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DoD News Briefing with Secretary Geren from the Pentagon

Presenter: Secretary of the Army Pete Geren
November 07, 2008
                MR. GEREN: Thank all of you for being here today.   
 
                As you know, the secretary of Defense has identified this month as Warrior Care Month for the whole Department of Defense. And today with this event, we are kicking off our Warrior Care Month outreach for the Department of the Army. And as we thought about how you tell the story, of warrior care, we thought it's critical to really tell the whole story of warrior care.   
 
                As an Army, as a Department of Defense, we've made extraordinary progress in taking care of soldiers, sailors, airmen and Marines in this conflict. You go back to World War I. And approximately 70 percent of people who wounded, in battle, survived.   
 
                Now over 90 percent of the troopers that are injured, in battle, survive. And that's for -- as a result of many different efforts. And it doesn't just begin in the hospital. It doesn't begin in the Warrior Transition Unit. It doesn't begin in a Forward Surgical Team. It begins with the individual soldier.   
 
                As an Army, we have done -- we've made tremendous investment in preparing our individual soldiers to be combat lifesavers. And if someone's injured, the first -- actually we teach the soldier how to take care of himself.   
 
                We teach the buddy how to take care of his buddy with combat lifesaver training. And then we've got the medic. We've got the doctor at the forward aid station and the surgeon at the Forward Surgical Team.   
 
                And then we've got the specialist surgeon at the Combat Support Hospital, then evacuation from theater, usually a regional medical center in Germany, and then back to the United States, maybe to Walter Reed, maybe to BAMC. But the progress that's been made, in taking care of soldiers and increasing the survivability of the soldiers, starts with the individual soldier.   
 
                And that's what we'd like to do today, is start with -- go all the way from battlefield to specialty hospital to warrior transition unit and describe for you all the continuum of care that -- for our wounded soldiers that literally begins before the person's wounded, begins with this individual training.   
 
                And then, as you work your way through the system, the system becomes increasingly sophisticated. We've got -- Army medicine is the best in the world. Army medicine has been responsible for so many of the extraordinary breakthroughs. And we've seen, over the course of this conflict some extraordinary advances in the development of prostheses, the development of other wounds that are -- have been suffered by our soldiers in this conflict, whether they are TBI -- what we've learned and what we've done to deal with PTSD and other wounds of war.   
 
                But our effort this month is going to be to tell the whole story, from the battlefield to the hospital to the warrior transition unit. And there are soldiers, too, that are in our care for the rest of their lives. So it doesn't stop with the point they take the uniform off. We've got our program -- our AW2 program for our severely wounded and we -- it's our plan to work with them as long as they need it. 
 
                So I don't know how we're going to work through, if we're just going to -- if Staff Sergeant Smith, now, I'd like to call on you.   
 
                Or Colonel, I don't know how you want to actually MC it, but -- 
 
                MR.   : Staff Sergeant Smith -- I can -- 
 
                STAFF SGT. SMITH (combat medic, 1st Squadron, 3rd Armored Cavalry Regiment): Thank you sir and thanks for having me here. 
 
                I had the privilege of serving two tours in Iraq in the OIF 1 and OIF 3. Basically, I was a combat medic for the 1st Squadron, 3rd Armored Cavalry Regiment. Served in al Qaim and al Asad during OIF 1 and in Baghdad and Tal Afar in OIF 3.   
 
                My basic task that I had to do every day was to ensure basically I would wake up in the morning making sure that the overall health of the soldier in my units -- soldiers in my unit was okay, whether they've had something from a common cold to a flu or anything like that, making sure they're okay. 
 
                Once I was sure everything was okay, then it was out and about to the mission, where I would actually send out junior line medics as well as myself. And we would go out into the towns -- into the areas in whatever mission we had, whether it be a basic patrol -- mounted patrol in vehicles and humvees, or if we were to walk to the city even -- and I can talk with some of the citizens of the areas -- or if it was something such as conduct a raid or anything like that. And basically, being the medic, I was also a(n) infantryman or a artillery man and doing all those tasks that they performed. 
 
                Normally -- things goed good (sic) normally. Sometimes things would get bad. And from the point of injury right there, that's when we would take care of them, as you've seen in the media previously where these soldiers would suffer from blast injuries from improvised explosive devices or gunshot wounds and soldiers getting blown up by improvised explosive devices, losing limbs and bleeding. 
 
                Things have gotten advanced thus far. We have things like our combat action tourniquets, which we were able to apply immediately and move the soldier out like that, or if they had gunshot wounds that -- the training that we've received here in the Army today, medics are probably about the closest thing now that we have to doctors. They start IVs. They can do IVs, whether through bones -- things like that, with the intraosseous kits, things like that, the new advanced tourniquets, as I stated before, even to sealants or taking care of somebody's airway and, you know, putting tubes down their throats -- combitubes or -- (inaudible) -- and things like that. So we are able to do things like that. 
 
                From there, maybe a medevac wasn't possible. Maybe we're unable to get a helicopter out to them. And if we were close enough, we'd take them to our aid station right there at our main base. And if it was convenient enough, we'd get them to the forward surgical team if they needed further care.  And we evaced them out. From there we would track the soldier and they would get to a level three care center in maybe Balad or Baghdad, depending on the care needed. And if they needed further care, then they'd go out to Landstuhl Medical Center and then from there -- but we were always tracking those soldiers. 
 
                So being there on the front line and being able to take care of those guys right there obviously was a great privilege. Being a medic and also -- slash infantryman or artillery man, it's a great job to have. 
 
                That's all the remarks I can actually come up with on that. (Laughter.) 
 
                GEN. CORNUM: Thank you. 
 
                MR. GEREN: Thanks, Sergeant. 
 
                GEN. CORNUM: Well, I can't compete with that story in any way.   
 
                Currently as the director of Comprehensive Soldier Fitness, we are -- we are focused on helping people develop strength and resiliency that will carry them through the stress of deployment. But I would like to pick up from where Sergeant Smith left off. Certainly, the buddy aid and the self aid has been important. Everybody's learning that. And now -- and -- I mean, for example, the tourniquet that you can put on with one hand, so if one gets injured you can take your good one and apply it. 
 
                What Mr. Geren said about we have now probably 20 percent higher survivability rate, that means that we have people with much worse injuries getting through the system. So they go from the point of injury -- they go to either the CSH or the Forward Surgical Team. They get resuscitated there. We have learned -- because unfortunately most surgical lessons are learned during war time -- we have learned some different techniques. We have learned, for example, about hypotensive resuscitation, where you don't get their blood pressure back to normal because it will push their clot off. We have learned about giving Factor VII, which increases your clotting factor. We've learned that whole blood, as opposed to the way we do it in civilian centers, really does replace clotting factors and replace red cells at the same time.   
 
                We've just learned that combat trauma is really not necessarily -- can be treated the same way as a car wreck in San Antonio. And we have applied those things very rapidly. So those guidelines went out as soon as we recognized the difference because of the Joint Trauma Registry. They went out as practice guidelines to all the surgeons.   
 
                And we also instituted pre-deployment training for the surgeons and the ICU staff because that's not the kind of thing that people see. Whether they're in the active component military or they're in the Reserves or the National Guard, the things you're going to see when you go to a Combat Support Hospital or a Forward Surgical Team are not what you see at your downtown local facility. 
 
                The other thing that has really saved a lot of lives and decreased, I would say, morbidity later is the critical care and transport. It used to be that transporting people, if they weren't healthy enough to walk on, they had to sort of stay there in the theater until they were. But we have got absolute flying ICUs now, where there are many soldiers who came through Landstuhl, where I was the commander. They came through -- they had been intubated at the aid station, they came through, we operated, did some stabilization at the Combat Support Hospital. They then got on the aircraft, were still intubated, had, you know, nine --  
 
                MR. GEREN (?): Maybe everybody in the room besides me knows what intubated is. 
 
                GEN. CORNUM: I'm sorry. Put a tube down the throat and breathe for them. Put them on a respirator. 
 
                MR. GEREN (?): Okay. 
 
                GEN. CORNUM: So, you know, if you've got a significant chest or abdominal injury, one or two extremity injuries, you've got all this hardware holding the legs together, they would come to Landstuhl still intubated, still on the respirator. Oftentimes they would -- we would then reoperate them, do a washout of the abdomen or the big wound, and then put them on, to where they would really get the kind of definitive care that General Horoho is going to tell you about. She was at Walter Reed and now out at Madigan. 
 
                So the ability to fly people instead of making them stay in country, for days to weeks, has really, really increased the survivability substantially. Because there are lots of things that you just don't have, in a Combat Support Hospital, at the same, at the same rate.   
 
                You may have one dialysis machine but you don't have a whole ward. So the ability to get people back to where, to where, you know, the level-four care was, has really been key, I think.   
 
                The training that our medics get is really unparalleled in the world. They really are, they are not just national registered emergency medical technicians. But then they have follow-on care because again whether you're a doctor, a nurse or a medic, what you do with a trauma in the field is not exactly what you do with a trauma in Downtown Washington.   
 
                And so we teach them the tactical combat casualty care, which is somewhat different. So they are really even more advanced than the people that you would find riding an ambulance here.   
 
                And I think with that, I will pass it to General Horoho.   
 
                (Cross talk.)   
 
                GEN. HOROHO: Good morning. General Patty Horoho. I'm the commander of Madigan Army Medical Center and then also the Western Region Medical Command and the chief of the Army Nurse Corps.   
 
                And part of what we did when we looked at Warrior Care Month, for the western region, is we came up with a theme. And the theme that we came up was, keeping the promise.   
 
                And we did that to ensure that we are committed to ensuring continuity of care, from theater operation to our military treatment facilities, and making sure that we have continual improvement in every aspect of care, for our warriors and also for the family members.   
 
                You know, and part of what we've done, since the start of the war, is we've moved from the concept of lessons learned to actually lessons applied. And we've done that through advances in training, research and development and also provisions of care.   
 
                And when SECARMY talked about the unprecedented survival rates going from World War I, of 70 percent, to over 90 percent in OIF, that was done from changing some concepts that resulted within those areas that I talked about: training, R&D and the provision of care.   
 
                And one of the major ones, when you look at it, from the point of injury, is that we've changed from the golden hour, which was the civilian trauma care concept of getting lifesaving measures done, within that first hour, to actually focusing on the platinum 10 minutes.   
 
                And the way that we've done that is we've looked at ensuring that we've got highly trained combat medics, and they're called 68 Whiskeys. And every one -- every single platoon has one 68 Whiskey assigned, like Staff Sergeant Smith had talked about. Those individuals are trained to the National Registry EMT-B standard, but then they're also augmented by advance combat trauma training, which collectively gives them an advance skill set to be able to make a difference in the lives of our warriors, whether they're Army, Navy, Air Force, Marine or Coast Guard, within that first 10 minutes of their injury. 
 
                The other piece of that that is so crucial is that every single solder that is deployed is trained in self-aid and buddy aid. And we do that so that we then have force multipliers across the entire theater of operation. And they have the opportunity to have combat lifesaver training, so that we make sure that they've got the skill set to be able to save lives in theater. 
 
                In addition to that training, what we've done is we've made some changes in our medical equipment as we looked at the different types of injuries that were coming back. And we really focused on airway management and preventing blood loss. And the reason why those are the two areas that if you can make a difference in ensuring that they have a patent airway and then decreasing blood loss, we've seen that we've got a higher survival rate. 
 
                So everybody's already mentioned the Combat Application Tourniquet, which is a tourniquet that can be done by one-handed. And I can tell you from my experiences at Walter Reed, when I talked with many of the wounded warriors that were amputees and I'd ask them, you know, tell me a little bit about how you were injured, almost every single one of them said that it was either them placing the tourniquet on themselves or a battle buddy placing the tourniquet on them which is what saved their lives. 
 
                We then focused on improving the first aid kit. And it's a one- pound kit that every soldier is deployed with. It has a tourniquet in it. It's got the elastic bandage, a hemorrhage control bandage, and then nasal pharyngeal airway. And that's a small tube that you can put through the nostril of the nose down to kind of open up the airway and keep it patent for air flow. And then they have gloves and tape.   
 
                In addition to that, then we have what's called the WALK, and it's a Warrior Aid and Litter Kit. And that is, having that first aid kit but being able to take care of multiple casualties, in addition to light-weight litters that can be carried on an individual's back to help move our warriors on the battlefield and get them to safety, because a lot of times when they are getting wounded and our medics are out there doing heroic actions, a lot of times it's under enemy fire. 
 
                We're also in the middle -- when we talk about research, we're in the middle of testing our combat gauze as well as WoundStat. And those are two new agents that we're looking at in comparison to what we're using right now, which is HemCon-R and the QuikClot. 
 
                And the reason why we're doing that is we found that these two agents are resulting in a decrease in blood loss and an increase in survival rate, and so these are looking at improved post-injury blood pressures as well. 
 
                So we've now had an individual on the battlefield who has been injured, has been treated either by their battle buddy or a combat medic, and then they're either evacuated back to a Forward Surgical Team or to the Combat Support Hospital. And there they receive full spectrum of medical care which we've got arrayed on the battlefield. 
 
                The Forward Surgical Teams allow forward surgical capability to stabilize and prevent further injury, and then in the CSH you've got the full standup complement of your health-care team, as well as we've added CT scanners there. That is a technology that is used Stateside in our military and civilian hospitals that has dramatically improved our capability to better treat our warriors that are wounded.  
 
                In addition to that, we have ICU teams that provide complex intensive care to rapidly manage our patients, and then when they are further evacuated out, they've got a critical-care team that is taking care of them along that entire route.  
 
                So when you look at it, it's point of entry; getting intervening, quick medical treatment; robust evacuation. And so sometimes, in -- soldiers, or sailors, or airmen or Marines that are injured on the battlefield, in less than 36 hours could be receiving care in our CONUS military treatment facilities.  
 
                We've evacuated over 42,000 warriors since the start of the war in 2001; 36,000 of those have been from OIF and 6,000 from OEF. And then once they are evacuated back to CONUS, they're then assigned to a warrior transition unit, where we work with individualizing their health-care plan, both in the medical area, behavioral health issues, psychological health, looking at careers, whether or not they're going to stay on active duty or transition to civilian life. We look at their personal aspect and individualize a plan to help them reintegrate to work, help them reintegrate into their unit, reintegrate with their family, and then we also look at social conditions. 
 
                And so -- that warrior transition unit is going to be described in more detail by Brigadier General Cheek. 
 
                GEN. CHEEK: Okay. I guess I would -- well, first, I'm Brigadier General Gary Cheek, and I'm the director of the Army's Warrior Care and Transition program, which is -- gives me oversight of our -- the program that we run to take care of our wounded, ill, and injured soldiers. 
 
                And I guess first off I'd -- I would say that like our experience in combat, where we've learned lessons and had to change techniques and apply new equipment and other things, it's really no different for our -- for what we've done in treating our soldiers and our outpatient care. We've learned a lot of lessons and we've really come up with a completely new approach in how we take care of them. 
 
                Currently, we've got 11,064 soldiers in our warrior transition units. That's as of the 3rd of November. And just simply breaking that down, about a third of those were evacuated from theater. About a third of them are in there for some condition related to the global war on terrorism, and that could be a soldier who nursed an injury through his deployment but now is getting it taken care of. And then the other third are not related to deployment. That could be a soldier with multiple deployments that was in a car accident, just as an example. 
 
                But I guess the point and the reason I bring up those numbers -- 11,064 -- is every one of those is an individual soldier with very unique medical conditions, very unique personal problems, challenges and opportunities, very unique goals and aspirations, very unique family conditions, as well. And so for each of them, we sit down with them and build an individual plan to work with them and do all we can both medically, but also personally and professionally for them. 
 
                Now, how do we -- how do we do that? We do it with 36 warrior transition units that are at our major post camps and stations across the United States and Europe, and then also with nine community-based warrior transition units, which are primarily for our Reserve component soldiers. And that's -- I'll call that kind of a non- resident approach, but it's uniquely tailored to, again, the unique conditions of our Reserve components, with the goal of getting them back as close to their families and their support network that they have as conditions permit. 
 
                Now, in designing this, we could have built a single rehabilitation facility and brought all soldiers to it. And that would have been one technique. And in fact, that's kind of how we did it in previous wars up until the 1970s, when we inactivated the last rehabilitative -- rehabilitation hospital at Valley Forge, Pennsylvania.   
 
                But we chose not to do that for several reasons. First, we have enormous capacity in our medical treatment facilities across the United States and we're able to leverage that expertise and that capacity at each of those places for our soldiers. The second thing is this is a much different Army than we had in the 1970s. This is not a draftee Army. It's a professional Army of volunteers. It tends to be older. It tends to be married. It also deploys and redeploys to combat as a unit.   
 
                And so rather than an individual solution, we wanted to put a soldier in a place where they could be close to their family, close to their comrades and their units. And we -- again, we tailored that on a lot of individual conditions. A single soldier might want to be closer to home than with his or her unit, but for the most part soldiers will choose to come back to their post camp or station to be closer to their comrades, at a place that they're familiar with. They know the installation and other things. 
 
                And I guess the other thing I would say that we have done is, on each of these places, we've put our soldiers in the best facilities that we have. We have put traditional military leadership to supervise and take care of them. And then we've brought in a medical management team, to provide very focused and tailored management of their care, with a wide array of services to help both the soldier and the soldier's family.   
 
                Central to that is what we call the triad of care that we've surrounded that warrior in transition with a squad leader, of which Sergeant Smith is one, at Fort Belvoir's Warrior Transition Unite, a nurse case manager, who helps manage appointments and schedule the medical care, and then a primary care provider that's going to kind of oversee, when we get into multiple conditions and how we orchestrate that care. They can take care of those things.   
 
                And that team, that triad will work with each soldier, to optimize their medical care. So it's a great system that we have set up. And I would tell you, the Army has a lot to be proud of. But then I would also tell you, we're not satisfied yet.   
 
                And I think over the past 18 months, we've put a lot of energy into getting this set up. But now we want to really focus on improving the performance of this organization. So here's what we're going to work on in the next year.   
 
                We want to make this process as predictable as we can, for soldiers and families, so that we can help them manage their expectations and we can let them know what's next and we can help guide them through that.   
 
                Now, we can do that, to a large extent, improving our own performance in administration, board processes and other things. But really the key is making the soldier the centerpiece of this. And a soldier has got to have enormous ownership of his or her transition plan so that they can be the one who really drives it forward.   
 
                We'll look at both soldiers and families. We do a lot of surveys. We want to make sure we're meeting their expectation. So we watch very carefully how we're doing performance-wise. And we're learning a lot of lessons that we can't use single approaches, for many of the families especially, because they are so unique both where they live, their needs and other things.   
 
                And then the other part of this is for the transition part, we're developing a comprehensive transition plan for each soldier. In fact, I brought just this little book as an example.   
 
                I was at Fort Benning this week. And Fort Benning has created an individualized plan for each soldier. The soldier sits down with his squad leader. They develop their goals. And they actually do separate assessments of how they're doing toward reaching those goals.  
 
                But again we want to try and make this program as high-performing as we can, very efficient without jeopardizing the best interest of the soldier. So I think, you know, we've done a lot to get this set up. But really I think this next year may be even more exciting, in terms of what we can really bring to the program.   
 
                We've got a lot to learn. And it is very tough. With 11,064 soldiers and 11,000 plans, it's difficult to meet those expectations.   
 
                So we may not get to a hundred percent, but we're going to -- we're going to push it pretty hard. So I really look forward to what we get done in the next year. 
 
                So I think with that, we're ready now to answer any questions that you all might have. 
 
                Q     Mr. Secretary, considering all of those things that you've outlined, sort of, including vast improvements in battlefield care and care of wounded who are brought back to the United States, as you look ahead, what do you see as your greatest challenge? Is it an improvement for battlefield care? Is it something in the warrior transition units? Or is it something not related to physical care but rather mental-health care of the soldiers as more and more come back with stress disorders and other mental-health issues? 
 
                MR. GEREN: You have soldiers and civilians working on every piece of the -- of the continuum of care effort. And they each have their own set of priorities and they're working to improve every step of the process. But from the department standpoint, we have dedicated considerable resources and effort and made a very high priority that mental-health care issues, PTSD, traumatic brain injury and -- as you know, just recently we entered into a partnership with the National Institute of Mental Health to undertake a five-year study of suicide so that we can help us as an Army help society better understand the factors that contribute to suicidal behavior and address that growing problem within the Army as well. 
 
                But we have applied considerable additional resources in the mental-health, emotional-health area and not just on treating those invisible wounds of war, but also trying to better understand how we can prepare our soldiers so that -- that they don't suffer those wounds, build resiliency. And Dr. Cornum can talk in some length about the resiliency training, the battlemind training.   
 
                But we have across the department, not just in the Army, a very strong emphasis on the mental-health issues. And roughly a year ago we began the chain teaching for PTSD, a plan to literally teach every single soldier in the Army, every single soldier with a face-to-face training initiative dealing with those mental-health issues, how to spot them, how to treat them, also reaching out to their families. So as we think about this conflict, the traumatic brain injuries, our blast -- the injuries that result from blast, the signature wound of this war, the effect on brain -- obviously, one of our major areas of emphasis, and then deal with the issue that's been with us as long as there is war, and that's the reaction to stress, the post-traumatic stress challenges. 
 
                As Dr. Schumacher's (sp) pointed out, you end up with post- traumatic stress disorder if it goes untreated.  
 
                Our job is to address post-traumatic stress and begin the healing process so it doesn't lead to disorder. But -- great emphasis on the mental-health issues; great emphasis on the traumatic brain injuries.  
 
                But, again, across the whole spectrum of care, you've got soldiers and civilians committed to making the medics more effective in the field. The advances we've made in prosthesis technology, it's just miraculous. You see what we can do with a prosthesis seven years ago and what we can do now. 
 
                So you've got -- we have areas where we are emphasizing, from a budget standpoint, Army-wide. But there is extraordinary effort going on at every piece of the care puzzle, with great leaders pouring their hearts into taking the piece that they own and making it better. 
 
                Q     Rebecca Moses (sp), from the Asahi Shimbun newspaper. This is going back to what you were talking about with PTSD, and this may be more of a question for Doc Cornum. Is there anything being done actively to address the -- I want to say the stigma regarding PTSD, especially -- not that it's MOS-specific -- but among 11 Bravos and 13 Bravos? 
 
                GEN. CORNUM: Well, certainly your comment about that group of people, the people who are actually involved in combat have a much higher level of post-traumatic stress symptoms afterwards than the people who are -- who feel safe and were not involved in combat -- probably about double. And there is. And battlemind training, which is -- which is a -- probably the only mental-health training that has actually been validated and shown that people who got it have less severe symptoms upon their redeployment, when they fill out all those surveys about their symptoms, and they feel more comfortable going to mental health. 
 
                I think the reason that is is because they probably -- they understand that what the -- the symptoms they're exhibiting are really not evidence of a disease. They're a normal reaction to having been exposed to very abnormal situations. That has reduced stigma more than, really, probably anything else we could do. We have not -- we are now putting an emphasis on several things. One is making sure that battlemind training is done to standard and is done for everyone, which has -- which we have discovered has not happened.  
 
                The other thing we are doing was we're doing another study comparing doing battlemind training with other resiliency-producing training, starting in basic training, starting before everybody's focused on, you know, pre-deployment, but -- because it should work to make you not only more resilient to going to battle, but more resilient in every -- in every stressful situation you face.  
 
                And we're comparing that and trying to take the best between battlemind -- and then the ACEP, the Army Center of (sic) Enhanced Performance, has also got techniques and training procedures that they would like to see expanded in the Army. 
 
                And we're going to do some validation studies, to make sure that that's true. And if that is, then we will promulgate those throughout the Army.   
 
                There are post-deployment battlemind training modules as well. We have some for couples. There is also a warrior resilience training, basically based on the Warrior Ethos. It's only been done so far in one division.   
 
                But they are also interested in having the community at large validate whether or not, not only do people like it and tell us that they feel like it has helped them, but whether or not we can show a decreased rate of severe symptoms, whether we can show, you know, enhanced willingness to go seek mental health care.   
 
                So I think normalizing their symptoms, into a normal response to an abnormal situation, will do a lot to decrease the stigma of seeking mental health care.   
 
                MR. GEREN: And the chain teach, where we are talking to every single soldier and we've now done it with over 900,000 soldiers, I think, that's done a great deal to get soldiers comfortable talking about those kind of issues, with each other, and to start to make them -- enable them to spot the symptoms in themselves, spot the symptoms in others and name them and not just deal with this, you know, generalized sense of anxiety.   
 
                We do these mental health surveys in theater. And the last one we did, MHAT V, actually showed progress on the issues that would -- you could use as proxies for a stigma.   
 
                You know, are you embarrassed to talk to somebody about a mental health issue? Are you -- do you think that if you're going to talk to a superior, about a mental health issue, is it going to ruin your career?   
 
                We have several questions that get at that point. And last year compared to this year, Mental Health Assessment in Theater, showed every one of those, we had -- we start where we are. They linger in the 40 to 50 percent range. But we saw improvement in every one of those indicators.   
 
                So I think that's just a barometer of progress, whether the soldiers in combat now, a higher percentage of them, are actually willing to go and seek help without concern that it is going to affect their ability to continue to serve, in the Army, or to be promoted in the Army.   
 
                So is it still a challenge? Stigma is a challenge. It's a challenge in society in general. It's certainly a challenge in the culture of the Army, where we have a premium on strength, physically, mentally, emotionally.   
 
                But we are making progress and recognize that that's one of our impediments to making great progress.   
 
                So a lot of focus on trying to figure out how we get people to open up about these issues. 
 
                Part of it, too, is directing some -- the training and the education at the families so that their spouses can recognize it and help them come forward and deal with their issues. 
 
                Q     Can I just ask a quick follow-up of General Cornum? Do you have either a percentage or a number as to how many soldiers currently are getting or have gotten the battlemind training? Do you know at this point where you stand? Because it was -- wasn't it -- it was just a trial for -- for some time, right? 
 
                GEN. CORNUM: It was a trial for -- it was a trial for a while. And while it was a trial and we were -- and the medical research people were actively, you know, studying people before, during and after -- the people who took it, people who didn't -- I could have told you that. Right now, I can't. We just -- just very recently have been looking at making that part of the pre-deployment SRP to ensure that did you get your battlemind, to make sure on the post- deployment, did you get your battlemind. Then we even have a follow- on for the reassessment, the post-deployment reassessment. 
 
                So at this point, I honestly cannot tell you what percentage of people have gotten it. 
 
                SEC. GEREN: We'll get back to you with that. 
 
                GEN. CORNUM: But we will get back to you to that. 
 
                Q     Okay, or is it -- is it something that they are now all supposed to be getting? Or, I guess, where do we stand? Are they -- is everyone supposed to be getting it, so you're not sure at this point how many have? Or is it still sporadic such that they -- some people can decide whether or not to -- 
 
                GEN. CORNUM: My -- I believe it is -- I believe it is actually part of the -- of the pre-deployment training. But it can be given either, you know, very effectively or less effectively. And so I can't tell you how many -- how many people get it, for example, sitting in an auditorium, looking at a large slideshow; how many people get it in a small squad and platoon where you can talk about it with a trained facilitator. That part I cannot tell you. 
 
                LT. COL. CARL CASTRO (DIRECTOR OF MILITARY OPERATIONS, MEDICAL RESEARCH PROGRAM, FT. DETRICK, MARYLAND): I would just -- Secretary Geren directed within a week of taking over that every soldier would receive both the pre-deployment battlemind training and the two post- deployment battlemind training modules. So it is -- it is a requirement for every soldier to receive it. 
 
                STAFF: Col. Castro, could you identify yourself, please? 
 
                LT. COL. CASTRO: Col. Castro. (Laughter.) 
 
                STAFF: Louie (sp). 
 
                Q     If I could ask about the third of the population of these WTUs who are not -- who are in the system not because of deployment injuries. 
 
                SEC. GEREN: Right. 
 
                Q     Are they a drag on the system for the wounded care? And is there a plan to reorganize it so that they can have their own path for medical care so that they're not a drag if, in fact, they really are? 
 
                SEC. GEREN: Let me first say, before you answer, I mean, we -- we look at every soldier based on the soldier's wound, illness or injury -- not where the wound, illness or injury came from, but it's based on the needs of the individual soldier. 
 
                And we don't distinguish whether you lost your leg in a backhoe incident in a construction accident or in some other fashion. So our philosophy is to treat the wound, illness or injury and have the system respond to that, and not distinguish based on where the wound originated. 
 
                But Gary. 
 
                GEN. CHEEK: If you'd asked me that question a couple months ago, I would have given you a different answer, in that we -- I guess the right way to put it is, we linked our warrior transition units to a lot of our units that were deploying. And one of the things that we did is we made a decision in the Army in October of last year that for deploying units if they had soldiers in the Medical Board or that were medically non-deployable, we directed them to move those soldiers to the warrior transition units. And many of those soldiers did not have severe injuries or ones that required that focused, managed care. 
 
                Now, it wasn't necessarily a bad decision. In fact, we really provided great service to those deploying units to be able to focus on their task, and we probably also helped a lot of those soldiers by giving them more attention to their medical conditions and more focus on the forward processes. And so one of the benefits of that decision is we did move a lot of soldiers through board processes and other things, and so we had some positive effects. 
 
                But in the end what we found was, is that we brought a lot of soldiers into the program that didn't need that nurse case manager to really watch their -- you know, their medical conditions and other things. And so we really risked devoting too many resources to it. 
 
                So we have changed our policy to make it the severity of the wound, illness or injury as the key that brings the soldier into the program. And since, for example, July when we put this order out, the number of soldiers in our warrior transition units has dropped by about 1,200 soldiers. And it's slowly coming down. We didn't have any kind of a culling of the herd. We didn't force anyone out.   
 
                But a couple of other points about that. Those soldiers don't go away. If we're not going to take care of them in a warrior transition unit, they're still going to be in the Army. We're still going to have medically non-deployable soldiers. So we have asked our commanders to watch this carefully because we don't want to overburden units managing them or rear detachments. And so we may yet adjust again. And it may not involve the warrior transition unit. But we do -- every soldier, obviously, very special to us in taking care of them, and so we want to make sure we do that properly.  
 
                But historically, Army units take care of soldiers with a wide array of medical problems. Every day in the Army there are tens of thousands of soldiers going to sick call or getting into accidents or other things. And units have done a tremendous job of taking care of them, getting to appointments, rehabilitative care, and that type of thing.   
 
                So, for the more minor conditions, or routine rehabilitation, the Army leadership and Army units can take great care of those soldiers. And that's what we're counting on. But we are going to watch it to see its aftereffects. 
 
                But I would tell you, our warrior transition units are not overburdened; they are not having a difficult time coping with the number of soldiers that are in there; we are not understaffed. So we're really in great shape to take care of this. And I do believe over the course of the next year that the numbers will very likely decline slowly.   
 
                And we have no target number we're after. If the number went up to 20,000, the Army would focus the resources to take care of soldiers appropriately. So we just want to make sure we're really focused on those severely wounded, ill or injured soldiers that need the complex, you know, management that this unit provides. 
 
                MR. GEREN: The point I wanted to make, though, when General Cheek talked about the population, he broke it into thirds. Evacuated from theater, dealing with issues that may have developed in theater but didn't require evacuation then, and third, totally unrelated to deployment.   That's a way to describe the population, but that doesn't determine how we treat them or how we care for them. That care is not related to which one of those thirds they happen to fall into. So I just -- we don't distinguish between those thirds; they're all treated the same.  
 
                Q     My name's Carl Osgood. I write for Executive Intelligence Review. I actually want to follow up on what you were just talking about, General Cheek, about the -- you said the WTUs are not overstaffed. I know that -- I presume, anyway, that the rate of -- I mean, the intensity of combat in Iraq is much lower than it was, let's say, two years ago, which presumably means you're getting a lot fewer wounded than you were then. So I'm just wondering how you manage the capacity of the system. Right now it seems to be below -- the demand seems to be below capacity, but how do you maintain it so that, if you have another surge of wounded, that you can handle the surge? 
 
                GEN. CHEEK: Well, on every installation, the commanders are responsible for making sure that they've got the appropriate cadre. 
 
                And then the regional medical commands, of which General Horoho is one of them; she will make sure that we have the appropriate medical, either nurse case managers, doctors and even specialty care. So we can move some of that around to match a surge.   
 
                The other thing we can do is, because we have 36 of these units, we have a little bit of flexibility in where we place the soldiers. The other thing, and I'll use Fort Campbell as a great example of this. Fort Campbell, starting this month, will begin the redeployment of, I believe, it's like four brigades from both OIF and OEF.   
 
                Well, with redeployment of four brigades and 12,000 soldiers, we have a predictive model that we use to determine what, we believe, the number of soldiers that will be added to the Warrior Transition Unit. In this case, the estimate is about 200.   
 
                So right now if you looked at the Cadre, at Fort Campbell, you would see that they have already built to the capacity to meet that. And we confirmed that with them just the other week.   
 
                So there's a little bit of science in this. But we do have some flexibility. But the real trick though is, you have to be able to work it both ways. I mean, we don't want to have excess capacity.   
 
                So if the numbers drop down, you know, we want to make sure we're not over-resourcing it. But it isn't easy. It's probably easier to match a little bit of growth than it is, you know, the larger decreases. But we watch that on a weekly basis.   
 
                Q     Hi.   There was some talk earlier about reducing the stigma for psychological wounds. The Defense Department is considering whether troops suffering from PTSD should merit the Purple Heart. I was wondering what your thoughts are on the matter.   
 
                MR. GEREN: The Secretary of Defense has raised that issue. And we do provide Purple Hearts for wounds that come from a concussive effect and wounds that are related to a violent incident.   
 
                The issue of PTSD; I don't want to try to speak to that. It's something the secretary has raised.  It's an issue that's under consideration. But I couldn't tell you, as a department, where the matter stands at the present time.   
 
                (Cross talk.)   
 
                Thank you all for coming out today and giving us an opportunity to discuss this with you.   
 
                Dr. Gates said it the best. Other than the war itself, there's no higher priority than taking care of our wounded.   
 
                And I can tell you that's part of the heart and soul of everybody in the United States Army, soldier and civilian.   
 
                We are a learning and adaptive organization. The stress of war accelerates the learning curve. And if you look at the way we take care of soldiers today, the way we took care of them six or seven years ago, there have been just extraordinary advances. Over the course of the last seven years, there's just no element of Army care for our wounded that hasn't shown dramatic improvement. 
 
                General Cheek focused on the area that has been much in the public eye, and that's the treatment of our outpatients. We have completely reorganized our Army to better take care of those in our outpatient, and it's a work in progress. We will continue to refine and make it work better. 
 
                But as an Army, our soldiers and civilians have had much to be proud of. Our doctors, our nurses, our medics, our med-tech folks, our researchers have just done an extraordinary job of expanding the envelope of knowledge on how we take care of wounded warriors.  
 
                And I'm very pleased that Dr. Gates has set aside this month to try to get our -- internally, our soldiers, sailors, airmen and Marines focused on care of our wounded, ill and injured and have the country focus on it as well.   
 
                Extraordinary progress has been made. It is -- it's an ethic that every soldier, every army civilian lives, and that's taking care of their fellow soldiers. Soldiers take care of each other. And although we've got areas where we have to improve, are going to improve, I think if you look at what our soldiers and our Army civilians have done over the last seven years, it's extraordinary progress and it demonstrates their commitment to each other. 
 
                And so we're looking forward over the coming month to have an opportunity to talk with you all further and highlight different aspects of our care for our wounded, ill and injured. But thank you all for coming out today. Appreciate it. 
 
                Q     Thank you, sir. Thank you, General Horoho. 
 
                GEN. HOROHO: Thank you.
 
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