Ripple Effect
Written by Commander Eric Hall and Captain J. Christopher Daniel
As such, research at the Naval Medical Research Center (NMRC) focuses on finding solutions both to conventional medical problems on the battlefield, such as bleeding, and non-conventional weapons, such as thermobaric blast, biological agents and radiation. Overall, the mission of NMRC’s more than 1,500 employees at the Silver Spring, Md., headquarters and at its laboratories around the world is to conduct research, development, testing and evaluation to enhance the health, safety and readiness of Navy and Marine Corps personnel in peacetime and contingency operations.
More specifically, the center’s research covers infectious diseases, biological warfare defense, directed energy bioeffects, combat casualty care, dental, environmental health, bone marrow transplantation, aerospace and undersea medicine, medical modeling, simulation and mission support, warfighter performance, epidemiology and behavioral sciences.
In addition to being a research and development facility in its own right, NMRC is currently the headquarters for nine subordinate Navy medical research and development laboratories. Six are in the United States: the Naval Health Research Center in San Diego; the Naval Submarine Medical Research Laboratory in Groton, Conn.; the Naval Medical Research Detachment in Great Lakes, Ill. (formerly Naval Institute for Dental and Biomedical Research); the Naval Medical Research Unit in San Antonio (formerly Directed Energy Bioeffects Laboratory); the Naval Aerospace Medical Research Laboratory in Pensacola, Fla.; and the Environmental Health Effects Laboratory in Dayton, Ohio. Three of the labs are overseas: in Cairo, Egypt; Jakarta, Indonesia; and Lima, Peru.
EMERGING THREATS
At the overseas laboratories and in the respiratory diseases program at the Naval Health Research Center, the NMRC assists in worldwide monitoring of new emerging infectious diseases such as avian influenza, SARS and the recent 2009 H1N1 influenza outbreak. Research by these labs helps, among other things, inform vaccine development efforts for malaria, dengue fever and diarrheal diseases. Field trials of diagnostics tests, vaccines and drugs include, for example, studies conducted in Papua, Indonesia, that contributed to the FDA approval of a drug with the trade name Malarone, for combating a particular type of malaria.
These laboratories also support international military-to-military collaborations and public health capacity-building efforts. A prime example of that was the center’s support in the worldwide response to the 2004 tsunami in Banda Aceh, Indonesia, and the more recent earthquakes in central Java and in Peru.
The Biological Defense Research Directorate (BDRD) at NMRC has five primary areas of focus: immunodiagnostics, molecular diagnostics, medical countermeasures development, genomics research and operations. One of BDRD’s best-known achievements is the development of handheld assays to detect the presence of biothreat agents. These assays are widely used not only within Department of Defense and U.S. federal agencies but also internationally.
Working together, the immunodiagnostics and molecular diagnostics departments have developed over 24 paired assays to detect the agents currently considered to pose the most significant threats to U.S. military forces. Ten of these assays have been transitioned to the DoD Joint Program Executive Office for Chemical Biological Medical Systems (JPEO-CBMS) Critical Reagents Program (CRP), which mass produces the tests for use throughout DoD. Additionally, BDRD functions as the antibody conformance testing laboratory for the CRP. BDRD and CRP also collaborate to stockpile antibodies for DoD.
Most notably, BDRD outfits the Navy and Marine Corps with biothreat agent field testing capabilities, trains personnel in biological warfare detection, and provides subject matter expertise. In 1995, the directorate developed the first portable laboratory capable of molecular detection, enabling military personnel in the field to quickly conduct confirmatory assays to detect the presence of biological agents.
BDRD’s medical countermeasures department, meanwhile, engages in research involving new vaccine delivery systems, DNAbased vaccines and therapies for pre-exposure protection, human monoclonal antibodies for post-exposure therapy, and innate immune agonists. The group is working to produce multi-agent vaccines by combining vaccine targets and conducts research aimed at stimulating a broadly protective innate immune response against biothreat agents.
COMBAT CARE
The combat casualty care directorate at NMRC consists of three departments: trauma and resuscitative medicine, undersea medicine and regenerative medicine. The trauma and resuscitative medicine department conducts research on a variety of topics pertinent to the protection, care and resuscitation of combat casualties, primarily those occurring in austere circumstances with anticipated delay to definitive care. The undersea medicine department conducts biomedical and clinical research and development to identify ways to further increase the safety and improve operational capabilities of explosive ordinance disposal, salvage and husbandry divers, as well as submariners and U.S. Navy SEALs. The Regenerative Medicine Department specializes in developing treatment strategies for traumatic combat injuries and assessing technologies to improve the engraftment of transplanted tissue.
Maintaining and enhancing human performance to support military operational missions has been a long-standing area of Navy medical research and development, including efforts to prevent the onset of illness or degradation of readiness in the extreme environments of heat, cold and lack of oxygen.
An example of this type of research, a reduced oxygen breathing device developed at Naval Aerospace Medical Research Laboratory, has been used in dozens of research projects and is currently used for hypoxia refresher training for Naval aviation personnel. Additionally, Navy researchers are the leaders in research on the prevention and treatment of decompression sickness, and the laboratory in Great Lakes has been a national leader in dental mercury abatement, having developed a process that removes 99 percent of the mercury from dental wastewater.
Navy Medicine takes a lead role in full-scale exercises that test the equipment, procedures and other factors that can result in greater survivorship in a disabled submarine. Much of the information learned from these exercises is reflected in the Naval Sea Systems Command Technical Manual, for which the Naval Submarine Medical Research Laboratory develops the medical component. Likewise, motion maladaptation syndromes and other vestibular-related conditions can adversely affect operational performance, and a whole range of countermeasures— including tactical decision aids for operations involving real or apparent motion, down-time recommendations and pharmacological measures—have been developed to deal with these sorts of conditions.
The Naval Health Research Center (NHRC) has the lead in epidemiologic studies spanning the entire careers of military personnel. With the development of combined career history and medical databases, many studies are being conducted on the relationship of deployments, occupation and other factors to disease and injury. A major effort in this regard is the Millennium Cohort Study that NHRC established for DoD. The largest longitudinal study ever conducted in the military, it follows 150,000 deployed personnel for a period of over 20 years to ascertain the occurrence of health outcomes.
EXPEDITIONARY MEDICINE
At Navy Medicine’s Acquisition Program, there is an increased attention to portfolio management and programmatic development. Current efforts in expeditionary medicine cover Navy operations in terrestrial, surface, submarine and aviation environments and the USMC in expeditionary operations. With Navy Medicine providing medical care, force health protection and health services support to the Marine Corps, many of the major products developed in the program are based on USMC requirements.
In the clinical care portfolio, the largest and most complex effort is the Navy’s wound management program. In collaboration with surgeons from the National Naval Medical Center and the Walter Reed Army Medical Center, the program has made significant progress toward providing definitive wound closure guidelines. The unique nature and extent of war wounds mandates comprehensive approaches to management. Using biological markers from the wound and from the blood, an advanced statistical model is applied that provides guidance to the surgeon that the wound will not require further surgical intervention and is truly ready for closure. This effort will result in a substantial reduction in MTF resources, shorter hospital stay times and an earlier return to rehabilitation and duty for servicemembers.
The wound management program also has resulted in a refocused attention on the role of heterotopic ossification (HO), which is abnormal bone formation, often in soft tissue in war wounds. Combat wounded are far more likely to show HO, particularly in those suffering a traumatic brain injury. The resulting bone formation can impede recovery and affect rehabilitation.
NMRC participates actively in the U.S. and international scientific community, making hundreds of presentations and patent applications each year and frequently winning acceptance for articles in the world’s leading peer-reviewed scientific journals. Its entrepreneurial spirit is considered essential, not least because NMRC is not a direct Navy-funded enterprise. It receives the vast majority of its funding on a competitive basis, with reimbursement from various sources both within and outside DoD. In sum, with its network of laboratories, NMRC aims to steer its research toward results that are operationally relevant and help address whatever may be the next big thing of the future. ♦
Commander Eric Hall, Ph.D., is a public affairs officer and director of administration at the Naval Medical Research Center in Silver Spring, Md. Captain J. Christopher Daniel, M.D., is the center’s commanding officer.