Q&A: Brigadier General Stephen L. Jones
Medical Advocate
Priority One Is Supporting the Deployed Soldiers and Their Families
Brigadier General Stephen L. Jones
U.S. Army Assistant Surgeon General
for Force Projection
Brigadier General Stephen L. Jones was born in Fort McPherson, Ga., and graduated from Vanderbilt University in 1974 and Vanderbilt University School of Medicine in 1978. He completed his training in internal medicine and cardiology at Walter Reed Army Medical Center. He earned a masters of science degree in national security studies from the National War College.
Previous assignments include command surgeon, U.S. Army Cadet Command; command surgeon, Multi-National Force-Iraq; command surgeon, Combined/Joint Civil Military Operations Task Force-Bagram, Afghanistan; commander, Blanchfield Army Community Hospital; command surgeon, United States Southern Command; medical director, TRICARE Northeast; commander, DeWitt Army Community Hospital; university physician, National Defense University; deputy commander for clinical services, Womack Army Medical Center; commander, Medical Element, Joint Task Force Bravo, Honduras; division surgeon, 25th Infantry Division (Light); director, coronary care unit, director, cardiology clinic, and assistant chief, cardiology service, Tripler Army Medical Center; and director, cardiology clinic, Walter Reed Army Medical Center.
Jones is a graduate of the U.S. Army Command and General Staff College, Armed Forces Staff College, and National War College. He is a Fellow of the American College of Cardiology, a member of the American College of Physicians, and American College of Physician Executives.
His awards and decorations include the Defense Superior Service Medal with Oak Leaf Cluster, Legion of Merit with second Oak Leaf Cluster, Bronze Star Medal with Oak Leaf Cluster, Defense Meritorious Service Medal with Oak Leaf Cluster, Meritorious Service Medal with third Oak Leaf Cluster, Joint Service Commendation Medal with Oak Leaf Cluster, Army Commendation Medal with Oak Leaf Cluster, Army Achievement Medal with Oak Leaf Cluster, Afghanistan Campaign Medal, Iraq Campaign Medal, Global War on Terrorism Service Medal, Korean Defense Service Medal, Humanitarian Service Medal, National Defense Service Medal, Joint Meritorious Unit Award with Oak Leaf Cluster, Army Superior Unit Award with Oak Leaf Cluster, Combat Medical Badge, Ranger Tab, Air Assault Badge, Parachutist Badge, and Expert Field Medical Badge.
Interviewed by MMT Editor Jeff McKaughan
Q: As you transition into the role as assistant surgeon general for force projection, what do you see as your primary goals and tasks to address in the short term?
A: My first priority will always be to support our deployed soldiers and their families. While serving in Afghanistan and Iraq, I could not have asked for more responsive support than that provided by Army Medical Department. I intend to continue that same level of effort. Implementation of the Army Medical Action Plan, our program to assist warriors in transition and their families, is one major goal.
Education of our leaders on how best to care for soldiers with traumatic brain injury and post traumatic stress disorder is another. Medical support of detainee operations remains an important mission. I will also do whatever I can to assist U.S. Army Recruiting Command and U.S. Army Cadet Command recruit and develop our future medical leaders.
Q: Do those goals and tasks change much when viewed over a longer time frame?
A: My priority of supporting soldiers and their families will not change. As we accomplish the goals I discussed and integrate these new initiatives into our daily operations, then new challenges will no doubt arise. When they do we’ll develop new goals.
Q: Force projection can have an offensive connotation to it, but it is obvious that Army medical teams can project U.S. good will into an area. What do you see as Army medicine’s role in providing health care—and I don’t necessarily mean just battle wound treatment—to local populations?
A: Army medicine has two major roles in providing health care to local populations. The first is to respond to an immediate crisis to save lives and relieve suffering. We do this both at home and abroad; the deployment of the 14th Combat Support Hospital to New Orleans after Hurricane Katrina, and of the 212th MASH to Pakistan after the devastating earthquake in 2005 are recent examples.
The second role is to develop the host nation’s capability to care for its own people. Our goal is to build capacity; not create dependence. For example, we conduct train the trainer programs rather than train individuals. We often don’t take the lead; that’s the mission of the U.S. Agency for International Development. The Army Medical Department can support the country team with subject matter expertise, logistical capabilities and a presence in the country that may be vital to reconstruction. Our focus is short term, to create the conditions that allow USAID and international aid organizations to succeed.
Q: Is it possible to break out how much of your medical capabilities in Iraq and Afghanistan are primarily focused on battlefield-type medicine and how much focuses of routine and preventative health care for the local population?
A: In both Iraq and Afghanistan the vast majority of our medical capabilities are focused on providing combat casualty care for coalition forces. At any one time however, there are likely to be more local civilian patients in our combat support hospitals than soldiers. Our soldiers truly care about the local population and will risk their lives to bring them to our hospitals for care. Iraq has a more developed medical infrastructure and requires less assistance with health care.
Our most important task is to help them improve security and their economy. Afghanistan is less developed; USAID and the military are helping to build a basic health care system that provides care to all Afghans. The goal is to have a primary care clinic within a four-hour walk of every Afghan. The medical staff of our provincial reconstruction teams are assisting provincial health directors develop their local health care systems.
Q: In general, is the move to digital health records in its current form making it easier at the lowest level of battlefield health care or is more work needed to make the systems easier to use? How deep is the use of digital records in deployed locations?
A: We are making gradual progress implementing digital health records through the Theater Medical Information Program [TMIP]. Inpatients evacuated from theater had digital records when I left Iraq last summer. This has been implemented for outpatients in some areas. Digital records have greatly improved our ability to track patients and share information. During OIF it was very difficult to keep families informed of the medical condition of casualties. Detailed information was only available after the soldier reached Landstuhl [Air Force Base], which often took several days to a week. Until then families knew only what was available through casualty assistance channels.
Both the information flow and the casualty flow had significantly improved by the time I was deployed to Iraq. Casualties reached combat support hospitals in minutes to hours and were quickly evacuated to Germany. If medically indicated they could be flown out that night; usually they were evacuated one to two days later. The Joint Patient Tracking Application [JPTA], which was developed at Landstuhl Regional Medical Center allows providers to review medical information from Combat Support Hospitals online.
This improves care by allowing providers to see detailed information on incoming casualties in advance. Just as importantly, it allows the staff at our CONUS MEDDACs to keep families informed of the care their loved ones are getting.
Q: In a related issue, do you have a way to capture data on the types of injuries that soldiers are taking to provide feedback in order to develop better body armor, hearing protection, eye protection and so on?
A: All services are actively entering casualty data into the Joint Theater Trauma Registry. The AMEDD looks not only at clinical data, but also the associated operational information reported by line units when casualties are incurred. As command surgeon for the Multi-National Force-Iraq I worked closely with the Central Command surgeon, Army’s Medical Research and Material Command, Institute of Surgical Research, Army Material Command, and the Joint Improvised Explosive Device Defeat Organization [JIEDDO].
While deployed from May 2004 through July 2006 I saw several significant improvements in body armor fielded. Among those were the advanced combat helmet, deltoid and axillary protectors [DAPS] and side SAPI plates. The armor on our vehicles was also constantly being improved. And of course casualty data was used to improve clinical care. After surgeons in our combat support hospitals noted some patients were hypothermic on arrival, hypothermia prevention kits were fielded to forward medical units.
Q: What are your views on the size and footprint of the forward surgical teams and the Level III facilities? Are they as compact as you would like them to be? Are there still equipment components that, for their individual parts, need to become smaller?
A: AMEDD combat developers have worked hard to ensure our deployed medical units have the organization, structure, capability and flexibility to provide responsive support to our warfighters. Their success was demonstrated in both Iraq and Afghanistan where the medical footprint was tailored to provide the right level of support to operational commanders.
As units change locations and the operational tempo changes, the medical footprint is able to respond as well. Forward surgical teams are vital in Afghanistan where medical evacuation from remote provincial reconstruction teams and forward operating bases can be difficult or delayed by weather. They’ve proven to be very capable, and we’re continuing our efforts to decrease their size and weight, particularly with their shelter system, anesthesia equipment and oxygen sustainment/delivery systems.
Q: Do you have a working list of technology items or devices that are making a difference in force projection health care and is there another list of things that are needed in your hands sooner rather than later?
A: Control of hemorrhage is the key to saving lives on the battlefield. The use of a tourniquet immediately rather than as a last resort to stop life threatening hemorrhage has saved hundreds if not thousands of lives in Iraq and Afghanistan. Every soldier in theater is required to carry the Combat Application Tourniquet System [CATS] at all times.
The hemostatic bandage [HemCon] is another great advance. Improved survival on the battlefield involves more than just technology; effective training at all levels is also essential. Training in self-aid/buddy aid and our combat lifesaver program keeps casualties alive until the combat medic arrives.
With the implementation of our 68W program and the tactical combat casualty care course, those combat medics are more capable than ever before. Better training in resuscitative care and surgical techniques for AMEDD providers have also contributed to the highest battlefield survival rate of any conflict in history.
Q: Much attention is on Afghanistan and Iraq but Army medicine is deployed in a variety of places around the world. Other than the obvious lack of heavy combat casualties, how would you describe those deployments?
A: The primary mission of the AMEDD on each of these deployments is to provide force health protection to our soldiers. This includes not only the provision of world-class care, but the maintenance of a healthy and fit force and prevention of disease and non-battle injuries.
We have other missions on these deployments as well. They may include humanitarian relief such as in the deployments to New Orleans and Pakistan.
Medical readiness training exercises in Latin America and Africa provide outstanding training opportunities for Reserve units and generate enormous amounts of goodwill. They are sought after by U.S. Embassy staff and are essential elements of the combatant commanders’ theater engagement strategy. Military medicine is an important tool available to the combatant commander and our national leadership. It is increasingly seen as another element of national power and a strategic asset.
Q: What are the options for training and education programs for your deployed health care providers to keep them up-to-date with current technologies, procedures and news?
A: Continuing medical education is readily available on the internet for deployed providers. The AMEDD distributes training packages on important topics such as detainee health care and combat stress control through CDs and e-mails. Regular continuing medical education seminars for all branches are effectively used in theater to quickly disseminate lessons learned. Active research is also conducted.
The Army Human Research Protection Office works closely with ARCENT and the Multi-National Corps-Iraq to ensure all research is conducted in compliance with DoD regulations and federal statutes.
Q: What role does your office play in taking care of the soldiers before they deploy to make sure that you get soldiers that are healthy and capable of carrying on the mission?
A: One of the strategic objectives in the AMEDD Balanced Scorecard is deploy healthy and fit soldiers. The AMEDD is working several initiatives in this area for both active and Reserve components. We’re phasing in the periodic health assessment as a replacement of the periodic physical. When fully implemented, the PHA will improve the focus on those areas that directly affect medical readiness.
Other programs include the post deployment health assessment and the post deployment health reassessment. The ASG(FP) has oversight for the Army’s Medical Holdover Program, a program that ensures Reserve component soldiers who become medically non-deployable while in an active duty status receive expeditious and compassionate medical treatment. Since November 2003, the Army has provided compassionate treatment to over 21,000 MHO soldiers and successfully returned over 80 percent to the Army force.
Q: Can you tell me a little bit about your people that are out there doing the job everyday? What has been the retention rate for the more highly skilled clinicians and providers, and what are you doing to improve those numbers?
A: A lot of outstanding and innovative work is being done across the AMEDD every day. We have a team of great Americans that includes military, GS and contractor staff.
We do have a shortage of physicians, nurses, dentists and behavior health specialists, but I’ve been impressed by the number of providers who have joined the Army after September 11, 2001 in order to serve their country.
Many retired physicians have also returned to active duty, some for the opportunity to deploy. To attract new providers, the Army offers the Health Professions Scholarship Program that pays tuition, books, supplies and a monthly stipend to those in certain graduate health care programs.
We’re working closely with the Department of the Army, Department of Defense, and members of Congress to improve recruiting and retention incentives. These include raising the stipend for HPSP, creating more flexibility for educational loan repayments and revising minimum service obligations for practicing civilian health care professionals who want to wear the uniform.
Q: Is there anything else you would like to add?
A: I’m looking forward to working with the DA, OTSG and MEDCOM staff to take care of soldiers and their families. ♦