Providing Full-Spectrum Care For Total Force Readiness

COL John J. Melton
Womack Army Medical Center
Ft. Bragg, NC

From Combat & Casualty Care, Q2 2019 Issue

COL Melton is a graduate of the U.S. Military Academy, West Point, New York (B.S. 1992), the Foster School of Business, University of Washington, Seattle, Washington (M.B.A. 2004), the Command and General Staff College (2008), and the Army War College (M.S.S. 2015). Prior to this assignment, COL Melton served as the Commander, Irwin Army Community Hospital and Director of Health Services for Ft. Riley, Kansas.

Other key assignments include: Deputy Commander/Chief of Staff, Womack Army Medical Center, Ft. Bragg; Deputy Commander/Chief of Staff, Martin Army Community Hospital, Ft. Benning; Commander, U.S. Army Health Clinic Bamberg and Director of Health Services for Warner Barracks, Bamberg, Germany; Chief, Resource Management/Chief Financial Officer, Landstuhl Regional Medical Center, Landstuhl, Germany; Executive Officer, 43rd Area Support Medical Battalion, 62nd Medical Brigade, Ft. Lewis; Chief, Program Analysis & Evaluation, 18th Medical Command, Yongsan, Republic of Korea; Chief, Resource Management, 121st General Hospital/U.S. Army Community Hospital-Seoul, Yongsan, Republic of Korea; Chief, Program & Budget, Brooke Army Medical Center, Ft. Sam Houston; Commander, Headquarters Company, 52nd Evacuation Battalion, Yongsan, Republic of Korea; Executive Officer, F-Company, 702nd Main Support Battalion, 2nd Infantry Division, Cp Casey, Republic of Korea; and Treatment Platoon Leader, F-Company, 702nd Main Support Battalion, 2nd Infantry Division, Cp Casey, Republic of Korea.

COL Melton is a certified Defense Financial Manager, board certified in Healthcare Administration, and a Fellow in the American College of Healthcare Executives. COL Melton is also an Arbinger Advanced Facilitator and TeamSTEPPS Master Trainer.

COL Melton holds active memberships in the American College of Healthcare Executives, American Society of Military Comptrollers, Healthcare Financial Management Association, Association for Patient Experience, International Honor Society Beta Gamma Sigma, and the Medical Service Corps Silver Caduceus Society.

COL Melton’s awards and decorations include the Legion of Merit (with 1 Oak Leaf Cluster), Bronze Star Medal, Meritorious Service Medal (with 5 OLC), Army Commendation Medal (with 4 OLC), the Army Achievement Medal (with 4 OLC), Meritorious Unit Citation, Expert Field Medical Badge, Parachutist Badge, and the Order of Military Medical Merit.

Combat & Casualty Care had the opportunity to speak with
COL John Melton, Commander, Womack Army Medical Center (WAMC), Ft. Bragg, NC, regarding current focus areas and efforts at WAMC.

C&CC: Please tell us about your role as WAMC Commander and current mission focus.

COL Melton: As the Womack Commander, I am responsible for and manage the Fort Bragg Military Health System in executing Joint Health Service Functions to effectively generate readiness for the force whether it be the Army Total Force, Joint Force, or All-Volunteer Force and their families. I serve in a dual-hatted capacity as the Army Readiness/Defense Health Agency Medical Treatment Facility Commander in Direct Support to the Senior Commander and all Fort Bragg tenant organizations.

As an integrated system of Readiness and Health, Womack enables the Operational Force to achieve overmatch by ensuring every Soldier is physically and cognitively “Ready to Fight Tonight” and proficient in their respective critical medical wartime skills.

C&CC: From a clinical-specific perspective, what are some areas of concern today that are preparing WAMC to handle types of casualties being seen?

COL Melton: To realize the transformational changes directed in the National Defense Authorization Act legislation, we must continue to reorganize resources and pursue partnerships that afford opportunities for higher complexity patient volume. This allows us to tailor curriculum pathways to achieve currency and sustain proficiency for both teams and individual occupational specialties at home station.

Integrating didactic instruction, preceptor teaching, clinical experience, live tissue training, and evidence-based clinical simulation opportunities under various conditions is essential. This construct leverages our expertise in support of operational medicine thereby reducing the variance in casualty management processes in full mission profile training.

C&CC: From a forward operations perspective, how is WAMC helping “push forward” skills application to better address point of injury trauma requiring immediate care, particularly in life-threatening situations?

COL Melton: There is a need to rapidly build and sustain a prolonged field care capability at point of injury that decreases the number of preventable trauma deaths and enhances survivability in close combat, specifically at Role 1 which includes self-aid, buddy-aid, and first-responder care. We resource and integrate curriculum pathways to enhance the capability for both medical and non-medical Soldier specialties to support an effective Role 1 casualty management system.

As an example, every month we start an accredited development program for our supported units for the Combat Medic (68W). This program includes a twenty week enhanced Paramedic certification program, a two week Flight Paramedic certification course, a five day Delayed Evacuation Casualty Management course, a three day Tactical Combat Casualty Care course, a six week Inpatient Unit preceptor training rotation, a six week emergency room preceptor training rotation, a six week Advanced Life Support EMS Unit preceptor training rotation, skills sustainment clinical rotation opportunities, and skills validation recertification.

We can design and tailor training pathways to satisfy their needs, depending on the supported unit commander’s training and readiness requirements, similar to range control.

C&CC: From a communications standpoint, can you talk about any key program efforts that WAMC is helping to advance?

COL Melton: Womack Army Medical Center and Soldiers from the 44th Medical Brigade had the opportunity to field test innovative technology in Army medicine to improve patient’s care October 3 using Medical Hands-free Unified Broadcast (MEDHUB). MEDHUB uses mobile pressure sensors, accelerometers and other technology cleared by the U.S. Food and Drug Administration to improve the communication flow between patients, medics and receiving hospitals. As of today, Army medics document all pre-hospital or pre-medical treatment facility interventions on a Tactical Combat Casualty Card. Documentation by the medics is handwritten and important in order to guarantee fluidity in patients’ care from first responders to the transfer of patients into the hospital of a military treatment facility. This system really fills an operational gap of ours where we’re not able to take those trending sets of vitals in the back of the ambulance and project that information forward. MEDHUB’s suite of technology autonomously collects stores and transmits non-personally identifiable patient information from a device, such as a hand-held tablet, to the receiving hospital via existing long-range Department of Defense communications systems. The receiving hospital displays the information sent from MEDHUB on a large screen so clinicians can see what is inbound, including the number of patients and their vital statistics.

The Womack Emergency Room had the opportunity to test the pilot system during real-world tragedies with Soldiers from the 44th MED. Often there is little to no communication before an ambulance arrives at the emergency room. Medics either get a call from range control with some information or an ambulance just shows up. They can’t prepare for how many patients or what the injury or injuries are. It could be an amputee or a cut. MEDHUB is being developed through a project with the U.S. Army Medical Material Agency (USAMMA) and the U.S. Army Medical Material Development Activity (USAMMDA) both subordinate organizations of the U.S. Army Medical Research and Materiel Command (USAMRMC). Now we have the opportunity to properly assess an emergency and gather the appropriate staff and resources for the patients. The USAMRMC will continue testing the system with users and are on track for wider Department of Defense use by 2019.

C&CC: With lessons learned from expanding surgical capabilities across DoD, can you speak to ways WAMC is advancing efficiencies in field surgical care?

COL Melton: We are executing multiple initiatives the build the requisite clinical capabilities and medical education capacities to optimize Womack as a training platform.

As the Role 4 providing definitive care, we serve as a readiness training enabler for Fort Bragg. As Low Titer Group O Whole Blood becomes the standard for the Role 1 first responder, we are expanding the program in training, testing, collection, and storage for our supported units. Low-density specialties rotate in Womack for skills proficiency, Role 2 forward resuscitation surgical teams perform surgeries as a team in our surgical suites, and we support Role 3 combat support/field hospital training exercises.

We have entered into multiple resource sharing and partnership agreements that afford opportunities for higher complexity patient volume. This provides the means for both individuals and teams to sustain skills proficiency closer to home station. Civil-military medical sustainment skills programs closer to home station avoids TDY costs and time away from families. Just recently, a vascular surgeon returning from deployment completed a rotation at a Level 1 Trauma Center in Durham, NC, as part of a new agreement.

In May, we are hosting the American College of Surgeons and the North Carolina Office of the Emergency Medical Services to verify and designate Womack as a Level 3 Trauma Center. We are growing four new Graduate Medical Education programs. The Accreditation Council for Graduate Medical has approved our new Internal Medicine and Transitional programs which are required for our new general surgery and orthopedic programs we are applying for later this year.

C&CC: In terms of day-to-day healthcare, what are some ways WAMC promotes better force health, even for transitioning servicemembers?

COL Melton: Population-focused health care is the active process to assess the health care needs of a specific population and organize work flows for the population as a whole rather than for individuals. This expedites Soldier disposition for Return to Duty or separation which affects the P-Level Manning of an Army Operational Force unit.

For example, one problem is that musculoskeletal disorders constitute the largest class of injuries sustained our tactical athletes and the highest number of non-deployable Soldiers. Synchronizing work flows around this at-risk population allows for the active profile management and integration of multi-discipline practice guidelines to streamline the assessment, diagnosis, treatment, rehabilitation, and reconditioning to prevent re-injury. This is also nested with the Holistic Health and Fitness (H2F) System, a comprehensive approach to health, nutrition and fitness using evidenced-based strategies to optimize the ground combat power readiness of each and every Soldier tactical athlete.