CRCC - COMPREHENSIVE WARRIOR CARE

AUGUST, 2011

Concussion Restoration Care Center

Hail and Farewell:
Out with the old, In with the new!
MESSAGE FROM THE OIC Hello all. Well, its just about over and I cannot believe it! The new team is taking over and we are winding down, getting ready to come home. Before I get ahead of myself I did want to introduce a new member of the team, LTJG Valentin Chapa who contributed this last month to clinic functions of patient flow, Data Base Quality Assurance and direct patient care. most caring and professional people that I have ever met. I am truly humbled to have had the pleasure of working with these folks. Over the last few months the war has seen times of both increased and very low kinetics. I have to admit, this is the only place that I like it being NOT busy! Our Hero segment will focus on a Marine who radiates Honor, Courage and This last edition will introduce the Commitment. We were all blessed to new CRCC team. I can testify that they know him. are both enthusiastic and motivated to I hope these newsletters have given continue the privilege of caring for these you a better understanding of what is awesome Warriors. going on in the world of Navy Medicine, This last month, yet another VIP and describes how we are doing our part toured the facility: General Chiarelli, the in the war. This tour has been a privilege Vice Chief of Staff for the Army, who and honor. brought an Army team to see how we do Enjoy and God Bless business. His team included Major Earl Frantz, DO General Horoho, Brigadier General CDR, MC, USN Thomas and General (RET) Franks. This was a very unique visit, because after the tour we had a three hour discussion on how we do business. They concluded that the multi-disciplinary approach we use is extremely effective and worth duplicating in other areas of operation. I couldnt agree more, however having a great model of care is the smaller part of our success. The real foundation to the success of the CRCC is the people who work here. This team is made up of the

In this Issue
Letter from the OIC Hail and Farewell Stories from our Heroes The CRCC Research Program

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CRCC - COMPREHENSIVE WARRIOR CARE

HAIL AND FAREWELL The concussion restoration Care Center has performed admirably, but it could not have done so without the help, perseverance, and dedication over the past 7 months of the following people: CDR Earl Frantz, Officer In Charge; CAPT Judy Schauer, Sports Medicine physician; CDR Rick Sams, Family Practice physician; CDR Walt LaBrie, Psychologist; LCDR Katie Ditto, Occupational Therapist; LCDR Rachel Oden, Physical Therapist; LT Mike Okasinski, Psychiatrist; LCDR Dan Clark, clinic manager; LTJG Valentin Chapa, Case Manager; LT Jake Norris, Research Psychologist; HM1 Jason McGee, Leading Petty Officer (LPO); HM2 Jonathan Huffman, Assistant LPO; and the following staff corpsman: HM2 Alvin Jules, HM3 Woodberry, HM3 John Tissier, HN Stephen Roach, HA Josiah Garcia, HN Jack Underwood, and HN John Prolo. The people listed above were part of building a clinic that established the most comprehensive collection of data for battlefield concussions in any US war. The work done there helped hundreds of Marines, Sailors, and Soldiers and was noted by the highest levels of the US Military. It evolved from a small clinic in a cramped wooden building to a center of excellence for concussion and musculoskeletal management on the front lines of war. The outcome of everyones hard work may not be seen for several years; but for that they built and populated a database of information that military researchers will pour through for years. No doubt, the CRCC will continue to evolve in function and doctrine. Further advances will be the result of hard work from the incoming group of Navy Medicine warriors: CDR Peter Lundblad, Sports Medicine Physician; CDR David Stevens, Family Practice Physician; LCDR Trent Marcus, Family Practice Physician; LT Daniel Houlihan, Occupational Therapist; LCDR Bryn Bost, Physical Therapist; LCDR Victor Ruterbusch, Psychiatrist; LT Jacob Kuriakose, Psychiatrist; LT Scottie Knox, Psychologist; LT Claudia Rojas, Psychologist; LT Erin McKee Psychologist; LT Lisa Dobison, Senior Nurse; LT Cindy Porcadas, Staff Nurse; LTJG Lola Lakin, Staff Nurse; LT Jake Norris, Research Psychologist; MAJ Melinda Eaton, USAF, Research Psychologist; HM1 Gideon Kain, Leading Petty Officer (LPO); and the following staff corpsman: HM1 Joseph McDaniel, HM1 Francis Santarina, HM2 Drew Kastelic, HM2 Chad Chartier, HM3 Joseph Fountaine, HM3 Brian Bernstein, HM3 Rashad McKenzie, HM3 Ernest Harris, HN Samuel Malone, HN David Williams, and HN Gregory Tramble. Dan Clark LCDR,NC,USN

AUGUST, 2011

Alpha Surgical Company, Camp Leatherneck

Alpha Surgical Company, Camp Leatherneck

Bravo Surgical Company, Camp Leatherneck

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CRCC - COMPREHENSIVE WARRIOR CARE

STORIES FROM OUR HEROES Caring for these warriors over the last 6 months has been the highlight of my career. I can think of no other patient interaction that typified my experience than an appointment I had a week ago. When the Marine Sergeant walked into my exam room, the dried blood on his face made it evident that he had recently been in battle. Despite my seeing hundreds of concussed patients, his demeanor and composure surprised me. Normally when we see a warrior just coming out of battle they are frequently withdrawn and visibly troubled. Though he appeared concussed processing his thoughts a bit slower than usual he had an uncanny focus and a resolve. He recounted his story to me in detail. Just 16 hours before our meeting, he was a leading his sniper team on a combat patrol. His best friend was walking in front of him when it happened. The Sergeant felt like someone threw him to the ground and his vision immediately blurred. As he scrambled to his knees live rounds were landing close by, and his friend called for help. Although dazed and unable to see clearly, he realized his brother in arms had stepped on an IED. He directed his squad to take cover and called in an airlift request. The Navy Corpsmen applied a tourniquet to his comrades upper thigh, and they both were taken to a landing zone. While waiting for the arrival of the air evacuation helicopter, he held his best friends hand. Befitting of true warriors, they laughed together because his friend lost only one leg; his genitals affectionately referred to as my junk by injured Marines went unscathed. In route to the combat hospital, the medic flushed the Sergeants eyes. He was then able to see clearly, and for the first time he looked down at his best friend and saw him in a sleep-like state. As his eyes panned down, he felt sick, seeing a mangled left leg with exposed bone and flesh. The right leg was visibly deformed, contorted into the shape of the letter L. When they arrived at the hospital, the Sergeant was admitted to the ward, and his friend was taken immediately to the operating room. Ten hours later he said good-bye to his friend who was evacuated to Germany. Just 16 hours from his injury, this battle weary, sleep deprived Marine Corps Sergeant walked into my life. After recounting the story, he looked me straight in the eye and said, Doc, I only have two requests. This was odd but intriguing. My experience told me that he would want to have a certain medicine, perhaps a phone call or a place to sleep. What he requested both inspired and challenged me. He first asked that I get him back to his men as soon as possible. Semper Fidelis always faithful - is the Marine Corps motto. His second request: Please set me up with someone to talk to so that I am not a jerk to my wife and kids when I get home. Im sure this young enlisted Marine wasnt familiar with the research linking chronic physical and psychological disability to Post Traumatic Stress Disorder. I am also confident he didnt know

AUGUST, 2011
that a joint Navy Medicine and Marine Corps endeavor created the CRCC to bring a multidisciplinary model of care to the concussed warrior. What he did know was that he had seen horrific things, was under a great deal of stress, and he needed help. Over the next week this warrior was treated for concussion, combat stress, emotional scars and musculoskeletal injuries. He saw a physical therapist, a chaplain, a family physician and a clinical psychologist all under one roof. When he left to go back to the battle, he was still bruised in both body and spirit. Bruised but not broken, prepared to give to his band of brothers and to his family in the way that he so passionately desired. I am optimistic that this Marine Sergeant will do well. Treating the battle weary concussed warrior in theater will hopefully protect him from future emotional and physical disability. It is our hope and prayer at the concussion center that by giving these heroes the help and tools they need, we are treating not only their mild traumatic brain injury, we are effectively treating their traumatic mind injury. Earl Frantz CDR,MC,USN

Doc, I only have two requests: . . .get me back to my men and please set me up with someone to talk to so that I am not a jerk to my wife and kids when I get home.

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CRCC - COMPREHENSIVE WARRIOR CARE

CRCC RESEARCH PROGRAM
The most exciting phrase to hear in science, the one that heralds the most discoveries, is not "Eureka!" (I found it!) but "That's funny..." ~Isaac Asimov

AUGUST, 2011
THE NEW! CRCC TEAM
CDR Peter Lundblad - Sports Medicine Physician CDR David Stevens - Family Medicine Physician LCDR Trent Marcus - Family Medicine Physician LT Erin McKee - Clinical Psychologist LCDR Bryan Bost - Physical Therapist LT Daniel Houlihan - Occupational Therapist LT Lisa Dobison - Senior Nurse Manager/ECW LT Cindy Porcadas Staff Nurse ECW LTJG Lola Lakin Staff Nurse ECW Maj Melinda Eaton, USAF Research Psychologist LT Jacob Norris - Research Psychologist HM1 Gideon Kain - Leading Petty Officer HM1 Joseph McDaniel Psychiatry Technician HM2 Drew Kastelic - General Duty Corpsmen HM2 Chad Chartier General Duty Corpsman ECW HM3 Joseph Fontaine - General Duty Corpsman HM3 Brian Bernstein - General Duty Corpsman HM3 Weston Langley General Duty Corpsman ECW HM3 Rashad McKenzie General Duty Corpsman ECW HM3 Ernest Harris General Duty Corpsman ECW HN Gregory Tramble Psychiatry Technician ECW

For the last six months, the CRCC has partnered with the Joint Combat Casualty Research (JC2RT) to establish a clinically-oriented research program to produce new scientific knowledge that can provide information back to the in-theatre clinician. Recognizing that comprehensive in-theatre treatment of battle-related concussion was relatively new and that battle-related concussions were poorly understood by both clinician and scientist alike, the prior CRCC OIC, CAPT Keith Steussi and JC2RT researcher CDR Tom Bosy planted the seeds for a research program in late 2010. Under their successors, CDR Earl Frantz and LT Jacob Norris, the research program took root. The collaboration has since produced amazing results! In May, HM2 Huffman overhauled the clinics internal database, allowing the clinic to provide Navy Medicine data across all clinical domains. Ultimately, this will aid the clinic in developing future research protocols to describe battle-related concussions. The research extends beyond the walls of the CRCC. In May, CDR Sams, CAPT Schauer, CDR Frantz submitted a paper to the journal Military Medicine, describing two unusual cases of syncope (dizziness) following concussion. In late June, CDR Richard Sams, CDR Walter LaBrie, and LT Norris presented preliminary results on the utility of computerized neuro-cogntive testing following concussion to military clinicians in Kandahar. The CRCC/JC2RT has also been strong in developing some of the first research protocols for use at Camp Leatherneck by in-theatre clinicians.

Two such proposals have gone as far forward as the US Army Medical Research and Material Command Institutional Review Board (IRB), the ethics review panel that reviews all research in the CENTCOM area of responsibility. The topics for research include: sleep disturbances and concussion; in-theatre tracking of concussed individuals following return to duty; and the natural history of blastrelated concussion. Once the IRB processes are complete research will commence on these topics. While numerous other efforts stateside have looked at concussed military personnel upon return from deployment, the CRCCs efforts should give clinicians a clearer picture of how concussions look in the hours to weeks after injury. As the first of its kind, the CRCC/JC2RT partnership is a model of success for real-time in-theatre research, asking questions with the potential to benefit the soldier while still on the battlefield. CONUS DoD researchers investigating concussion are hoping to engage the CRCC/JC2RT in order to assist them with furthering research and improving care. As CDR Frantz and his team begin to turn over their mission to the next team of CRCC clinicians, LT Norris will assist in the continuation of the research program to ensure that information is captured, results are validated, and new knowledge is disseminated consistent with the highest scientific and ethical standards. Jake Norris LT, MSC, USN

Mailing Address
2d Supply BN Rein ATTN: SURGICAL CO UNIT 73730 FPO AE 09510-3730

DSN Phone:
318-357-3900

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