Q&A: Brigadier General Timothy K. Adams

Written by Ted McKenna

Brigadier General Timothy K. Adams
Commander
Army Center for Health Promotion and
  Preventative Medicine

Adams re-entered active military service in 1986. His assignments include group veterinarian for the 7th Special Forces Group at Fort Bragg, N.C.; commander of the 100th Medical Detachment; officerin- charge of the mobile sub-team of the 483rd Medical Detachment in Dhahran, Saudi Arabia, as part of Operation Desert Storm; company commander/instructor of the 1st Special Warfare Training Group at Fort Bragg; Northern Europe Veterinary Detachment, North Germany Division; chief of the U.S. Army Medical Research Institute of Chemical Defense’s Applied Pharmacology Branch; commander of the 72nd Medical Detachment’s veterinary service, deployed in support of Operation Iraqi Freedom; chief of the Integrated Toxicology Division at the U.S. Army Medical Research Institute of Infectious Diseases; Joint Task Force Katrina staff veterinarian; deputy commander of USAMRICD; and commander of USAMRICD. Following assignment as the assistant surgeon general for force projection in October 2008, Adams assumed command of the U.S. Army Center for Health Promotion and Preventive Medicine July 7, 2009. He also serves as the 24th chief of the U.S. Army Veterinary Corps.

He is a graduate of the Army Medical Department Officer Basic and Advanced courses, Command and General Staff College, and the National War College. His awards and decorations include the Legion of Merit (with one Oak Leaf Cluster), the Bronze Star Medal (with Oak Leaf Cluster), the Meritorious Service Medal (with four Oak Leaf Clusters), the Army Commendation Medal, the Army Achievement Medal (with two Oak Leaf Clusters), the Meritorious Unit Citation, the National Defense Service Medal (two Bronze Service Stars), Southwest Asia Service Medal (three Bronze Service Stars), Global War on Terrorism Expeditionary Medal, Global War on Terrorism Service Medal, Humanitarian Service Medal, Kuwait Liberation Medal (Kingdom of Saudi Arabia) and the Kuwait Liberation Medal (Government of Kuwait).

His skill badges/tabs include the Expert Field Medical Badge, the Special Forces Tab, the Parachutist Badge, the Scuba Divers Badge, Honduran Jump Wings and the Gold German Troop Duty Proficiency Badge. He is also a member of the Order of Military Medical Merit and holds the surgeon general’s “A” Proficiency Designator for Veterinary Comparative Medicine.

Adams was interviewed by MMT Editor Ted McKenna.

Q: CHPPM works on a huge array of occupational and health hazards. Are there any affecting personnel that are particularly noteworthy at the moment?

A: It is a huge array of things. Just to give you some background first, we’re an organization of about 1,100 individuals, 650 civilian, 270 military and 250 contractor employers. We’re spread out all over the world. We have five subordinate commands: We have one in Japan; one in Germany; and three in the United States, at Fort Lewis, Wash., Fort Meade, Md., and Fort Sam Houston, Texas. We’re a multidisciplined organization. We have individuals who are experts in the areas of engineering, chemistry, physics, biology, toxicology, epidemiology, industrial hygiene, medicine, nursing, occupational physical therapy, audiology, dentistry and ophthalmology—about 50 scientific disciplines. Most of the sciences you can think of, we’ve got an expert in our organization. The missions that are predominantly in demand are involved with environmental health engineering, occupational health, toxicology, entomology, health promotion and risk assessment.

Q: Hazardous waste is an issue in Iraq right now, with how things are being disposed of.

A: Right. There are a couple of occupational and environmental health areas we are engaged with now in Iraq—the disposal of solid waste, as well as drinking water quality and air quality. These are the big ones.

Q: Because obviously people deploy in these extreme situations or foreign countries where the quality of the air or what have you isn’t good.

A: Absolutely. Especially in Iraq. They have these horrendous wind storms and one of the biggest potential hazards to human health there is particulate matter in the ambient air. This is particularly a problem when you have these seasonal sandstorms. While this isn’t expected to cause long-term health effects, it can cause respiratory irritation and make certain medical conditions, like asthma, worse.

Q: So it’s just those kinds of things that here at CHPPM you have to study what’s going on in the field and then gear your research toward.

A: Exactly. We sample, analyze, assess and then provide risk assessments and recommendations to ameliorate that. We don’t set policy; we don’t enforce policy. We are a consulting organization. A combatant commander ultimately has responsibility for these hazards in their area of operation, and to control them. We may be asked to come in, assess and provide recommendations to the combatant commander as to how to control these threats.

Q: You’re responding to things that are developing in the field, and allocating resources to look at them?

A: Exactly. We send out teams. We can send out epidemiological teams. That’s another science that we’re very heavily involved in, epidemiology, which is basically the incidence, distribution and the control of disease. We have epidemiological teams that will go out and do these assessments. Then we have industrial hygienists and also occupational health specialists who assist as well.

Q: Anything in epidemiology that’s super important right now, such as H1N1?

A: Yes, that one. H1NI certainly is being tracked. If you recall when the concerns about influenza first surfaced, it was avian influenza that was the big concern, which is H5N1. It’s been isolated in multiple countries around the world. It’s a very virulent form of influenza. Humans have contracted it, but the good news is that it’s not contagious from human to human. That’s where you get your serious pandemics, when you have a very virulent virus that is communicable among humans. H1N1 is now on the front.

Fortunately, so far it is not very virulent, but it has that capacity to spread from human to human. In addition to surveillance, CHPPM’s preventive medicine mission includes emphasizing the importance of continued preventive measures. Most important, these include getting vaccinated for both H1N1 and the seasonal flu. Then things such as, washing hands frequently with warm soap and water—alcohol-based sanitizers work well too—and being sure to sneeze into a tissue or even your sleeve if nothing else is available. If people do get sick, they should stay home and avoid contact with other sick individuals. All these actions help to reduce chances of contracting as well spreading these viruses.

Q: You’re a veterinarian so you probably have that appreciation for the origins of these viruses?

A: Yes, I am a veterinarian, absolutely. So the concern is that this thing could potentially mutate and become a virulent strain. So we monitor that. We’re on the lookout for mutated forms, virulent forms. There are tests that can be performed to actually speciate the actual virus and find out whether it’s H1N1 or any variant thereof.

Q: At MMT, we try to look at the technologies behind military medicine as much as possible. With H1N1, for example, or the other things you do, is technology helpful in terms of collecting information about surveillance of incidents of H1N1? Perhaps there’s software that helps keep track of it, for example.

A: Certainly. We don’t develop technology here, first of all. But we do try to leverage existing technology as much as possible— typically off-the-shelf technology. Often we’ll modify it or tweak it to our needs. But we have a program technology, for instance, that we share among our commands that will allow the commander to track a given project that individuals are engaged in to see where they are in execution and deliverables. This is a Microsoft capability that we call Open Project Management. We also are standing up a capability called—and this relates to suicide prevention— ABHIDE, which is the Army Behavioral Health Integrated Data Environment. This is an integrated data environment that will standardize and centralize data collection and integrate it so that it can be rapidly accessed for analysis. We can then provide the commanders the information they need on suicide risk factors and protection factors.

Q: Vice Chief of Staff [Peter] Chiarelli gave a presentation at the AUSA/Medcom Medical Symposium show recently about the suicide prevention work being done by the Army.

A: That was a good talk. He’s very engaged in suicide prevention and in fact stood up the Army suicide prevention, risk reduction and health promotion task force. The task force developed over 250 tasks addressing suicide and risk reduction and health promotion. CHPPM has been assigned several of those tasks. An integral part of that is this ABHIDE, because ABHIDE allows us to access multiple databases that have efficacy for studying suicide but currently are not integrated, so that we can use all the data. We can manipulate it, model it and crank out the information that potentially will be useful in identifying suicide risk factors and protective factors.

Q: Because there’s a lot of research collected, but it’s in different places and not correlated?

A: Right, it’s compartmentalized and fragmented. Different agencies have their own data collection capabilities, and they’re not necessarily talking to each other. Some may assess only three or four parameters, maybe demographics, medical history and a couple more. Then yet another database may assess three or four other parameters. It’d be nice to have them all integrated, so that we can manipulate the data. Say someone says, ‘I wonder whether religion is a factor in suicide?’ Well, then we can assess that to see if there’s a correlation between, say, religions, or marriage or failed relationships. A lot of this we know already. There are some very strong risk factors that have been identified. But it’s not giving us what we need to come up with the protective factors that will reduce suicide.

Q: Is ABHIDE different from another new program at CHPPM, the Behavioral and Social Health Outcomes Program?

A: That program is the program that the ABHIDE initiative falls within. Our mission is basically to identify, assess and counter environmental, occupational disease and injury threats to health, fitness and readiness in support of Army missions and the national defense strategy. So we do occupational, environmental and disease surveillance in general—zoonotic and non-zoonotic disease, which mean those transmitted from animals to humans, and those just human to human—and also injury prevention. Certainly, behavioral health is going to be part of our mission. The BSHOP— that’s the acronym, Behavioral and Social Health Outcomes Program—is in charge of standing up the ABHIDE capability.

Q: And then there is also something called the Public Health Command that you are standing up? What is that exactly?

A: CHPPM has been around for a while, in some form or fashion. It hasn’t always been called CHPPM. It used to be called Army Environmental Hygiene Agency, and then even before that it was called something else, the Army Industrial Hygiene Laboratory. It started right after World War II. They’ve done preventive medicine and health promotion [for a long time]. But also out there we have a veterinary component, and in the Army, the veterinarians are in large part involved with public health. The biggest part of our veterinary mission is food.

Q: The logistics of providing food?

A: Food safety, hygiene and quality assurance, and also now food defense, now that there is the terrorist threat that predominantly was not out there before. So the difference between our old mission, which is still an enduring mission—food safety, hygiene, and quality assurance, and now food defense—the difference is the threat. One is an unintentional threat, and one is an intentional threat. It’s all public health preventive medicine. The Army surgeon general, as part of a larger Medcom reorganization, saw potential for merging these two organizations and their respective public health missions into one command. He had a lengthy analysis of seven or eight months’ worth, and the suggestion was that a public health command was a viable option. Then he further requested viable courses of action to pursue and came up with a single course of action that he announced July 17 in a warning order that there would be a public health command, with the core command [resulting from] the integration of the veterinary command, Vetcom, and CHPPM, and [with] certain select assets of Vetcom realigned to the medical treatment facilities that are commanded and controlled by the regional medical commands. However, the Public Health Command would retain the sole responsibility and accountability for all public health-relevant missions for the Army, in an effort to restore, improve and sustain health across the force.

So the key is a single point of responsibility and accountability for public health missions, with an end state to be an integrated public health team that will protect and enhance health.

Q: Because previously it was scattered among different commands?

A: Yes. I saw the end state and the intent, and for my folks, to add more clarity, offered a restated end state for our purposes. That is, an organization with integrated, synchronized and standardized best practices to assure optimal delivery of public health. We’re integrating both commands. We’re going to synchronize the execution and implementation of public health delivery, and it will be standardized best practices. Right now we have six different regions in Medcom, with preventive medicine assets in all of them—some of them owned by the medical treatment facility commanders, some of them not owned by the medical treatment facility commanders. Some of them are provided by CHPPM; some of them are provided by those locally owned assets, so they are disparate as far as the command and control goes, and how they are utilized is not standardized. You may have an audiology program here that is totally different from one over here, and prioritizations aren’t necessarily standardized. The hope is to seek best practices and then standardize that across the enterprise.

Q: In the medical world, there’s always an emphasis on collaboration. Is CHPPM working much toward integrating and sharing information with private industry, academic institutions and others?

A: We certainly collaborate. We’re often consulted by other agencies within DoD, the federal government and academia. We have provided services for the other military services. Even though we are not technically a joint organization, by the classic definition, we serve all services, and we are the public health command for the Army. There is also public health capability within the other services, but I would say probably not as robust as CHPPM’s capabilities and capacity. Who knows, though? Maybe down the road there will be a joint public health command.

Q: There’s a trend in the DoD for joint operations in general, correct?

A: Exactly. They have the joint task force CapMed, which is integrating medical treatment capabilities for the National Capital Region. They’re doing something similar out in San Antonio. We have a joint program within CHPPM. It’s our Tri-Service Vision Conservation and Readiness Program. Currently, it’s being led by a Navy optometrist who is assigned to CHPPM. It has been very successful. This is with the Army, Navy and Air Force participating. Again, I think it’s exciting in that it can serve as the model, and more exciting than that, even, it can serve as a model for public health. Because in public health and preventive medicine, we all know that an ounce of prevention is worth a pound of cure. But it’s never really the focus, the paradigm. The medical health care system has never really been focused that way.

Q: It’s usually an afterthought.

A: It’s usually treatment-focused. Here, we can sort of change the paradigm from one of a “sick” health system—in other words, where we treat illnesses and sickness—to one that promotes health and prevents sickness.

Q: Any other points you’d emphasize?

A: Just to close the loop on the public health command—because it is breaking news for the military, and there’s a lot of interest in it from the other services as well—the warning order went out July 17. It’s going to be a phased process. There are three important dates for the implementation, the first being October of this year. We should be a provisional command no later than that. Then we’ll have initial operating capability no later than October 2010, then full operating capability no later than October 2011. Right now, as part of the warning order, CHPPM has been charged—me specifically, to form and to lead a transition team that will do an in-depth analysis that will generate the concept plan for implementation. The concept plan will describe the missions, the role’s responsibilities and policies that will need to be implemented for this Public Health Command. Right now we have a draft charter that will be approved soon. A transition team will stand up by the end of this month and start doing the analyses that will look at organizational structure and operational capabilities to best align these assets to give functional capabilities to the command that will optimize mission success. It’s a big task because we’re scattered all over the world, and then Vetcom is also scattered all over the world. Vetcom engages in 83 different countries in some capacity or another, because food sources are often where we operate.

Q: Because food often comes from animals, so you’d naturally be dealing with animal care wherever you’re deployed.

A: We’re all over the world operationally, and we like to provide our soldiers with Class A rations—Class A rations being fresh food or prepared food rather than MREs [meals ready to eat] or something like that.

Q: So Vetcom is really important to operations.

A: They’re hugely important. They are the USDA overseas, because we don’t have a USDA to inspect in, say, Jakarta, or places like that. With the new Public Health Command, the animal care piece is going to [be overseen by the] military medical treatment facilities [MTFs]. They’ll have command and control of those personnel, and they will execute that part of the mission, though we will still retain oversight of all public health. There are benefits to doing that: personnel might be better looked after if they were assigned locally. Then they would have the advantage of the camaraderie, and the sense of community, the enhanced training capabilities and capacities that are afforded locally.

So there were some good reasons for doing that. Plus it generates a shared interest in a common mission. Those MTF commanders are going to not only own those soldiers, but they’re going to be responsible for the execution of that mission that those soldiers are there for. We too will have that same obligation to make sure the integrity of that mission is maintained.

The vet mission is quite large, and it’s often generated at often DoD level or even from other organizations. It’s executed, though, by these level 1 and 2 assets that we talk about that are actually at the installations, or by deployed units as well. We have combat service support units with veterinary assets in them too that deploy to, say, Iraq or Afghanistan, and they do food inspection as well, and quality assurance.

Most of our vets are predominantly military. That’s another synergy that we have—we’ll be taking a predominantly military organization and merging it with one that’s predominantly civilian, so I think you’ll get a synergy there, and also some cross pollination and subject-matter expertise.

I told you I’d talk about that we’re doing in theater. We’re involved in the assessment of the trash burning over there. We’re providing the teams and doing analyses over there; apparently there’s going to be another requirement generated fairly soon.

Q: Yes, it seems that with every war, there’s a lingering health care issue—Agent Orange in Vietnam, Gulf War Syndrome in Operation Desert Storm. Is the trash burning issue in this war going to lead to some sort of chronic condition?

A: Well, certainly trash burning has been going on a long time. I don’t want to minimize it, but breathing byproducts of combustion is just not good period, whether it’s out of your fireplace or whether it’s at a burn pit. It’s all about exposure and time, and if you’re exposed for a long time and at a high concentration, it can have short-term health effects. So we’re assisting the COCOM [combatant commander], who has ultimate responsibility for these hazards. It’s the COCOM’s responsibility to assure identification, assessment and amelioration or countering of these hazards. We assist in a consultative fashion to let them know what the risk is. We provide the risk analysis; we provide the recommendation. We’re doing that with the burn pits, and we’ve done it with the fires as well. We’re also doing particulate matter studies. That’s what you get when you’re burning stuff; you’re getting particulate matter being generated and gases.

Q: It exacerbates conditions that are already over there.

A: And it depends what you’re burning, too, obviously. You can burn things that are extremely noxious. There are guidelines and procedures to be followed as to what you burn, where you burn it, how you burn it, stand off distances, depth of the pits—things like that. We will be continually engaged in to help assure that it’s being handled appropriately. There is also the Qarmat Ali [investigation]. We did a study of an industrial water treatment facility, where there was concern about chemicals.

What happened was the place got overrun and looted, and they ran around and just sort of took what they wanted and destroyed part of the infrastructure. Incident to that, these bags of sodium dichromate were broken open and allowed to be blown into the ambient air. Sodium dichromate is actually used as an anti-corrosive that they run through the pipes so they don’t rust.

This was not in soluble form; it was in what were like cement bags, and troops were placed in the area to secure the area. There was a question as to exposure, and levels of exposure and potential health risks. There was a contractor involved with this, a civilian contractor that ran the operation there. They were augmented with security forces who were also potentially exposed. They had us come in quite some time after the fact, to do an assessment and determine whether there was a reasonable health risk to individuals in the area. They did environmental air sampling, and we also followed up with blood sampling. There’s not a lot you can do to assess levels of that in the body, short of a post-mortem, other than red blood cell levels. You’ll probably see more about that; CHPPM will continue to stay engaged.

Q: Since you just started recently, given all the work that goes on here, how do you get up to speed on the research and other activities? How do you get on top of the work that’s going on here?

A: Well, you go to a lot of briefings, and no, I’m not even close yet. I just got here July 7, and I was on a plane the next day and was gone almost the entire month. Out of the two months I’ve been here, I’ve probably been gone a month and a half. The way I like to do it, and the way we’re proceeding, is to visit each directorate. We have eight directorates that span those areas of expertise I mentioned earlier. They do a full laydown of what their mission is and their personnel. It is a huge mission. The capabilities here are huge, and it takes a while to get a handle on it. Some will say you never do totally get a handle on it.

Q: And you just got here and they’re having you rearrange things already.

A: Yes. But when you look at all those sciences, it’s almost impossible to master it all. What I hope to do is to know who to go to, and how to get stuff done, when these requests for services come in. The other thing we should mention is we provide products, too, and we are engaged in risk communication to the force. We have over 250 products that are available; we send out close to 150,000 items a week, health education kinds of things. The e-catalog was added in October of last year. Items in highest demand are information in the area of suicide prevention, H1N1 prevention and the prevention of heat injuries. Those are the three biggest areas, though we certainly do other things as well.

We serve not only the operational community, but the Army community and garrison as well, here in stateside and Germany and places like that, as well as in the field. Although we’re not technically what you’d call a combat service support unit, what you’d expect to deploy, we do a lot of deploying. We go all over the world, to around 80 different countries. Last year I think our deployment man-days was 1,500. We’ll do environmental assessment—what is the soil like, the insects—that’s all part of the assessment we make. In the beginning of this war, you may have heard about problems with soldiers coming back with leishmaniasis, which is a parasite that you can get over there by the sand fly. The bug is the sand fly that passes along the leishmaniasis, and you get this open, nasty looking lesion. Leishmania, it’s called. So that’s what we do: from bugs to bottled water, you could say. ♦

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