Air Force Medical Research
The Air Force Office of the Surgeon General has recently issued a broad agency announcement calling for innovation and advancement in technology solutions. AF/SG ensures a quality, cost-effective, prevention-based health care continuum for 2.4 million beneficiaries worldwide and serves as the functional manager of the AFMS.
The U.S. Air Force surgeon general’s (AF/SG) mission is to develop and implement medical programs and policies that provide for the health care of active duty and retired military personnel and their family members. The office optimizes Air Force readiness potential to support national security strategies and defines and disseminates health care policy in support of the 42,000 personnel of the Air Force Medical Service (AFMS), the 20,000 members assigned to the AF Reserves and the Air National Guard, and 74 medical treatment facilities (MTFs).
In addition, AF/SG ensures a quality, cost-effective, prevention-based health care continuum for 2.4 million beneficiaries worldwide and serves as the functional manager of the AFMS. In this capacity, AF/SG advises the secretary of the Air Force and Air Force chief of staff, as well as the assistant secretary of defense for health affairs, on matters pertaining to the medical aspects of the air expeditionary force and the health of Air Force personnel. The AF/SG has the authority to commit resources worldwide for the AFMS, to make decisions affecting the delivery of medical services, and to develop plans, programs and procedures to support worldwide medical service missions.
The Office of Headquarters, U.S. Air Force Surgeon General, Modernization Directorate (HQ AF/SGR), is charged with identifying shortfalls within the current health delivery system and planning, programming, budgeting and fielding the technology and services required to surmount that shortfall.
The scope of this effort encompasses identification, exploration, demonstration and validation of new, advanced health surveillance technologies in realistic scenarios. Research program areas focus on specialized medical materiel or procedures designed to enhance force health protection, restore health, prevent casualties, and maintain a fit and healthy force.
The scope of this effort and the priorities attached to specific projects are influenced by changes in military and civilian medical science and technology, operational requirements, military threat assessments and national defense strategies. The extramural research and development program plays a vital role in the fulfillment of the objectives established by the AFMS.
To this end, the AF/SG has issued a broad agency announcement (BAA) soliciting concepts that will address the operational requirements of AFMS in meeting its responsibilities. Within this BAA there are five research areas of interest.
Health Surveillance
AFMS conducts health surveillance to protect the warfighter and its beneficiary population, utilizing diagnostic, therapeutic, and forensic science and technology. AF/SGR is currently seeking to enhance its health surveillance capabilities through the integration of advanced diagnostic platforms, patient intake devices, decision-support tools and real-time informatics for alerting and warning.
Advanced Diagnostics
The advanced diagnostics modernization effort focuses on prevention, diagnosis, treatment of endemic diseases that possess the capability to decrease military operational effectiveness, or disorders associated with trauma and/or critical illness. Endemic diseases of principal interest are infectious diseases of operational significance, particularly respiratory, infectious and diarrhea diseases caused by bacterial or viral pathogens.
Other noteworthy areas include, but are not limited to: metabolic disorders/diseases, hematological and immune systems, ophthalmology (vision correction, injury and biomarkers), traumatic brain injury, systemic inflammation (mediators, genomics, proteomics and metabonomics) associated with trauma and critical illness, and other diseases or syndromes of interest to the military medical system.
In order to implement Advanced Diagnostics into the AFMS, clinical decision support systems integrating advanced diagnostics with an inference to generate case-specific advice will be considered. Specific areas of research being sought are:
Diagnostic Platforms: The advanced diagnostics thrust area supports the development of diagnostic platforms for detection, identification and surveillance of infectious agents of military medical relevance, and the development of immunological-based and nucleic acid-based platforms as well as genomics, proteomics and metabonomics platforms pertinent to the direct and indirect agent detection, surveillance and diagnosis of systemic inflammation associated with trauma and critical illness. Other system specifications and areas of interest that will be considered for funding include: miniaturization and/or ruggedization of diagnostic platforms that can be used outside the lab or in the field (e.g., handheld-type devices); point-of-care laboratory diagnostics; robotics; and investigations to improve specimen collection, storage, shipment and/or processing techniques.
Patient Intake Devices: Patient symptoms, vital signs, history and demographic data are captured through various devices and systems before diagnostic tests can be performed. AF/SGR is looking for faster, more accurate and efficient methods to capture this data in order to speed up the time from when a patient presents themselves to a medical treatment facility, a diagnostic test is performed, and a result/notification/or alert can be sent to the appropriate health care provider and/or decision-maker. Other essential considerations include: ease-of–use, throughput, reduction of hospital staff work load, and connectivity with appropriate health care systems.
Decision support Tools: AF/SGR is seeking novel ways to infuse advanced epidemiology decision support tools (DST) with current bio surveillance systems to identify or mitigate the outbreak of naturally occurring endemic diseases and/or the covert or overt release of biological agents.
The intent of the DST thrust area is to develop a set of Web-based tools to perform a variety of analyses on health surveillance data. These tools will include data selection/filtering, data interpretation and analysis, data visualization, modeling, simulation and predictive analysis. Ultimately, DST will provide decision-quality information to commanders and health care providers, and deliver enhanced health surveillance situational awareness.
Real-time Informatics: AF/SGR is seeking to improve health surveillance situational awareness by integrating advanced diagnostics and other innovative technologies for rapid pathogen identification with relevant information systems currently in operations.
The intent of this modernization thrust area is to provide health care providers and commanders at all levels the information needed to make time-critical decisions and provide a real-time “detect to warn” capability. With the advent of real-time diagnostics, AF/SGR is looking for ways to get mission-critical health surveillance information out of the labs and into the hands of the operational decision-makers in near real-time.
Other considerations include the ability to share health surveillance data with appropriate local installations and between neighboring and regional application nodes and for national/global centers for biothreat surveillance. Data must not only interface with medical C4I network, but must be interoperable with AF C4I systems (both classified and unclassified networks). Data network should automatically receive alerts from diagnostic platform and health surveillance system, generate a plot of the hazard area, display it on the common operational picture and generate an alerting message to appropriate health care providers and operational commanders. The information system needs to reduce the time from diagnosis to warning to less than five minutes.
Therapeutics
Therapeutics research should center on population health dynamics issues. Research and development of therapeutics (ADTRP) supports studies for the development of enhanced human performance therapeutics. Studies to screen, synthesize and develop therapeutics for militarily-relevant infectious agents. Proposals dealing with novel drug delivery systems (such as sustained-release) and methods of targeting drugs (to reduce toxicity) or delivery of drugs to the active sites, elimination of cold-chain product shipment and storage requirements are desired.
Human Performance and Systems Integration
AFMS human performance research is needed in order to optimize warfighter performance in all environments, maintain warfighter orientation and awareness, and detect, prevent and mitigate effects of adverse environments and events on the human. The development of analysis aids is essential to Air Force human systems integration, as well as being applicable to human performance.
The human performance enhancement effort includes research in the areas of improved cognitive performance, contribution to sustained effectiveness during high operational tempo, operational human performance measurement, injury prevention during high-demand physical training, enhancement of human and machine interface, and enhanced battle space situational awareness. The human systems integration effort includes research into tools and methods for incorporating the human into system design and specification. This includes models of the human suitable for use by engineers to describe the human as part of the system.
This research program may be coordinated with programs funded by the Air Force Research Laboratory in the area of human effectiveness research.
Current areas of emphasis include:
- Performance optimization research on hydration, nutrition, musculoskeletal, fatigue, cognitive or fitness factors, to include improved physical and cognitive training techniques.
- Orientation and awareness to address spatial disorientation counter-measures, vision enhancement, auditory enhancement or proprioceptive enhancement issues.
- Detection, prevention and mitigation research covering human exposure and combat casualty assessment and countermeasure efforts.
- Analysis aids should include the development or application of tools, models and simulations needed to identify and quantify human effects, particularly with application to engineering disciplines to allow engineers to treat the human as part of the system.
Operational Medicine/ Investigations
AFMS operational medicine research/studies/investigations/analysis is considered in several key areas.
Occupational Toxicology
Includes a particular interest in nanoparticles and emerging technologies in the workplace (such as aptamers), new alternative fuels (e.g., Fischer-Tropsch), and fine particulate matter (desert dust).
Air Evacuation
Covering interests in the effects of air transport on pathophysiology of critical illness, effects of altitude on physiological parameters in critically ill patients, development of safe-to-fly criteria (e.g., association between end-points of resuscitation to include Hb level and qualification for flight), association between development of extremity and abdominal compartment syndrome and flight, evaluation of neurophysiological change and flight, and serum myoglobin level and risk for muscle deterioration in flight.
Product Developmental Requirements
Research and development efforts aimed at developing devices capable of supporting trauma resuscitation, patients in organ failure, wound care/healing, pain control, and infection control will be considered. These devices need to be small, light, mobile, rugged, man-portable and airworthy with primary use during flight. Specific examples include:
- Diagnostic and monitoring equipment
- Noise immune stethoscope
- Hand-held in-flight medical imaging
- Small spinal immobilization device
- Closed loop resuscitation and maintenance systems
- Medical simulation programs for training and contingency planning
- Telehealth
The scope of the Air Force telehealth program includes research, identification, exploration and demonstration of key technologies and their clinical effectiveness. Telehealth is defined as “the use of electronic information and communications technologies to provide and support health care when distance separates the participants.” The goals of this effort are to:
Reduce the medical footprint and increase medical mobility while ensuring access to essential medical expertise and support
Improve the skills and efficiency of care providers
Improve the delivery and quality of medical/surgical care for AFMS beneficiaries
Reduce bandwidth and enhance data-packaging and image compression while speeding data transmission between locations
The AF/SG has made it clear that all research involving a human being as an experimental subject will require prior informed consent of the subject. For the purpose of this BAA, this provision will not be waived.
Directed Energy
AFMS directed energy (DE) is needed to assess warfighter threats, to conduct exposure analysis and assessment, to protect warfighters and individuals from DE threats, to treat and mitigate DE injuries, and to counter-proliferate DE technologies.
Threat assessment efforts should focus on the detection and warning of DE threats in the areas of threat warning and standoff detection.
The analysis of DE threats seeks DE sensoring technologies and an analytical software package.
Human exposure analysis and assessment efforts should be centered on dosimetry and exposure reconstruction (integrating dosimetry and dose reconstruction/ modeling), sub clinical injury detection (field and clinical screening tools), and exposure modeling (intelligence-based threat modeling and post-exposure reconstructive modeling).
Human threat protection materiel solutions are sought for ocular hazard protection (protective eyewear, protective coatings for windows and cockpits, and active protection) and skin and whole body protection (protective clothing and shielding).
Treatment and mitigation of DE injuries should focus on ocular (clinical tools for retinal injuries and corneal injuries) and DE-induced burns and whole body effects (clinical tools for DE-specific burns and EM-based injuries).
DE counter-proliferation, including medical intelligence and DE-bioeffects analysis and tracking, are sought.
Special Programs
The AF/SGR is frequently directed by Congress to manage funding of research programs with specific goals and end-points for health-related issues relevant to military personnel, military dependents, veterans and the health of the American public. These research programs are generally concerned with topics relating to health care delivery; detection, diagnosis, control or eradication of specified diseases, conditions, or syndromes; data management; or other initiatives relevant to health needs, and must align with the four research areas previous described here. Funding of these areas is dependent upon Congressional direction and availability of funds. ♦