Army Medical Action Plan
What is it?
The Army Medical Action Plan (AMAP) is an Army initiative to develop a sustainable system wherein wounded, injured and ill Soldiers are medically treated and rehabilitated to prepare them for successful return to duty or transition to their homes and communities. The development of the AMAP was
directed by the Vice Chief of Staff of the Army to resolve difficulties Soldiers were having with the outpatient and disability evaluation system at Walter Reed Army Medical Center. The source of many of these difficulties were identified in the findings of a Department of the Army Inspector General investigation from March 2007 that found policy inconsistencies, inadequate training of personnel, and data and information management inaccuracies that diminished the ability of the physical disability evaluation system to meet the needs of Soldiers.
The AMAP establishes an integrated and comprehensive continuum of care and services for Warriors in Transition. Warriors in Transition are active or reserve Soldiers who meet the appropriate criteria to fall under the provisions for Medical Hold, Medical Holdover, or Active Duty Medical Extension. Included in this population are active component Soldiers who require a Medical Evaluation Board (MEB) or have complex medical needs requiring more than six months of treatment. Warriors in Transition do not include Initial Entry Training, Advanced Individual Training, or One Station Unit Training Soldiers except in extraordinary circumstances. Exceptions to this definition must be approved by the local military treatment facility and the Soldier’s unit commander. The continuum of care includes family members and both Department of Veterans Affairs and civilian health care providers.
What has the Army done?
The AMAP, developed in April 2007, was translated into a five-phase Department of the Army Execution Order (DA EXORD 118-07) entitled “Healing Warriors” and published 4 June 2007. During Phase I (April to June 2007), Army leadership and various commissions solicited input and listened to the concerns of Soldiers across the Army, their Families, and numerous health care professionals. As a result of that input, the AMAP expanded its collaboration to include the Army National Guard, the Army Reserve, the Department of Veterans Affairs and numerous other governmental and nongovernmental agencies.
In May 2007, Army leaders approved ten “Quick Wins” for implementation across the Army by Jun 15, 2007. These included:
1) Improved Command and Control. Previously, wounded and ill Soldiers undergoing prolonged evaluation and treatment (termed Warriors in Transition) were separated into either Medical Hold Companies (active component Soldiers) or Medical Holdover Companies (reserve component Soldiers) which fell under different commands with varying leader-to-led ratios, disparate resources, and often disparate billeting and support structures. The Warrior Transition Units (WTU) created as part of the AMAP are part of the Army’s new Soldier-centric health care system wherein every Warrior in Transition and family member has a triad of support. This support triad is comprised of a squad leader, a primary care manager, and a nurse case manager. The triad supports the warrior in his or her mission to heal.
2) Institutionalizing the Structure. Previously, the companies supporting Warriors in Transition were not formally manned. Each location was left to devise a method of manning these units by diverting personnel from other duties. In addition, the baseline manning document of the medical treatment facility was not adjusted to account for increased workload with increasing numbers of Warriors in Transition. A formal manning document now exists that authorizes personnel to provide leadership, clinical oversight and coordination, and administrative and financial support at a strength based on the size of the population supported. At the heart of this structure is the triad of the squad leader, the primary care manager and a nurse case manager to provide a synergistic level of support incorporating leadership, medical oversight, and medical coordination and management.
3) Prioritized Mission Support. Army leadership has directed the senior commander on each Army installation with a Warrior Transition Unit to make Warrior in Transition facilities and furnishings top priorities for repairs and improvements. In addition, these commanders conduct monthly Town Hall meetings to identify areas for improvement to better serve Warriors in Transition and their Families. Commanders and staff from the medical treatment facility, Warrior Transition Unit, and garrison all attend these meetings.
4) Flexible Housing Policies. Policy now allows single Soldiers to choose a non-medical “caregiver” who will receive military or guest house lodging in the same manner that Family members of married Soldiers have been authorized. Warriors in Transition are now considered on par with key and essential personnel for military housing vacancies.
5) Focusing on Family Support. Previously, Families arriving at medical treatment facilities in support of a wounded or ill Warrior received varying levels of support. The Army, recognizing the importance of supportive Families, has institutionalized best practices Army-wide. Escorts now meet Families at airports and bring them to the medical treatment facility to meet their Warrior. Soldier and Family Assistance Centers have been established to: provide administrative and financial assistance; assist with coordinating government entitlements, benefits and services; and provide information and assistance in obtaining nongovernmental benefits and services. A Soldier and Family Hero Handbook is provided to all Warriors in Transition and Families as a further aid. Formal Family Support Groups have been established with the support of a full-time Family Readiness Support Assistant. The Medical Command has trained ombudsmen who identify and resolve issues directly.
6) Development of Training and Doctrine. Cadre and staff in the companies supporting wounded and ill Soldiers previously received no formal training, and no formalized standard operating procedures existed. The Army has developed standard operating procedures for the newly established Warrior Transition Units (WTUs), focusing on the mission of these units—to set the conditions to facilitate the Soldier’s healing with the goal of returning the Warrior to duty, or to facilitate the transition to active citizenship. Orientation programs for new WTU commanders and cadre have been developed and all Warrior in Transition Unit Commanders and staff have been trained. Newly assigned cadre are required to complete the resident course version of this training at the Army Medical Department Center and School. Army Medical Command has developed training programs in the identification and treatment of Post-Traumatic Stress Disorder with special focus on social work personnel, nurse case managers, and psychiatric nurse practitioners. The Army leadership has established a Post-Traumatic Stress Disorder and Traumatic Brain Injury awareness chain teaching program for all leaders and Soldiers.
7) Maintaining Full Patient Visibility. In previous wars, commanders often found it difficult to locate Soldiers after they were evacuated from the battlefield. Total Army implementation of the Joint Patient Tracking Application as part of the Army Medical Action Plan has greatly improved this situation by providing a notification to each Warrior in Transition’s commander that includes instructions on how to contact the Soldier and how to submit awards and evaluation reports for battlefield service. The Army Medical Department recognizes that Soldiers requiring evacuation may prefer to receive their care close to supportive family and has developed a system to allow Soldiers to designate a preferred treatment location prior to deployment.
8) Facilitating the Continuum of Care and Benefits. Communication and coordination of efforts between the Departments of Defense and Veterans Affairs continue to improve. Army Medical Command is collocating Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA) liaisons and nurse case managers to support the continuum of care and benefits, thereby easing the transition of care and support from the military to the Department of Veterans Affairs. The Army has developed formal mechanisms to seek the Soldier’s approval and transmit important medical and administrative information between the Army and the Department of Veterans Affairs to expedite the continuum of care process.
9) Improving the Medical Evaluation Board (MEB) Process. Soldiers undergoing a Medical Evaluation Board previously had to make an appointment with their nurse case manager to find out the status of their MEB. Army Medical Command has created the MyMEB website on the Army Knowledge Online webpage, allowing Warriors to go online and access the status and progress of their MEB. Located on Army Knowledge Online at https://www.us.army.mil/suite/page/417118, “MyMEB” automatically downloads information from the MEB Internal Tracking Tool database. In addition, a physician dedicated to assisting Soldiers with the MEB process is being assigned for every 200 Soldiers in the process. To further assist Soldiers in expediting the MEB process, the Army Medical Command has implemented new access-to-care standards for Warriors in Transition. Only Soldiers preparing to deploy have priority over Warriors in Transition for non-emergency appointments.
10) Enhancing Physical Evaluation Board (PEB) Representation. Reserve Component lawyers and paralegals have been called to active duty to provide additional legal advocacy for Warriors undergoing the PEB process and to act as legal advocates for these Warriors in Transition.
In Phase II (Jun 16 to Jul 15, 2007), the Army provided the necessary leadership structure to allow Warriors to focus on healing, ensuring each Warrior receives personalized, one-on-one attention. Squad leaders have a close working relationship with nurse case managers assigned to that squad. The squad leader and case manager work as a team in conjunction with the third member of the triad, the primary care manager. Each part of the triad has clearly delineated responsibilities to care for the needs of the Warrior, with enough overlap to provide a safety net of support that should not allow for any Warrior to fall through the cracks.
During Phase III of the execution of the AMAP (Jul 16 to Sep 3, 2007), the Army focused on conducting staff assistance visits (SAVs) to select installations with newly formed WTUs. The Army has 32 WTUs stateside (including Alaska and Hawaii) and three additional WTUs at Army installations in Germany. The 35 WTUs include the Warrior Brigade at Walter Reed Army Medical Center, 14 Warrior Transition Battalions, and 20 Warrior Transition Companies. Four SAV teams, with subject matter experts from 15 Army agencies and the Department of Veterans Affairs, visited and provided assistance at Army installations including Walter Reed; Tripler Army Medical Center in Honolulu; and Forts Benning, Bliss, Bragg, Campbell, Carson, Drum, Gordon, Hood, Knox, Lewis, Riley, Richardson, Sam Houston and Stewart. At the conclusion of the SAVs, the AMAP cell analyzed trends across the Army.
Phase IV (Sep 4, 2007 to Jan 1, 2008) began with organizations achieving initial operational capability. This level of capability enables WTUs and SFACs to provide critical services to Warriors in Transition and their Families. A Department of the Army Inspector General (DAIG) follow-up inspection occurred during this phase. In preparation for the inspection, SAV teams worked closely with the DAIG to ensure that inspection teams understood WTU and SFAC inspection criteria. As an azimuth check on the progress of the AMAP and to develop next generation capabilities to further develop Soldier-centric health care delivery, an Army Medical Action Plan Assessment Conference was held 21-26 October 2006.
What continued efforts does the Army have planned for the future?
Phase V, which began Jan 2, 2008, commenced with organizations achieving full operational capability and completion of first generation AMAP objectives. Critical to this phase will be acting on areas of weakness, championing and accomplishing needed legislative changes, obtaining funding to support ongoing improvements, ongoing development of expanded training capabilities, continued monitoring of progress, and the full development of future capabilities.
Why is this important to the Army?
The brave men and women of the U.S. Army continue to serve honorably and courageously in this persistent conflict to eradicate terrorism that threatens the well-being and future of all Americans. In keeping with the Warrior Ethos which declares that America’s fighting men and women will never leave a fallen comrade, the Chief of Staff of the Army, General George W. Casey, Jr., has said that, “Taking care of wounded warriors is the most important thing we can do.” By continuing to develop a Soldier-centric system of care that both ensures our brave men and women are medically fit to fight while also standing beside them in illness, injury, recovery, and transition either back to the force or to promising lives in the private sector, the Army ensures that our heroes will indeed receive the care and assistance they so richly deserve.