WOUNDED WARRIORS
welcomed at new Walter Reed National Military Medical Center
Jessica’s story Wife of wounded warrior shares her courageous battle
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November 2011
WOUNDED WARRIORS
welcomed at new Walter Reed National Military Medical Center By Jim Mahaffie Walter Reed Army Medical Center has treated thousands of wounded veterans from the Army, Navy, Marine Corps and Air Force, as well as wartime traumatic brain injury (TBI) patients and those with post-traumatic stress disorder. Some 18,000 service people who served in Iraq and Afghanistan have spent time at the original facility in Washington, D.C.
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he center closed its doors in August after decades of serving the armed forces. Lt. Gen. Eric Schoomaker, the Army surgeon general who presided over the ceremony, said in his closing speech, “Clearly the heavens are struggling with the finality of this, too.” The new Walter Reed National Military Medical Center in Bethesda (WRNMMC) is the result of the merger between the Walter Reed Army Medical Center and the National Naval Medical Center in Bethesda. In August, injured vets and officials cut the ribbon outside the doors of the Wounded Warrior Barracks, just one of the new buildings at the center. The merger has been ongoing since the Department of Defense’s Base Realignment and Closure (BRAC) initiative, which mandated bringing together Walter Reed and the National Naval Medical Center among other streamlining measures across the military. The creation of the WRNMMC was the largest-ever capital infrastructure program in the military health system. New residential suites are fully equipped for vets who use wheelchairs and/or have prosthetics. Another component is the new America Building, a seven-floor, 515,000square-foot building that houses most of the outpatient clinics and resources. Two other new buildings add an emergency department, cardiology, imaging, nuclear
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The new America bui lding at Walter Reed National Mi litary Medical Center, at Bethesda (WRNMMC), is an outpatient faci lity that houses a cancer treatment center, a pharmacy, and several outpatient clinics, such as dermatology, audiology and physical and occupational therapy.
medicine, two intensive care units, dining facilities and more than 450 inpatient rooms. Five new access gates have been created along with other traffic infrastructure, including a 327,000-square-foot parking garage with 944 parking spaces, and another parking garage that is near11.11.11 - Advertising Supplement
ing completion. Other upgrades include new utilities, renovations to existing medical facilities and a new fitness center. There are several new Fisher Houses on the campus,
See WOUNDED WARRIORS, Page 9 Page 3
Brain injuries and psychological health: Treating the invisible wounds of war “We have a comprehensive plan for anyone who is wounded. It’s seamless, and though a patient may move from ward to ward, they no longer move (from) hospital to hospital.” --David Williamson, M.D., neuropsychiatrist and medical director, inpatient TBI program Walter Reed National Military Medical Center in Bethesda By Jim Mahaffie
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everely injured in a suicide bombing in an Iraqi marketplace in 2006, Army Capt. Mark Brogan was evacuated through Germany to the National Naval Medical Center in Bethesda, and then transferred to Walter Reed Army Medical Center in Washington, D.C. Brogan has spent the last five years in and out of Walter Reed, and is now in the traumatic brain injury (TBI) program. TBI has become the signature wound of the conflicts in Iraq and Afghanistan. “The good news is that we’ve been able to pull together all the different medical and rehabilitation specialties in one place to support wounded warriors,” said David Williamson, M.D., neuropsychiatrist and medical director of the inpatient TBI program at Walter Reed National Military Medical Center in Bethesda. “We have a comprehensive plan for anyone who is wounded. It’s seamless, and though a patient may move from ward to ward, they no longer move (from) hospital to hospital.” This year Walter Reed Army Medical Center merged with the National Naval Medical Center to become Walter Reed National Military Medical Center. Among the new campus facilities in Bethesda is a National Intrepid Center of Excellence (NICoE), an evaluation, treatment-planning and research facility that provides care to service members and families dealing with TBI and psychological health conditions such as post-traumatic stress disorder (PTSD). More than 125,000 people donated $65 million to build the center. The key to treating TBI is catching it Page 4
early and proactively preparing for it, Williamson said. “Walking and eating is one thing, but as you move up to complicated brain functions like emotions, learning, and operating a vehicle, or being a parent, spouse, employee or soldier, these are daily challenges for many returning vets. We have specialists who work on all of these, working on speech and movement as well as putting families back together.” Williamson said his teams spend half their time working with wounded warriors who sustained injuries years ago, such as Brogan. “Five years after Mark was hurt, things keep creeping up on us, and we have to deal with them as they come,” said his wife, Sunny. Mark is currently in the inpatient program at the center, where he is being weaned off of certain medications and coping with seizures. He wants to go back to school and find employment, and he said the center is helping him figure out what he can do. “This is the most intensive and comprehensive treatment I’ve had at one time,” he said. “Speech and occupational therapy all used to be completely separate. Here it’s all one team, and they all know what others are doing for me.” “We’ve created a new model, where trauma surgeons and neurosurgeons talk with neuropsychologists early on. That way, we can intervene early–and head off problems like suicides, depression and splintered families,” Williamson said. “We also follow up with patients so we
Dr. David Wi lli amson, Neuropsychi atrist and Medical Director of the Inpatient Traumatic Brain Injury Program at Walter Reed National Mi litary Medical Center in Bethesda, Md.
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See TBI, Page 5 11.11.11 - Advertising Supplement
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can pull people back into treatment if they’re not thriving,” said Louis French, M.D., chief of TBI outpatient services at the center. “The military invested a lot of money and effort in prevention, education and awareness of TBI,” French said. “Troop commanders are aware and looking for it. So the continuum of care starts before the point of injury.” Despite the deeply ingrained training and psyche of “soldiering on,” young men are more willing to admit when they need help today, he said. “It opened my eyes… it’s like the weight of the world is off my shoulders,” said Chief Warrant Officer Kurt Garrett in a video about the center. Garrett sustained five concussions in his 23 years as a Marine, and his PTSD dated back to Operation Desert Shield
and his tour in Iraq. “Some of my favorite experiences here were art therapy, speech therapy and physical therapy.” With the daily meetings, interactions and group sessions, “you know you’re not alone, he said. Marine Sergeant Jonathan Stidham sustained injuries from an improvised explosive device (IED) in Afghanistan in 2009. “Before I came to NICoE, I was a zombie… kind of steamrolling through doctors.” He said that the one-on-one time with the staff was key to his recovery. “All kinds of different classes set you on the right path and motivate you get back to your life.” Thousands of U.S. service members have come home from overseas with invisible wounds, caused by explosions and head injuries, traumas they witnessed, residual effects of high stress situations and more. Now there’s a place not only for supportive, healing care, but also innovative research and technologies.
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A female veteran is greeted by Chief of Staff, Ross Fletcher, and other staff members at DCVAMC’s “Ladies’ Night.”
Combat veterans appreciate the DCVAMC’s Recreation Therapy program which includes competitive cycling.
In addition to being a leader in electronic health records, DCVAMC uses state-of-the-art technology li ke the DaVinci Robot for prostate surgery.
Di ane Phi llips, Patient Centered Care Coordinator, assists Veteran Jeffrey Graves with the Truth Point – Point of Service questionnaire.
A young combat veteran shows off his new VA adapted truck.
Volunteers and hospital personnel man the information tables at the regular Job Fairs at the DCVAMC.
Coming home to the Washington, D.C. VA Medical Center Conflicts over the past decade have brought about a number of major advances in military systems, and the Washington DC Veterans Affairs Medical Center (DCVAMC) is no exception. By Jim Mahaffie
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he VA was established in 1930 with 54 hospitals, and the DCVAMC has always been the flagship. Today the health care system comprises 171 medical centers, more than 350 clinics and 126 nursing home care units. With its proximity to Capitol Hill, Walter Reed National Medical Center in Bethesda and the Pentagon, the center, located on Irving Street in Washington, D.C., is the vanguard. “Our mission is not only to treat vets, it’s to provide opportunities for senators, congress and staffers to learn about us and what we need for our veterans. That’s a very important part of our function,” said Diane Phillips, R.N., patient-centered care coordinator at the DCVAMC.
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Phillips, an Army veteran and veteran nurse in emergency rooms throughout Washington, D.C., is proud of the initiatives she has been a part of during her three years at the DCVAMC. She said that four initiatives in particular have been virtual revolutions at the VA. The first is the Patient Aligned Care Team (PACT). Each “team let” includes a doctor, nurse, medical technician and administrative employee who are dedicated to each patient. “It used to be you never knew who you were going to see when you went to the VA,” Phillips said. With PACT, there is a direct link between the team and the patient. Each team is familiar with the needs of each patient, and every patient receives a personalized care plan.
“The VA’s converting completely to this model,” Phillips said. “It’s care delivery in a much more intimate way.” Another initiative is a system of immediate patient feedback called Truth Point. Bedside patient experience questionnaires provide real-time feedback that administrators use to address and resolve issues on the spot. “It’s been an incredible thing to watch grow, and has changed the face of this facility,” Phillips said. Open-ended questions such as “How could we do better?” and “Did you feel like you were taken care of?” have caught some really big problems, such as chronic employee rudeness and dining service problems, Phillips said. “Food was the No. 1 dissatisfier.
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Truth Point was the catalyst for us to purchase a new food service system.” She said Truth Point information is read every day in morning reports, and everyone hears it. “It’s data that we wouldn’t otherwise have or only get when it’s three months old.” One best practice that came directly from patient feedback is Ladies Night. “Women vets called the VA a ‘man’s world’ in surveys,” Phillips said. “So we schedule nights where we open up the center to women only, with pampering services, tours and educational opportunities.” In addition to manicurists and hair stylists, there are insurance specialists on hand. Home loan information is also available at these events. Philips said that one of most popular November 2011
stops at a recent Ladies Night was a booth with information about VA burial benefits. “Lots of women don’t realize the array of benefits (the) VA offers.” One surprise benefit of Ladies Nights came out of therapeutic jewelry making. Phillips said the VA wanted attendees to have a souvenir to bring home from events, so a staffer and jewelry maker ran classes at a recent Ladies Night. “Lo and behold, as they’re sitting with each other making bracelets, they start talking about sexual traumas, violence at home and other problems,” she said. “Now we put therapists in the group, and have captured 13 women whose situations would not otherwise be known.” More than 84,000 veterans are enrolled for care at DCVAMC, with more than 650,000 hospital visits annually, said Sarah Cox of the Public Affairs office. The center serves more than 14,000 veterans of recent conflicts. Outpatient clinics serve vets in Ft. Belvoir, Va.; southeast Washington, D.C., and Greenbelt; St. Mary’s County; and southern Prince George’s County. These clinics are the focus of another revolution called telehealth. Vets from all over the region once had to drive into Washington, D.C., to see specialists. But now, via high-resolution cameras, veterans in outpatient clinics can “see” a specialist in the district. “There’s telecardiology, telepodiatry, teleoptometry… we’re breaking into this November 2011
Our mission is not only to treat vets, it’s to provide opportunities for senators, congress and staffers to learn about us and what we need for our veterans. That’s a very important part of our function. --Diane Phillips, R.N., patient-centered care coordinator at the DCVAMCs area fast, eventually moving toward telehealth in the home,” Phillips said. New initiatives are constantly under way the VA. A new iPad app has been developed that will give clinicians access to patient data anytime and anywhere. The Caisson Platoon Equine Assisted Program at Fort Myer, Va. puts wounded warriors on the backs of the same horses that pull caissons at Arlington National Cemetery. The VA also has a campaign to end homelessness among veterans, with job fairs, food drives and other specialized programs. “It’s our hope that active-duty military preparing to go back to civilian life will enroll for care and take advantage of their well-deserved VA benefits,” said Brian A. Hawkins, medical center director at DCVAMC. 11.11.11 - Advertising Supplement
DCMVAMC BY THE NUMBERS
currently
126 nursing home units 171 medical centers more than
350 clinics 84,000 veterans enrolled 660,00 annual hospital visits 14,000 veterans of recent conflict served
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Photo provided by Capturing Life's Wonder
Chaz Allen participated in the Army Ten-Mi ler, a road race in which he competed using a hand-cranked cycle in October.
Jessica’s story C Wounded warrior Chaz Allen’s wife shares her courageous battle Jessica Allen got the phone call at 8 a.m. on Jan. 22 to let her know that her husband, Staff Sergeant Chaz Allen, had been critically injured by an improvised explosive device (IED) in Afghanistan. “When they’re killed they come to your door; when they’re wounded you get a phone call,” she said. Page 8
haz had lost both his legs above the knee and had a shattered elbow. “They request that you stay in one place in case he doesn’t make it,” Jessica said. “I followed the Army rule: Prepare for the worst and pray for the best.” Jessica sent daughters, Deryn and Ryann, to play at a friend’s house. “In case things went south, I didn’t want them to be there when someone showed up at the door.” Later she got a phone call that he was stable, and 24 hours later she got to talk to him. That’s the miracle of battlefield medicine, Jessica said. Chaz had a friend who was killed by a smaller IED in 2006. “They didn’t know how to save him then. Now they do, and those medics saved his life.” “If Chaz had been injured a few years ago, he would have lost his right arm because the technology was not there yet to save it,” Jessica wrote in her blog at www.adventuresofteamallen.blogspot.com. The Allen family faced months of medical
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By Jim Mahaffie issues, questions, juggling of daily lives and uncertainty. Deryn and Ryann stayed in their Tennessee home with Jessica’s mother, while Jessica went to Washington, D.C., every week to be by Chaz’s side. “We decided not to have the girls see him with all his tubes. We made a plan to bring the girls up for spring break when he would be tube-free,” she said. When the girls asked questions about their father and the future, Jessica’s policy was to answer them truthfully. “But when they stopped asking, I stopped telling them things. The rule is to ask Mom and Dad only–not anyone else.” The Allens stayed at the Fisher House on the campus of Walter Reed Military Medical Center in Bethesda from March through August. Fisher House Foundation offers a network of homes on the grounds of major military and VA medical centers.
See RELIEF, Page 11 November 2011
A ri bbon cutting ceremony was held in August to commemorate the opening of Tranqui lity Hall, the recently constructed wounded warrior barracks at Walter Reed National Mi litary Medical Center, at Bethesda (WRNMMC).
TRANQUILITY HALL
There are 153 suits in the newly-constructed TanquilityF Hall at Walter Reed National Military Medical Center, at Bethesda (WRNMMC). The ADA compliant wounded warrior barracks provides wounded, ill and injured a two-bedroom suite that includes a kitchenette (left), a washer and dryer, and a lounge area (right) which allows outpatients a place to stay with a non-medical attendant.
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for families of recovering service people to live with their loved ones. New facilities feature evidencebased design processes that maximize a soothing and healing environment, reducing stress and positively affecting patient outcomes. Patients were moved to the new
facility over the summer, as well as to a new facility at Fort Belvoir, VA. “We will continue to provide outstanding, world-class health care to our wounded warriors, this great nation’s leaders, military members of all services and their families,” said Rear Adm. Alton L. Stocks, commander of the WRNMMC. One of Stocks’ goals is to improve clinical and administrative processes at the WRNMMC. He also said that the center would con-
tinue to do groundbreaking research to improve the lives of all service members. Besides general medicine, the new center is fully equipped to treat TBI patients and amputees. As part of beautification and alignment with the formal naval hospital, the new center will feature the history of all military medicine contributions made by members of each branch of service, Stocks said.
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“The families get a chance to get away from the hospital. It’s all about creating a safe, comfortable environment where families share a common bond,” said David Coker, president of Fisher House Foundation. “They are united in their efforts to support sick or injured loved ones and in many respects become one extended family. They share the burdens and the joys together, and that makes them stronger. We’re grateful for the opportunity to touch the lives of the Allen family and become a part of their
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“If Chaz had been injured a few years ago, he would have lost his right arm because the technology was not there yet to save it,” Jessica Allen, in her blog, Adventures of Team Allen story,” he said. When the family was together at the Fisher House, they walked daddy to and from his appointments, Jessica said. “When you’re healing, you need a place that feels
Photos provided by Capturing Life's Wonder
The Allens stayed at the new Fisher Houses at Walter Reed Bethesda during Chaz’s recovery.
like home. Chaz was able to get outside, and I had a kitchen so I got to cook for my family—I need my cornbread!” The Allens bonded with other families at the Fisher House, over dinners and cookouts. Jessica and Chaz flew back and forth between Maryland and Tennessee with the help of Fisher House Foundation’s Hero Miles program, which collects donated frequent flyer miles and uses them to bring family members to the bedside of injured service members. “I was planning on exhausting our emergency fund, but Hero Miles stepped in and I had a plane ticket every week,” Jessica said. Chaz took his first steps on March 21. He rode in the Army Ten-Miler road race in Washington, D.C., on a hand-cranked bike with Team Fisher House last month. As he recovers, the Warrior Transition Brigade has set the Allens up with an apartment in Silver Spring for when Chaz needs to be at Walter Reed. In addition to traveling to be with Chaz and managing her family, Jessica owns an accounting business and completed 120 tax
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returns for clients during tax season. Extraordinarily upbeat, she admits there have been down times. She recalls opening a closet last spring and a pair of flip-flops that belong to her husband fell out. “I just sat on the floor and cried,” she said. The Allens have shared some amazing experiences in the past year. On Deryn’s 9th birthday, she watched the movie premiere of “Dolphin Tale” at the White House with other wounded warrior families. The Allens toured Congress, where they talked to several politicians. “I told them to get up there to Walter Reed and see your boys,” Jessica said. Fans of the rock band Train, the couple renewed their wedding vows on stage at a concert in Nashville. Lead singer Pat Monahan asked Jessica to say a few words, and in return she made him cry, she said. The Allens support other families of wounded warriors. “When you get hit by that crazy blow and you’re facing all the drugs, pain and confusion, it’s so awesome to have someone help you with what’s coming next,” Jessica said.
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November 2011