Q&A: Colonel W. Bryan Gamble
Written by Jeff McKaughan
Ensuring the Best Care in
Direct Support of the GWOT
Colonel W. Bryan Gamble
Command Surgeon
U.S. Central Command
Gamble was born in North Carolina and raised in Connecticut. Graduating in 1978 from Penn State University with degrees in food science and pre-medicine, he then entered the Army through the Health Professions Scholarship Program. He graduated from Jefferson Medical College in 1982 with a Doctorate of Medicine and completed a residency in general surgery at Saint Elizabeth’s Hospital of Boston from 1982 to 1987.
Gamble’s first assignment was as a general surgeon at Bassett Army Community Hospital in 1987. In 1989, he began training in plastic and reconstructive surgery at Walter Reed Army Medical Center. During training he deployed with the 85th Evacuation Hospital for the Gulf War. Upon completion of his fellowship, Gamble joined the teaching staff at Walter Reed and was named assistant professor of surgery at the Uniformed Services University of the Health Sciences, and appointed consultant at the National Institutes of Health/ National Cancer Institute. His next assignment was as deputy commander for clinical services at the U.S. Army Aeromedical Center, Fort Rucker. From 1995 to 2002 he served as consultant to the Army surgeon general for plastic and reconstructive surgery. While at USAAMC, Gamble deployed in support of the Bosnian and Macedonian missions, training medics in the use of telemedicine. In 1997, Gamble served as division surgeon, 3rd Infantry Division (Mechanized), deploying for Bright Star and Intrinsic Action missions. In 1999, he served the assistant secretary of Defense for Health Affairs as medical director/director of Clinical Operations for the TRICARE Management Activity. Assigned in 2000 as command surgeon at the National Defense University, Fort McNair, he subsequently attended the Industrial College of the Armed Forces and earned a Master of Science in national resource strategy. In 2002, he assumed command of MEDDAC-AK at Fort Wainwright, Alaska. Upon completion, Gamble was assigned to the assistant secretary of the Army for Manpower and Reserve Affairs as the assistant deputy for Health Policy. In 2005 he then took command of Landstuhl Regional Medical Center, serving the EUCOM region and as the primary receiving hospital for casualties from the CENTCOM AOR.
Gamble has attended the AMEDD Advance Course, Command and General Staff College and Senior Service College. He is entitled to wear both the Flight Surgeon and the Expert Field Medical Badges. Gamble has earned board certification in both general surgery and plastic surgery.
Gamble was interviewed by MMT Editor Jeff McKaughan.
Q: Good morning, Colonel Gamble. Could we start with an overview of what your role as CENTCOM command surgeon is and what your command looks like over the entire AOR?
A: In short, I serve as senior medical adviser and special staff principal for commander of USCENTCOM. My office plans, directs and oversees all joint and coalition health service support activities for the U.S. and coalition forces in the 20 countries of USCENTCOM, from Egypt through the Levant and Arabian Gulf to Central and South Asia. I serve as the Combined Forces command surgeon for Operations Enduring and Iraqi Freedom, leading medical planning in conjunction with the five subordinate component commands. We synchronize medical support by integrating coalition, DoD, Joint Staff, DOS, interagency and service components to achieve unity of effort and synergy. My office also leads the CENTCOM Medical Security Cooperation and Health Engagement Programs. Through these programs we leverage governmental and nongovernmental organizations to achieve international cooperation and collaboration to facilitate improved health care capability, capacity and regional stability in support of both our command and the national security strategy.
Q: What equipment items would be at the top of your want list, in particular items that would serve the most good further forward toward the point of casualty?
A: Our medical community has worked hard to ensure our troops have access to the best and most advanced medical supplies and equipment available. There are no want lists, but I can provide examples of what has been most valuable. The best device developed and fielded to all soldiers and medics has been the combat application tourniquet. Next would be the development and utilization of the hemostatic dressings, which have evolved into a second bandage that will better re-solve non-compressible hemorrhage cases. The wound-vac has also been instrumental in enhancing the clinical outcomes of many of our complex wound, burn and amputee cases. Additionally, the implementation and utilization of airworthy pain pumps during medical evacuation missions have drastically improved pain management for casualties while en route to definitive care hospitals either in Germany or the U.S. Lastly, development and fielding of an MRAP ambulance also enhances medical support and capability presence for our Army formations while conducting combat patrols.
Q: Can you describe how a medic or caregiver at a forward location can make suggestions either in equipment needs or techniques and ensure that those suggestions are heard and considered?
A: Multiple avenues are available to communicate innovations and adjustments. First, weekly VTC trauma conferences are held that connect all levels of care from the field units to the VA facilities. Input from the attendees help to formulate and/or revise clinical practice guidelines and training packages. The establishment of the Joint Theater Trauma Registry and System with forward-based elements feeds my office and the entire MHS near real-time data on those hurt so that we can proactively adjust care assets as required. Frequent visits to the theaters and the facilities engaged in caring for our warriors helps to keep my office engaged in the successes and issues as experienced by those on the ground. We get feedback via the chain of command and service component HQs from what they see and hear from their venue as well as through extensive lessons learned/hot washes conducted by units upon return to home station.
Q: Are there ways to make improved use of telemedicine capabilities and medical video conferencing?
A: We are making strides forward as telemedicine applications continue to advance, especially with radiology studies as connectivity improves. It must be remembered that telemedicine and video conferencing travel on a tight bandwidth pipeline with many other competing demands. We have recently received approval and are moving ahead with implementing a joint operational urgent needs request for dedicated medical bandwidth. This should be fully functional by late spring–early summer 2009.
Q: Especially in Iraq and Afghanistan, does the U.S. military medical system have a role to assist and train the Iraqi and Afghan military medical corps? Similarly, do you have much interaction with the local civilian medical agencies?
A: Yes, absolutely. In both Iraq and Afghanistan we have a command surgeon and staff as integral components of the respective security transition commands [MNSTC-I and CSTC-A]. The command surgeon has sole responsibility for developing a health system to support members of the security forces and their dependents. At this level they work primarily with the leadership of the respective military health system and work collaboratively to design programs that will build capacity. Our embedded training teams [EET] is one tool utilized to provide direct contact, training and mentoring of both Iraqi and Afghan medical personnel. Additionally our deployed combat support forces search for opportunities to interact with their local counterparts to both build relationships, and, more importantly, to build capacity into the local systems. With respect to my opportunities to interact with local civilian agencies, as the CENTCOM command surgeon I meet with senior health leaders as I travel in Iraq and Afghanistan. I use these meetings to get a feel for the progress that our forces are making, and also to determine how I—and my staff—can best support the efforts of our deployed forces.
Q: What have been some of the best lessons learned on the medical logistics side of things?
A: Some of the best lessons learned have been the effective doctrinal implementation and utilization of both a single integrated medical logistics manager as well as the appointment of a theater lead agent for medical materiel in order to have a lead organization with a focus on tactical and operational medical logistics issues. This allows our medical experts to maintain a unique balancing act where we have ensured that the medical logistics systems and processes remain accountable and assigned to the medical community, not the line logistics organizations and operations, while still remaining intimately connected with these structures in order to effectively and efficiently utilize the theater distribution network and assets. ♦