The Army is taking full advantage of the momentum we have towards building a ready, modernized, multi-domain Army capable of meeting the future demands identified in our National Defense Strategy. As the 45th Surgeon General and commanding general of U.S. Army Medical Command (MEDCOM), Lt. Gen. R. Scott Dingle is at the forefront of those efforts, providing advice and assistance to Army senior leaders on all healthcare matters and our healthcare system during a global pandemic. As the senior leader responsible for the development, policy, organization, materiel development, leadership, and management of the Army’s world-wide health service system, Dingle continues to build a medically ready force and a ready medical force, while validating the ability of the medical enterprise to sustain the strategic support area (SSA) during a contested operation.
People and readiness are top priorities for the Army Chief of Staff. How is the Military Health System postured to ensure our Soldiers are ready to train and deploy when called upon?
The mission of the Army is to deploy, fight, and win our nation’s wars. To do this, Soldiers and units must first be medically ready. Our initial contribution is ensuring they are healthy, strong, and ready to deploy. Our second contribution is a ready medical force. These medical units support our No. 1 priority: Readiness.
While not a traditional fighting force, our fight is in conserving the Army’s fighting strength and sustaining our Soldiers’ lives. We do this by ensuring that every health care worker, medical specialty, or unit can rapidly deploy and position itself as far forward as possible to sustain and conserve lives on the battlefield.
The first thing an injured Soldier yells in combat is “Medic!” That first responder has to be trained and ready to save that life. It starts with a ready medical force comprised of medically ready individuals. Returning our Soldiers to duty is our contribution to the force.
Readiness begins with the readiness of our people. What role has MEDCOM and the Army Medical Department played in the COVID-19 response?
We are fighting against a different enemy that is attacking our nation. The Army was called upon to support the Whole-of-Government approach. We first embedded military and civilian professionals that include scientists, doctors, medical planners, logisticians, strategists, and preventive medicine experts into various government organizations such as Health and Human Services (HHS), Federal Emergency Management Agency (FEMA), and multiple COVID-19 task forces.
Secondly, Medical Research and Development Command, under Army Futures Command, has been at the forefront since day one assisting with vaccine development, research, and creating medical countermeasures against COVID-19.
The next piece is our testing capacity. Initially, HHS and the Centers for Disease Control and Prevention stood up testing sites where Department of Defense (DoD) was responsible for 11 testing sites with nine belonging to the Army—a mission new to us as we supported diagnostic COVID-19 testing at those early testing locations.
We were directed to expand capacity within MEDCOM and synergize our effort with the Office of the Assistant Secretary of the Army for Acquisition, Logistics and Technology, G-4, and G-3/5/7 to ensure readiness. We expanded from nine to more than 42 testing locations. Commanders expanded their testing capability and capacity through a concerted effort with our strategic and industry partners which resulted in an abundance of capability and newer testing kits. Just before we began initial distribution to our labs, the Presidential Task Force asked us to redirect our resources across the country supporting states, local requirements, and our citizens thereby increasing testing capacity across the country.
We then focused on our Soldiers. Our mission rapidly shifted to conserving the health and building readiness for our hospital units and field hospitals that rapidly deployed to places like the Javits Center in New York City and to Seattle to provide immediate resources to local communities.
Lastly, HHS came back and asked us to expand our FEMA established Field Medical Stations (FMS) which consists of DoD civilian public health medical professionals who primarily support hurricane and emergency responses. We helped modify the FMS by creating an Urban Augmentation Medical Task Force that changed and enhanced the requirements needed to support a pandemic. We modified that original 85-person team with additional nurses and intensive care specialists who were better trained and suited for this particular environment and cross-leveled these skillsets from across the Army.
What are some of the steps we took to ensure the health of our force, both at home and at our installations abroad? Are there any lessons learned from the H1N1 and Ebola pandemics implemented to ensure the safety of our Soldiers as they continued their missions during the COVID-19?
We were able to rapidly pull our “Pandemic Emergency Response Plans” off the shelves to ensure the force health protection of our Soldiers. Our lines of effort were: Prevent, Detect, and Treat. This is not a combat operation in Afghanistan, but instead a medical pandemic operation requiring a synchronized response across the Army.
We quickly learned that the response to COVID-19 is a military operation—the hospitals are military units! During the Military Health System transition of all service hospitals and clinics to the Defense Health Agency (DHA), we were actively attempting to separate health care delivery from readiness with the services retaining readiness and DHA owning health care delivery. However, we now understand that these are inextricably linked and you can’t just separate the two.
In response to the need for medical professionals during the pandemic, can you discuss how we brought back volunteers to serve in military medical treatment facilities where we had vacancies?
Our requirement to support COVID-19 operations forward deployed across the country while also providing critical care to our Soldiers, beneficiaries, and local communities was a tough balancing act for our regional commanders who realized cross-leveling our medical professionals to fill gaps as we pushed our personnel forward would not be enough. We knew the answer was our Retiree Recall program.
Human Resources Command distributed the initial message which garnered over 25,000 responses from retired Soldiers who wanted to answer the call. Once we peeled back the onion, only 6,000 had the medical specialties we required; only 600 were fully capable of supporting this critical mission; and in the end, we put 170 health care professionals back on active duty to support COVID-19 requirements around the world.
Can you discuss the impact of recent reform initiatives across the Army medical enterprise, such as realignments to the DHA, Army Materiel Command (AMC), and Training and Doctrine Command (TRADOC), as well as Theater Lead Agency for Medical Materiel Service responsibility in support of combatant commands operations?
My vision for Army Medicine is captured with my “Five Rs:” ready, reformed, reorganized, responsive, and relevant. Recent reform initiatives across the Army medical enterprise all play into this approach, including realignments to DHA, AMC, and TRADOC.
Army Medicine is now in step with the rest of the Army, and marching in cadence. We nested with the rest of the Army when all of the schoolhouses realigned under TRADOC, and materiel development moved to Futures Command. The logistics piece now falls under AMC and G-4, and we leverage their existing systems and capabilities.
As Futures Command stood up, these cross-functional teams ensured the integration of medical research and development equities underneath one umbrella. The theater lead agents for medical materiel perfectly highlights the power of these reform initiatives. These designated units synchronize medical materiel needs for their respective combatant commands and are fully integrated with other logistics and sustainment enablers in the SSA. We are fully integrated to support multi-domain operations.
The reform piece is the next level. The National Defense Authorization Act is directing us to reform, and the law states what we will do. The management, authority, and control of medical treatment facilities will go through DHA.
We were in the process of transitioning those facilities when COVID-19 hit. In April, we paused to focus on the pandemic.
We are evaluating the transition plan. If there are lessons learned that we need to incorporate from our battle with COVID-19, we will add those and get this right.
You touched on relevancy in the 5 “Rs” and I want to think about the SSA in the future when those supply lines and lines of communication may not necessarily be safe all the time. How is the medical field and force evolving to stay relevant in that operating environment?
The medical field is always evolving to stay relevant. The multi-domain operations concept evolves as cross-functional teams develop and modernize their portfolios. Army Medicine must remain integrated in order to change with the Army and sustain multi-domain operations.
Being far forward on the battlefield and integrated into those systems and leveraging those capabilities will ensure Army Medicine stays relevant.
Can you discuss current health and wellness initiatives, such as the holistic health and fitness programs, and how they are shaping the Soldiers of the future?
The Army Combat Fitness Test (ACFT) and Holistic Health and Fitness (H2F) are TRADOC-led initiatives. We remain integrated with both initiatives.
H2F is about Soldier readiness and ensuring we have the right mix of specialties to prevent injuries or to help in recovery. Embedding physical and occupational therapists, dietitians, athletic trainers, and strength coaches will build Soldier readiness. These specialties will help the Soldiers and leaders understand how to properly eat, train, and prevent injuries. Preventing or reducing the high number of injuries primarily resulting from physical training will have a huge impact on Soldier medical readiness.
Our medical professionals from Army Public Health Center continue to advise, assist, and monitor the roll-out as we work to prevent injuries and utilize the H2F concept to rehabilitate and rapidly return those Soldiers to the fight.
Army G-4’s Go-For-Green initiative directly supports the Performance Triad—the synergy of sleep, nutrition, and activity that enhance Soldier readiness. We want our Soldiers to make wise, healthier choices.
Soldiers must get the right amount of sleep to maximize performance. We have the eating right to fuel the body; we have to increase our physical activity and training to better align with the new ACFT.
You were commissioned into the Army Medical Services Corps, which was a surprise to you. Your career has taken you to assignments historically not served by medical corps officers. What advice would you give to an incoming Soldier in the Army today based on your experiences?
Live your dream, set your goals, and anything is possible. Live above the level of mediocrity. The blessing for me coming in the Army was it introduced me to a team of teams in which the sky's the limit. I can go as far as I can see. I can climb as high as I’m willing to climb. I can run as far as I’m willing to run and nothing can stop me if I have the passion.
From the first time I came in, every day has been the best day. Every unit has been the best unit. Every job has been the best job. Even through adverse times, there was always a rainbow at the end of it. Through the determination of going after your goals nothing can stop you.
I’m the first surgeon general that is a Medical Ser-vice Corps officer. I am not a clinician. I am a medical operator, a medical planner, a health care administrator.
The evolution of our talent management system and the leadership of past surgeons general leveled the playing field—they said, “you know what, it’s not just going to be a doctor, but it’s going to be the best person, the most talented, the best leader, who is going to command our medical companies, our field hospitals, and become general officers.” As they leveled the playing field, it gave opportunity for nurses, Medical Service Corps officers, dentists, and every specialty to live their dream, to be the best in the show, and that has allowed me to ascend to where I am.
I’ve been very blessed in my career, a very unique glide path from being the first Medical Service Corps officer to graduate from the School of Advanced Military Studies. I came out of that course not as a medical planner, but as a combat planner and I took that mentality all the way from the 18th Airborne Corps to Afghanistan as part of CJTF-180. I took advantage of every opportunity presented to me by my leadership whether working on Provisional Reconstruction Teams or synchronizing joint and interagency operations with the CIA or FBI.
I have a great team now as the 45th Surgeon General and my story is live your dream, set your goals high, be a professional leader of excellence, and always build synergistic teams to achieve your goals. Nothing can stop you. I’m a guy from Upper Marlboro, Maryland, here as the surgeon general which was beyond my wildest dreams. As a college football and track athlete, I just love leader-ship, competing, and building teams. Coming into the Army, it was like “wow, this is the same thing.” Then I just set my goals high and lived my dream. Live your dreams, go after it, and have fun.
Arpi Dilanian is a strategic analyst in the Army Logistics Initiatives Group, Office of the Deputy Chief of Staff, G-4, Department of the Army. She holds a bachelor's degree from American University and a master's degree from Rensselaer Polytechnic Institute.
Matthew Howard is a strategic analyst in the Logistics Initiatives Group, Office of the Deputy Chief of Staff, G-4, Department of the Army. He holds bachelor's and master's degrees from Georgetown University.
This article was published in the October-December 2020 issue of Army Sustainment.