Newswise — Bethesda, MD – Suicide attempts, like suicides, have increased in the U.S. Army over the last decade. To better understand and prevent suicidal behavior, researchers from the Uniformed Services University of the Health Sciences (USU), the University of California, San Diego, Harvard Medical School, and the University of Michigan examined timing and risk factors for suicide attempts among U.S. Army enlisted Soldiers. They found the highest risk was among those who never deployed, and those who never deployed were at greatest risk during their second month of service. The study, which included more than 975,000 enlisted Soldiers, was published online (May 25) in JAMA Psychiatry, and was a component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Dr. Robert J. Ursano, the study Co-Principal Investigator and chair of the Department of Psychiatry at USU, and coauthors, used administrative records to examine risk factors, methods and timing of suicide attempts by Soldiers currently deployed, previously deployed and never deployed from 2004 through 2009. Of the Soldiers included in the study, 9,650 had attempted suicide. About 86 percent of those were younger than 30, about 60 percent were non-Hispanic white, about 76 percent were high school educated, and about 55 percent were currently married. According to this study, these findings suggest predictors of suicide attempts, which could provide greater opportunities for prevention of suicidal behavior in the military as well as in other populations. The authors also report that about 40 percent of enlisted Soldiers who had never deployed accounted for about 61 percent of the enlisted Soldiers who attempted suicide. Among those who never deployed, risk of a suicide attempt was highest in the second month of service. For Soldiers on their first deployment, the risk of suicide attempt was highest in the sixth month of deployment. For previously deployed Soldiers, the risk was highest five months after they returned. Additionally, Soldiers who were currently and previously deployed were more likely to attempt suicide with a firearm. Across deployment status, suicide attempts were more likely among Soldiers who were women, in their first two years of service, and had received a mental health diagnosis in the previous month. Soldiers with a previous deployment also had a higher risk of suicide attempt if they screened positive for depression or post-traumatic stress disorder after they returned from deployment, especially at a follow-up screening about four to six months after deployment. According to the study, deployment context is important in identifying suicide attempt risk among Army enlisted Soldiers, and a life/career history perspective can also help identify high-risk segments of a population based on factors such as timing, environmental context and individual characteristics. “Our findings while most relevant to active-duty U.S. Army Soldiers, highlight considerations that may inform the study of suicide risk in other contexts, such as during the transition from military to civilian life,” the study concludes. # # #
Newswise — An American aircraft, a TBM-1C Avenger, missing since July 1944 was recently located in the waters surrounding the Pacific Island nation of Palau by Project RECOVER—a collaborative effort to combine the most advanced oceanographic technology with advanced archival research methods to locate aircraft and associated Americans missing in action (MIA) since World War II. Scattered among the lagoon waters and coral reefs surrounding Palau’s island chain, and concealed within its dense mangrove forests, are several dozen U.S. aircraft and the remains of as many as 80 U.S. airmen. This US Navy TBM-1C adds to the growing list of wrecks discovered by Project RECOVER. “The importance of our mission is reinforced with each new discovery of a missing aircraft," said Eric Terrill, an oceanographer from Scripps Institution of Oceanography at the University of California San Diego, one of Project RECOVER's three founding entities. “But this is more than reconnecting with history; it's about locating the missing to enable the U.S. government to bring them home for a proper burial. With potential recovery sites around the world, Project RECOVER and its team of researchers and volunteers are expanding to intensify its searches using modern science and technology.” The most recent find was made possible by a substantial financial commitment from Dan Friedkin, founder and chairman of Air Force Heritage Flight Foundation and chairman of Gulf States Toyota and The Friedkin Group. As a member of the Project RECOVER team, Friedkin’s continued support is helping sustain ongoing missions, while enabling the organization to innovate its technology and expand its search and discovery efforts to focus areas around the world. “This recovery is another step closer towards Project RECOVER’s goal of finding the final underwater resting places of all Americans missing in action since World War II,” said Friedkin, one of nine civilian Heritage Flight pilots qualified to fly in formation with U.S. Air Force single-ship demonstration teams. “As someone who gained a passion for flying and admiration for our country’s brave service members as a child, I will continue to support the efforts of Project RECOVER and their partner organizations. Every family member impacted by the loss of a service member deserves this type of closure.” Upon locating this TBM-1C Avenger and other U.S. aircraft, Project RECOVER provides detailed information about discovered wrecks and possible links to airmen listed as missing in action to the Department of Defense’s Defense POW/MIA Accounting Agency (DPAA). DPAA is tasked with recovery and repatriation efforts, including notification of the families of these MIAs. Financial gifts to this cause are shared among Project RECOVER’s three founding entities—the University of Delaware, Scripps Oceanography, and the BentProp Project (a non-profit organization). Funds are being used in development of technology, data processing, and analysis, and field efforts that lead to discoveries of World War II wreckage and their associated MIAs. All three member organizations recently signed memorandums of understanding with DPAA to formalize their public-private partnership with the U.S. Government for conducting MIA related searches. About Project RECOVER Project RECOVER is a public-private partnership to enlist 21st century science and technology combined with in-depth archival and historical research in a quest to find the final underwater resting places of Americans missing in action since World War II. Established in 2012 with initial support from the Office of Naval Research and now private funding, Project RECOVER is a partnership among researchers at the University of Delaware’s College of Earth, Ocean, and Environment, Scripps Institution of Oceanography at the University of California San Diego, and the BentProp Project. The work blends historical data from many different sources to narrow underwater search regions with scanning sonars, high definition and thermal cameras, advanced diving, and unmanned aerial and underwater robotic technologies. While the bulk of the project to date has focused on searches in the Pacific Islands of Palau, the methods will now be applied to the many regions across the globe where servicemen are still missing. For more information visit: About the donor, Dan Friedkin Dan Friedkin is the chairman of The Friedkin Group, a consortium of automotive, adventure, hospitality, and entertainment companies. These organizations include: Gulf States Toyota, Gulf States Financial Services, GS Marketing, US AutoLogistics, Auberge Resorts Collection, Iconic Properties, Legendary Adventures, and Imperative Entertainment. Houston-based Gulf States Toyota, founded in 1969, is one of the world's largest independent distributors of Toyota and Scion vehicles and parts, serving 155 dealers in Arkansas, Louisiana, Mississippi, and Oklahoma. Friedkin is chairman of the Texas Parks and Wildlife Commission and the founder and chairman of the Air Force Heritage Flight Foundation, a non-profit organization established to honor the men and women of the U.S Air Force through Heritage Flight displays. He also flies right wing for the Horsemen Flight Team. In addition, he oversees the Friedkin Conservation Fund, a charitable organization established by the family working to conserve the habitat and wildlife on more than seven million acres in Tanzania. The Friedkins have also contributed over $100 million to support wildlife conservation and anti-poaching efforts in East Africa. About The BentProp Project The BentProp Project, a 501(c)(3) non-profit organization, has been searching for American MIAs for two decades. This team was created by Patrick Scannon and has consisted of dedicated volunteers, who conduct historical and archival research to support annual month-long searches, focusing primarily in the jungles and waters of Palau. The BentProp Project has been successful in locating and identifying numerous MIA crash sites, which has allowed DPAA to conduct recovery and repatriation missions for these missing Americans. About the University of Delaware’s College of Earth, Ocean, and Environment University of Delaware’s College of Earth, Ocean, and Environment (CEOE) strives to reach a deeper understanding of the planet and improve stewardship of environmental resources. CEOE faculty and students examine complex information from multiple disciplines with the knowledge that science and society are firmly linked and solutions to environmental challenges can be synonymous with positive economic impact. CEOE brings the latest advances in technology to bear on both teaching and conducting ocean, earth and atmospheric research. Current focus areas are ecosystem health and society, environmental observing and forecasting, and renewable energy and sustainability. About Scripps Oceanography at UC San Diego Scripps Institution of Oceanography at the University of California San Diego, is one of the oldest, largest, and most important centers for global science research and education in the world. Now in its second century of discovery, the scientific scope of the institution has grown to include biological, physical, chemical, geological, geophysical, and atmospheric studies of the earth as a system. Hundreds of research programs covering a wide range of scientific areas are under way today on every continent and in every ocean. The institution has a staff of more than 1,400 and annual expenditures of approximately $195 million from federal, state, and private sources. Scripps operates oceanographic research vessels recognized worldwide for their outstanding capabilities. The University of California San Diego is a student-centered, research-focused, service-oriented public institution that provides opportunity for all. Recognized as one of the top 15 research universities worldwide and born of a culture of collaboration, UC San Diego sparks discoveries that advance society, drive economic growth and positively impact the world. For the sixth consecutive year, UC San Diego has been ranked first in the nation based on research, civic engagement and social mobility. ####
Newswise — WASHINGTON,DC -- In an effort to ensure access to timely, quality healthcare for America’s veterans, the Veterans Health Administration (VHA) has published a proposed rule in the May 25 Federal Register that allows Certified Registered Nurse Anesthetists (CRNAs) and other advanced practice registered nurses (APRNs) to provide patient care to the full extent of their education and abilities. The policy change, which is consistent with recommendations from the National Academies of Medicine (formerly the Institute of Medicine), would define Full Practice Authority in VHA facilities for CRNAs, Nurse Practitioners, Clinical Nurse Specialists and Certified Nurse Midwives. Its definition of Full Practice Authority means that APRNs working within the scope of VA employment would be authorized to practice as described in the law in section 17.415(b) “without the clinical oversight of a physician, regardless of state or local law restrictions on that authority.” The proposal is supported by more than 60 organizations, including veterans’ groups such as the Military Officers Association of America and the Air Force Sergeants Association. The policy is also supported by AARP (whose membership includes 3.7 million veteran households), numerous healthcare professional organizations including the American Association of Nurse Anesthetists (AANA) and other APRN associations, and 80 Democratic and Republican members of Congress. “The AANA and its 49,000 members are one of many groups cheering the VHA’s actions today,” said AANA President Juan Quintana, DNP, MHS, CRNA, a nine-year veteran of the Air Force Reserve. “Veterans are waiting entirely too long to receive the quality healthcare they deserve and have earned in service to our country. The AANA strongly supports the VHA’s plan to solve this problem by utilizing readily available healthcare resources—such as CRNAs, nurse practitioners, and other APRNs—to the full extent of their practice authority.” With more than 1,700 facilities across 50 states, the District of Columbia and several territories, the VHA is the nation’s largest healthcare system, serving over 21 million veterans. In an organization this size, improving access to timely care can be a complex problem. However, with more than 6,000 currently employed and under-utilized APRNs, a big part of the solution was already available to the VHA. “Improving the VHA’s ability to provide better, faster care to our veterans doesn’t necessarily require increasing budgets or staff,” said Quintana. “One solution has been there all along, and is as simple as removing bureaucratic barriers to APRNs’ ability to be credentialed and practice to the full extent of their education, training, and certification.” The VHA proposed rule was backed by the results of an independent assessment of the VHA health system that was ordered by Congress and published in 2015. The researchers recommended that allowing CRNAs and other APRNs to practice to the full extent of their education and abilities would increase veterans’ access to care, reduce wait times, and even save money. The rule makes the VHA consistent with the U.S. Military service branches, which allow CRNAs and other APRNs to practice to the full scope of their education and abilities. Nurse anesthetists, who first provided healthcare to wounded soldiers on the battlefields of the American Civil War, have been the main providers of anesthesia care on the front lines of every U.S. military conflict since World War I. Immediately upon publication in the Federal Register, a 60-day comment period commenced during which interested parties can communicate with the VHA about the rule. About the American Association of Nurse Anesthetists Founded in 1931 and located in Park Ridge, Ill., the AANA is the professional organization for more than 49,000 nurse anesthetists across the United States. As anesthesia specialists, Certified Registered Nurse Anesthetists (CRNAs) safely provide approximately 40 million anesthetics to patients each year for surgical, obstetrical, pain management, and trauma stabilization services. CRNAs deliver essential healthcare in thousands of communities and are able to prevent gaps in access to anesthesia services, especially in rural, inner-city, and other medically underserved areas of the country. They are highly valued in today’s healthcare environment because they deliver the same safe, high-quality anesthesia care as other anesthesia professionals but at a lower cost, helping to control rising healthcare costs. Additional information about the AANA and CRNAs is available at, and
WASHINGTON (AP) -- Veterans Affairs Secretary Robert McDonald said Tuesday he regrets remarks he made comparing long wait times at VA health care sites to waiting in line at a Disney amusement park. "It was never my intention to suggest that I don't take our mission of serving veterans very seriously," McDonald said in a written statement. "If my comments Monday led any veterans to believe that I, or the dedicated workforce I am privileged to lead, don't take that noble mission seriously, I deeply regret that. Nothing could be further from the truth." McDonald's statement came after a Republican senator called for his resignation and GOP lawmakers and veterans' service groups slammed his remarks as insulting and inappropriate. Sen. Roy Blunt, R-Mo., said McDonald's "preposterous statement is right out of Never Never Land" and said the VA leader has shown he cannot ensure that veterans receive health care in a timely manner "Dismissing wait times when veterans can often wait months for an appointment is negligent and a clear sign that new leadership is needed at the VA," Blunt said as he called for McDonald to step down. McDonald said at a breakfast Monday that the VA should not use wait times as a measure of success, comparing waits for VA health care to the hours people wait for rides at Disney theme parks. McDonald said a veterans' health-care experience was more important than the time spend waiting for an appointment. House Speaker Paul Ryan, R-Wis., called McDonald's comments "disgusting and beyond the pale," although he stopped short of calling for him to step down. "This is not make-believe. This is not Disneyland, or Wonderland, for that matter," Ryan told reporters. "Veterans have died waiting in line for their care." Republicans said McDonald's comments were especially egregious since he took office in 2014 after his predecessor was forced out amid a scandal over chronically long wait times at VA health care sites and reports that as many as 40 patients died while awaiting care at the Phoenix VA hospital. Similar problems were discovered at VA health sites nationwide, along with a widespread practice among VA employees of creating secret lists to cover up the long wait times and receive VA bonuses. Rep. Cathy McMorris Rodgers of Washington state, a member of the Republican leadership, said McDonald's comments were hard to believe. "When you go to Disneyland, you aren't wondering if you are going to live long enough to make it to Space Mountain," she said. Democrats called Blunt's comment a blatant bid to boost his re-election chances. "Senator Blunt of all people should know another resignation at the VA will likely only make things worse," said Missouri Secretary of State Jason Kander, Blunt's likely Democratic challenger. Senate Democratic Leader Harry Reid of Nevada, who is known for his own verbal miscues, supported McDonald. Referring to himself as "an expert at wrong choice of words," Reid said McDonald "could have done a better job talking about Disneyland, but he didn't. He is a good man, he's doing his best under very, very difficult circumstances. So I support Secretary McDonald all the way."
On Monday the Secretary of Veteran Affairs, Robert McDonald commented that Disney doesn’t concern itself with its wait time for rides, and the VA shouldn’t be judged by theirs either. Benny Johnson of Independent Journal reached out to Disney to get their comments about Donald’s take on their wait lines, and unsurprisingly, didn’t take it lying down. According to Johnson, a Disney spokesperson responded with: “What the Secretary said was factually untrue. We take wait times very seriously. We continually push the boundaries to give our guests the best experience possible. A large team of highly trained industrial engineers are tasked with improving our guest’s experiences, from transportation, to guest flow, to ride comfort and certainly wait times. One of the things we take great pride in is if you have a wait time at our parks, your wait is enjoyable. We call this the Disney Difference. We recently remodeled the Dumbo ride, doubling its size and adding a Big Top area for families waiting for the ride. This area is a huge, interactive, air conditioned area for children to play in and where adults can relax with a buzzer they receive that notifies them when their spot is ready on the ride. And added: If you wait at the Haunted Mansion there are musical tombstones that will sing to you. There is a flowing honey wall at the Winnie the Poo ride. We designed animated crabs for The Little Mermaid waiting area which will interact with you and play games while you wait. We take every facet of the guest experience very seriously. If you have to wait, you should have fun while doing it.” When Johnson asked why McDonald felt it necessary to use Disney parks for comparisons to the VA, the Disney spokesperson responded with this: “I’m not sure. This company was founded by veterans. Roy Disney was an officer in the U.S. Navy and Walt drove an ambulance in France assisting service members directly after WWI.” The VA isn’t remotely in the ballpark of the efficiency and customer care that Disney gives to its guests. Furthermore, no one dies waiting in line for the Dumbo ride, as many of our veterans do waiting for something as simple as a blood test. Our veterans have more luck going on the Haunted Mansion ride than they do getting a simple X-ray done. Perhaps the VA could take a page out of Disney’s book instead of trying to compare themselves to them. Hats off to Disney and Benny Johnson.  From Brandon Morse, found on the web at:    
DENVER (AP) -- Congress is showing an increased willingness to let VA doctors talk to veterans about medical marijuana in states where it's legal, although final approval is far from certain. The House approved a measure this week that would let Veterans Affairs Department doctors help their patients sign up for state medical marijuana programs, something the VA now prohibits. "I'm certainly open to it," Rep. Mike Coffman, a Republican and former Marine from pot-friendly Colorado, said Friday. A Senate committee approved a similar measure last month but the full Senate hasn't voted. Medical marijuana is now legal in 23 states and the District of Columbia, but pot remains illegal under federal law. Arguments for medical marijuana are getting a warmer reception from lawmakers amid nationwide concerns about overuse and abuse of prescription painkillers and psychotropic drugs. Coffman, chairman of a House Veterans Affairs subcommittee on oversight and investigations, said he wasn't enthusiastic when his state first approved medical marijuana. But if the drug helps veterans deal with post-traumatic stress, it could reduce the use of stronger prescription drugs and save taxpayers money, he said. The measures in Congress wouldn't permit the VA to provide patients with marijuana, Coffman said. It would only free doctors to talk about it with their patients. Rep. Earl Blumenaur, D-Ore., who sponsored the House measure, said medical marijuana could be safer and more effective than other drugs for veterans suffering from chronic pain or the stress disorder. Providing access to pot as an alternative "is critical at a time when our veterans are dying with a suicide rate 50 percent higher than civilians and opiate overdoses at nearly double the national average," Blumenaur said in a written statement. Research on whether marijuana helps with PTSD has been contradictory and limited, and the VA has warned that increasing numbers of veterans who suffer from it have become dependent on pot. The VA didn't immediately respond Friday to a request for comment on the proposals in Congress. Congress has killed similar measures in the past, but backers say the proposals are attracting more votes this time. Blumenaur's measure passed Wednesday 233-189, including 57 Republicans in favor. Coffman's subcommittee held a hearing in Denver Friday on problems in the way the VA prescribes and keeps track of drugs. He cited the case of a pharmacy technician at the Denver VA Medical Center who officials said was found in an operating room trying to inject herself with a painkiller stolen from a hospital refrigerator.   BY DAN ELLIOTT
WARWICK, R.I. (AP) -- William Delaney, a former Marine, had already served four years of probation for an alcohol-related offense in Florida and was back in court, this time in Rhode Island, for driving under the influence. His newest brush with the law, combined with his alcoholism and depression, he feared, could close the door on the rest of his life. That was almost two and a half years ago. Delaney now mentors other veterans in that same court, and he's working toward earning his master's degree in social work to continue helping veterans. The Veterans Treatment Court opened five years ago in Warwick, Rhode Island, as the first specialty court in New England to help veterans avoid jail and turn their lives around. Like Delaney, most of the 220 veterans who have completed the program haven't committed another offense. The rate of recidivism stands at about 6 percent, according to the court. "We judge ourselves really harshly in addition to how the court judges us because of how far we've fallen," Delaney said. "It's just devastating. Even such a small thing as having a judge smile and say she understands, and having a treatment team that truly cares, it's a spark. It makes you believe you can do it differently this time." For Delaney, that jurist was Associate Judge Pamela Woodcock Pfeiffer. "She seemed like she cared. She reminded me of who I could be and who I was. I wasn't the bad guy," he said. "I wasn't the lost, drunk person. I could be something better again. That was the life-changing moment." Woodcock Pfeiffer also has kind words for the court and for veterans like Delaney. "I am totally convinced it's working," Woodcock Pfeiffer said. "People are very clear that if it were not for this, then they would have all these problems." The first veterans treatment court started in 2008 in Buffalo, New York. Similar courts sprang up nationwide as a way to help reform the criminal justice system, lower costs by reducing the prison population and recidivism rates, and connect veterans with treatment programs. Today, there are more than 250 and hundreds more are planned, according to Justice For Vets, which advocates for the establishment of the courts and provides training for jurisdictions with new courts. The Rhode Island court has received hundreds of referrals from District Court for misdemeanor cases. Veterans can opt to stay in District Court, where their case would likely be resolved faster. If they go to the veterans court, they have to follow whatever treatment the court prescribes to address substance abuse, behavioral or other issues and regularly check in with court staff, usually for 10 months to a year. At the end, often their case is dismissed entirely and expunged. The court currently has about 70 active cases. Chief District Judge Jeanne E. LaFazia said the veterans court gives people tools to reintegrate into their community. She credits Woodcock Pfeiffer for getting to know the veterans well, which invests them in the process. "By the time you get someone in here, they are often at rock bottom," LaFazia said. "You're helping them rebuild themselves. It's a remarkable difference." Both LaFazia and Woodcock Pfeiffer said the state has a duty to help veterans and give them a chance. The court holds graduation ceremonies for veterans who complete treatment. At a recent ceremony, Woodcock Pfeiffer praised the veterans for their hard work and asked them pointed questions about their future plans to make sure they would not fall back on old patterns. "I hope we've been able to give you hope, and the ability to control some of the things that sometimes control you," she said. The veterans were presented with a coin in the style of a military command coin, which is meant to show one's military affiliation and instill pride. It bears the last six words of the Pledge of Allegiance: With liberty and justice for all.   BY JENNIFER MCDERMOTT
LOS ANGELES (AP) — After three military combat tours in war-torn Iraq, Chase Millsap returned home to get on with a civilian life. But there was one thing he couldn't do: leave a comrade behind, certainly not one who had saved his life. Especially not the former Iraqi military officer who had worked with the Americans and was now living a precarious existence as a refugee dodging Islamic State militants seeking to kill him. For the past two years, Millsap has been fighting a different kind of battle, one to gain asylum for the brother in arms he simply calls The Captain.   "The Captain is the epitome of my personal commitment to take care of people," said Millsap, 33, who served in the Marine Corps and later joined the Army and became a Green Beret. For the time being, The Captain lives in southern Turkey, struggling to obtain refugee status in what he hopes will be the first step toward seeking permanent asylum in the United States. "If I go back, I'm sure I die," the 37-old Muslim and married father of two said recently during an interview over Skype. He agreed to speak, but, fearing for his safety, only wanted to be identified by his former rank. As he spoke, his 3-year-old daughter and 4-year-old son played in the family's living room. Millsap visited his friend last year at his cramped apartment, hoping he might help him expedite his refugee application. After running into one obstacle after another — The Captain couldn't get an interview at one government office because his papers were in English, not Turkish — Millsap returned to the United States and formed the nonprofit Ronin Refugee Project with a handful of other military veterans. It's dedicated to helping those who fought alongside Americans find safe harbor here or in other Western countries. After helping The Captain, they hope to turn their attention to others. "He's one of millions that's stuck in a system that is broken and he's just gonna continue to wait," Millsap said. "And so we decided to step up, me and a few other veterans." He will be in Washington on Tuesday to meet with members of Congress and others to discuss just how the U.S. might go about doing that. "That's really become my mission," said the newlywed who obtained his master's degree from the University of Southern California and then went to work this month as a community liaison helping U.S. veterans reintegrate into civilian life. Friendly and outgoing, Mills was a fresh-faced second lieutenant when he arrived in Iraq in 2006 to lead a contingent of U.S. Marines and Iraqi soldiers. The Captain, a lieutenant himself then, was among the latter group. "When I met The Captain, I was unimpressed at first," Millsap said, chuckling now. He was a Marine, after all, he is quick to add, and no decent Marine thinks anyone can do the job better than he can. Never mind that they were in the middle of nowhere, surrounded by danger in a foreign country where they didn't know the culture. His attitude began to change as The Captain patiently explained why he and his troops weren't getting buy-in from the locals or the Iraqi soldiers. It changed dramatically, however, after a sniper tried to take Millsap's head off during a routine patrol. "He quickly pushed me down and ran towards the gunfire and because of that, saved my life," Millsap recalled. The sniper, seeing an angry Iraqi soldier charging at him, chose to run rather than shoot again. "And that," Millsap added with a laugh, "is when I truly realized that this guy's OK." It was a coincidence that the two crossed paths a year later during Millsap's second tour. He was again in charge of a Marine contingent, and The Captain was now his Iraqi counterpart. The bearded soldier stared at him, incredulous that he'd returned to that hell. Millsap left the Marines after that tour to join the Army's Green Berets, rising to the rank of captain himself. The two didn't cross paths but kept in touch by phone and email — until one day, the communications stopped. The Captain, Millsap would learn a year later, had nearly been killed when an improved explosive device blew up his Jeep. He recovered and soldiered on until the Islamic State group began moving in and the death threats began. When calls to his home began identifying his children by name, he gathered up his family and fled to Turkey. Now, a typical day begins with physical therapy on his right arm, still damaged by the IED. That's followed by tasks like teaching his children the English alphabet, then studying English grammar himself so he can fine-tune his United Nations application for refugee status. The last time he met with a U.N. official, he said, he was told a decision might come within three months. That was four months ago. Now he's heard maybe in a month or two. Or maybe a year. He and Millsap check in by Skype once a week. During a recent call, he praised Ronin Refugee Project for not forgetting him. "I feel like you are my family. You are my brother. You and the other group of Marines are really gentlemen," he said before his voice began to break.     By JOHN ROGERS
Newswise — CHICAGO  Military surgeons face a unique challenge in that they serve as a “jack-of-all-trades” in an austere environment while deployed, only to return home to the expectation that they will compete with the standards of civilian surgical care, which has become increasingly subspecialized and highly dependent on minimally invasive technology. To address this issue, authors of a new article appearing online in the Journal of the American College of Surgeons ahead of print publication propose a new education and training paradigm that will benefit military surgeons and ultimately their patients in both practice environments.“The biggest hurdle we have to overcome is lack of operative activity. Evidence suggests that we fall significantly below our civilian counterparts in both overall case numbers and in case complexity,” said lead author U.S. Army Colonel Mary J. Edwards, MD, FACS, a pediatric surgeon at San Antonio Military Medical Center, Texas.The research team, consisting of surgeons from the San Antonio (Texas) Military Medical Center, the Naval Medical Center, Portsmouth, Virginia, and the Department of Defense Joint Trauma System, US Army Institute of Surgical Research, San Antonio, identified three levels of surgical education and skills training for military surgeons to participate in to sustain surgical skills: Core surgical competence: the basic credentials, training, and skills, usually obtained through graduate medical education and in-garrison surgical care, which form the foundation for readiness skills.   Basic and advanced medical combat readiness skills: the basic essential medical skills required for all military medical personnel deploying to a war zone, and advanced surgical readiness skills that allow members of surgical teams to deploy and optimally perform in their assigned roles.   Mission specific medical readiness skills: the required skills to perform a specific deployed surgical mission.   In terms of Level 1 of their proposed training, the article’s authors suggest that stateside Military Treatment Facilities (MTF) be evaluated to become verified trauma centers within their community and with the American College of Surgeons (ACS). This proposal would expand the role of the MTFs which the military currently relies on for its local credentialing committees to ensure the clinical proficiency of their surgeons. Further, every military hospital would actively develop cooperative agreements with surrounding hospitals to allow military surgeons to provide care for civilian patients—stationing military physicians at Level I trauma centers will ensure these providers are constantly engaged in active trauma practice and are available to mentor additional military trainees, according to the authors.However, maintaining critical skills for military surgeons runs in two directions. Not only is there a need for a closer relationship between military and civilian surgical care, but military surgeons also need to possess a unique set of skills for performing operations while deployed. “Wartime surgery requires specific skills that cannot be completely obtained with practice at modern civilian trauma centers alone,” the authors noted. “War surgery requires aggressive operative intervention, frequently with staged procedures and often in an austere environment with no access to basic X-ray and lab capability and no local subspecialty support.” For military surgeons to be properly prepared, training such as The Tactical Combat Casualty Care Course and the Operational Emphasis version of the ACS Advanced Trauma Life Support (ATLS) course should be ongoing, and all deployed surgeons should receive timely training in war surgery evaluation and treatment and the Joint Trauma System’s clinical practice guidelines, according to study authors. However, training alone does not suffice for military surgeons to be properly prepared to compete with civilian care. “No amount of predeployment training can make up for lack of operative activity on a day- to- day basis,” said Dr. Edwards. “This shortcoming is the biggest challenge our surgeons in uniform face today.”Authors suggest that because maintaining a complete set of trauma-ready skills for all military active duty and reserve general surgeons may not be achievable, emphasizing a team approach is important. They suggest the designation of surgeons being deployed as either “trauma ready” or “trauma assist,” with trauma ready surgeons being matched to high-volume missions and solo surgeon locations, and trauma assist surgeons being matched to a location that already has a trauma ready surgeon. “The military views every surgeon who at one point completed a surgical residency equally in terms of their ability to provide combat casualty care,” according to the authors. “This [viewpoint] potentially sets the provider and the care team up for failure.” Authors suggest that trauma surgical capabilities be shared jointly between the Army, Navy, and Air Force, and the most qualified surgeons be deployed as “trauma ready,” regardless of service or active/reserve status. Further, authors suggest that a fellowship-trained trauma medical director be designated for every area of operations to function as the area leader in trauma system development and performance improvement. “As surgery in the United States becomes more subspecialized and technology dependent, the military must leverage its requirement for general surgeons who are able to function in austere environments with limited communications and equipment, with the appropriate expectation of a very high standard of surgical care to our beneficiaries when returning to the United States,” the authors noted. In addition to Dr. Edwards, other article coauthors are Kurt D. Edwards, MD, FACS, COL, MC, USA; Christopher White, MD, FACS, COL, MC, USA; Craig Shepps, MD, FACS, CAPT, MC, USN; and Stacy Shackelford, MD, FACS, Col, MC, USAF. “FACS” designates that a surgeon is a Fellow of the American College of Surgeons. The data in this manuscript regarding Army general surgeon operative volume was presented at the Excelsior Surgery Society meeting at the American College of Surgeons 101st Annual Clinical Congress, Chicago, IL, October 2015.Citation: Saving the Military Surgeon: Maintaining Critical Clinical Skills in a Changing Military and Medical Environment. Journal of the American College of Surgeons. # # # About the American College of SurgeonsThe American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. 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Armed Forces Day in the United States Many Americans celebrate Armed Forces Day annually on the third Saturday of May. It is a day to pay tribute to men and women who serve the United States’ armed forces. Armed Forces Day is also part of Armed Forces Week, which begins on the second Saturday of May. A member of the US armed forces hugs his daughter. © What Do People Do? Many events across the United States take place on Armed Forces Day to honor Americans in uniform who served their country in times of war and peace. Those who are honored on this day include people who serve the Army, Navy, Marines, Air Force and Coast Guard. National Guard and Reserve units may celebrate Armed Forces Day/Week over any period in May because of their unique training schedules. Events and activities may include: Multi-service military displays in areas open for the public. Various educational activities that teach children about the armed forces. “Support the Troops” themed motorcycle rides. Large parades and other local celebrations. Certain types of music are also played at Armed Forces Day events, including at memorials and at cemeteries, as a way to respect those in the armed forces who died for their country. For example, buglers have played a bugle call, known simply as Taps, on Armed Forces Day in recent years.Taps is usually sounded by the United States military at events such as flag ceremonies, memorial services and funerals. Public Life Traffic and parking may be affected in areas where large-scale events are held for Armed Forces Day. Background On August 31, 1949, Louis Johnson, who was the United States’ Secretary of Defense, announced the creation of an Armed Forces Day to replace separate Army, Navy and Air Force Days. The event stemmed from the armed forces’ unification under one department – the Department of Defense. The Army, Navy and Air Force leagues adopted the newly formed day. The Marine Corps League declined to drop support for Marine Corps Day but supports Armed Forces Day too. The first Armed Forces Day was celebrated on Saturday, May 20, 1950. The theme for that day was “Teamed for Defense”, which expressed the unification of all military forces under one government department. According to the U.S. Department of Defense, the day was designed to expand public understanding of what type of job was performed and the role of the military in civilian life. Armed Forces Day was a day for the military to show "state-of-the-art" equipment to Americans. It was also a day to honor and acknowledge Americans in the armed forces. Parades, open houses, receptions and air shows were held at the inaugural Armed Forces Day.  Armed Forces Day is still celebrated nationwide today and is part of Armed Forces Week. Symbols Posters and other material used to promote Armed Forces Day often show images of Americans in the armed services dressed in their uniforms. Some posters show a collage of images, including images of those in the armed forces with their families or friends, as well as the United States Flag. Themes Some themes that were used for Armed Forces Day in the past included: Appreciation of a Nation Dedication and Devotion Freedom Through Unity Liberty Patriotism Power for Peace Prepared to Meet the Challenge Security Special Opportunity for Thanks Teamed for Defense These are only a few examples, and not a full list, of the Armed Forces Day themes in previous years.