for BUMED Readiness Conference

20 Apr 04

CAPT Gerry Cox, MC, USN

Director, Medical Programs, HQMC

Creating (R)Evolutionin MAP Training

Briefing for BUMED Readiness Conference

20 Apr 04

CAPT Gerry Cox, MC, USN

Director, Medical Programs, HQMC


  • HQMC/HS Staff and Roles

  • MAP Imperative

  • Trauma Training

  • Other issues

HQMC Health Services

  • RDML Robert Hufstader, MC, USN – The Medical Officer of the Marine Corps

  • CAPT Paul Zambito, MSC, USN – EA

  • CAPT Bill Reynolds, DC, USN – Dental Officer of the Marine Corps

  • CAPT Gerry Cox, MC, USN – Director, Medical Programs

HQMC Health Services

  • CDR Dave McMillan, MC, USN – PMO

  • CDR Jack Pierce, MC, USN – Clinical Staff Officer

  • LCDR Jim Letexier, MSC, USN – Homeland Security Officer

  • HMCM Celestino Magpayo – CMC

  • DTCS Steve Perez – Admin Chief

  • HM1 Buffie Dando - LPO

  • YN2 Troy Reed – Flag Writer

  • DT3 Natasha Galusha – Admin Asst

  • Mrs. Sylvia Bryant - Secretary

MAP Training

Individual Medical Readiness

Mental Health/ Operational Stress Control

CBR Protection

Open (“EZ”) Access

Family-Centered Care

Population Health

5VM Learning Continuum

MAP ImperativeOne of 8 Naval Medicine “Equities”

2004 TRICARE Conference – Navy SG Breakout Session

Current Situation

  • Platform training: 5 days/year inadequate

  • MAPEXs poorly supported/attended

    • most training provided in field setting

  • Individuals trained  individuals deployed

    • frequent personnel substitutions

      OIF AARs/Lessons Learned:

      inadequate training is a liability in combat!

Current Situation

  • No standard curriculum

    • MARFOR mission/organization/CoC

    • tactical/combat survival skills

    • field clinical skills

  • No predictable training plan (TEEP)

  • Suboptimal coordination between supporting/supported MARFOR platforms

    Who’s accountable for mission success?

Current Situation MTF COs Have Competing Incentives

  • Operational Readiness

    • Support current deployment

    • Train future deployers

  • Peacetime TRICARE mission

    • Focus on productivity, access, revised financing costs

    • Providers that need MAP training generate high-cost care

  • Peacetime care contributes to readiness too!

MAP ImperativeDefinition

  • MAP = method used by the Surgeon General to train, equip, and organize medical personnel to meet HSS requirements of Naval operational forces

  • Focus on:

    • developing standardized process for assigning and training MAP personnel

    • metrics to which a Commanding Officer can be held accountable

MAP ImperativeKey Elements

  • MTF & platform COs must have visibility of stable platform (Component UIC) manning documents (AMD, ODCR, EDVR)

  • MTF & platform COs must possess a list of validated and consistent platform training requirements, including periodicity of refresher training.

  • MTF COs possess in-house resources that can be applied toward MAP training

MAP ImperativeSteps for Standardization

  • Develop partnerships between platform COs and MTF COs

  • Drive training into the MTF/DTF

  • Assign responsible officer at MTF for each supported platform

  • Train to EMPARTS

  • Develop standardized deployment rotation policy

MAP ImperativeProposed Measures of Success

  • EMPARTS R-, A-, & T-status

  • MTF’s ability to supply platform personnel

  • Feedback from platform CO

  • Measures of MTF/DTF operations and productivity:

    • revised financing bill

    • network referrals

    • waiting times

    • available clinic hrs

– total RVUs

– OPVs

– inpt bed capacity

– surgical backlog

Navy Trauma Training CenterBackground

  • Congressional mandate – 1996 NDAA

  • Demo programs at EVMS (Navy 1997), JTTC Ben Taub (DoD, 1999-2000)

  • NTTC established 2002 to train FRSS and FST teams; focus on “salvage surgery”

  • 29 day rotation, 9 classes/yr, 24 trainees/class

  • 14 rotations since inception; 249 trained thru Mar 04 (60 MC, 55 NC, 7 PA, 127 HM)

NTTC IssuesTMO View

  • NTTC does not have capacity to provide all Navy and Marine Corps trauma training needs.

  • MAP personnel assigned to far forward resuscitation and surgical teams (FRSS, STP) are deploying to combat areas without adequate trauma training.

  • There is an immediate need to ensure that medical personnel deploying to OIF II-2 (Sep 04) are properly prepared and trained.

DiscussionTraining demand vs. NTTC Capacity

  • No written directive mandating NTTC training for specific platforms or personnel

  • No established standard for periodicity of refresher training

    • surgical community consensus view  q2 yrs

  • Analysis: NTTC can accommodate FRSS and FST demand…

  • … but not all platforms (CRTS, FH/EMU, T-AH)

Potential Courses of Action

  • Establish new, shorter trauma training program for those not involved with salvage surgery

  • Decrease length of NTTC rotation by teaching didactics at local MTFs

  • Joint training with USA/USAF programs

  • Expand other existing Navy programs

Overall Goal:

Raise the baseline of trauma expertise throughout Naval Medicine (both officer and enlisted) to reduce current knowledge gap and training time required before mobilization.

Methods: BTLS, ATLS, new salvage surgery courses, MTTs, patient simulators, etc.

Discussion:Specialist training quotas going unfilled

  • Process for scheduling units to attend NTTC working well

  • But… >1/3 of slots for surgeons, emergency physicians, anesthesia providers went empty

Units Scheduled for NTTC Training Mar-Oct 04

15 Mar – 12 Apr:1st FSSG FRSS / FST 1

26 Apr – 24 May: 1st FSSG FRSS / 2nd FSSG FRSS

31 May – 28 Jun:1st FSSG FRSS / FH Ports. (Det B)

05 Jul – 2 Aug: 3rd FSSG FRSS / FH Camp Pend. EMU

09 Aug – 06 Sep:1st FSSG Surgical Co. / FST 4

20 Sep – 18 Oct:FH Camp Pend. (Det B) / FST 9

25 Oct – 22 Nov:2nd FSSG FRSS / FST 7

Trauma Training CostsIndirect: Lost MTF Productivity

  • General surgeon should produce 6250 RVUs/yr

    • Value of care not provided by one surgeon during one month at NTTC = $71,875

    • Total system cost = $1.94M/year

  • Emergency physician should produce 4750 RVUs/yr

    • Value of one month at NTTC = $54,625

    • Total system cost = $983K/year

Example: NavHosp Camp Pendleton

  • 1st FSSG CUIC on deck for OIF II-2… and FH Camp Pendleton will be at tier 1 readiness

  • Effect of NTTC on specialist availability:

    • General surgeons: 5 total (4 FSSG, 1 FH); expect 3-4 to deploy next fall – will leave behind just one!

    • Emergency physicians: 9 total (6 Navy and 3 contract); expect 3-4 to deploy in fall; use remaining Navy physicians to cover extra shifts

    • Anesthesia providers: 1 CRNA deployed, 2 MDs on LIMDU; must reduce from 4 ORs to 3 ORs to support NTTC training

Potential Courses of Action

  • Mandate NTTC training prior to deployment

  • Use EMPARTS or new AQD to ensure right personnel are getting trained/re-trained

  • Backfill with Reservists

  • Backfill with blue-suit personnel from less impacted MTFs

  • Obtain resource support from TRICARE network

  • Program funds to purchase civilian care


  • MAP training is essential in GWOT

  • MAP training is expensive

  • MTFs are faced with lose:lose choices

  • Competing incentives mandate innovative approaches and additional resourcing

Medical R&D Initiatives

Combat Trauma Registry


PAs in Infantry Bns

Expeditionary Medicine IPT


Deployment Health Surveillance (OIF, Haiti)

Individual Medical Readiness

Mental Health/ Operational Stress Control

Sports Medicine

HQMC/HS Interest Items



Questions andDiscussion






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