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  Naval Hospital Bremerton Reminds Everyone that this is Flu Season


By Douglas H Stutz, Naval Hospital Bremerton Public Affairs –
There have been two fatalities directly linked to influenza in Kitsap County since November.  Neither were connected to the military, but with this in mind, Naval Hospital Bremerton is echoing the concerns of the Kitsap Public Health District and emphasizing the importance of flu shots.

 

“Getting a flu vaccine is the only known method to prevent the flu.  A vaccine isn’t 100 percent effective, but it can decrease the chances of influenza infection, and if someone still becomes infected, they are less likely to have severe symptoms,” stated Capt. Steven Kewish, Director for Medical Services, also strongly stressing that a person does not get the flu from the vaccine.

According to Hospital Corpsman Kit Reed of NHB’s Immunization Clinic, there have been approximately 2,200 vaccines provided at the clinic during the flu season, with over 1,780 in Nov. and Dec. and another 420 in January. NHB’s annual Influenza Vaccination Shot Exercise (SHOTEX) also gave out 3,882 vaccinations for five days in Nov., averaging 776 people a day during that time– either by FluMist or
injectable vaccine (shot).

NHB has currently given the flu vaccination to more than 6,000 beneficiaries. Those who have not received their vaccination can visit NHB’s Immunization Clinics at the main hospital and branch health clinics, for both injectable and, for healthy patients between 2 years and 49 years of age, the intranasal flu vaccine.

“We are not only giving the influenza vaccine but also childhood vaccines, supporting active duty members getting ready for deployments/going overseas who need inoculations, and other routine vaccines.  Without the hard working staff at the Naval Hospital none of that could be done. The most gratifying part is knowing we are helping and preventing our patients from getting sick,” said Reed.

NHB’s Immunization Clinic is available from 8 a.m. to 4 p.m., Monday through Friday. BHC Bangor is 7 a.m. to 3 p.m., BHC Everett is 7 a.m. to 4 p.m. and BHC Puget Sound Naval Shipyard is 7 a.m. to 3:30 p.m., all Monday through Friday.

Chief Hospital Corpsman Mark Sizemore, Family Medicine Leading Chief Petty Officer, attests that there is still a need for inoculations even after the seasonal influenza vaccine immunization program held in Nov. 2015 specifically designed for Sailors and Marines, mission-essential healthcare personnel, and eligible beneficiaries.

“Everyone who has gotten their flu vaccination, that’s good. But there are different strains of influenza out there. Plus, over the holidays people travel from state to state and even to other countries so a person can be exposed to it,” Sizemore said.

“Even if a vaccine doesn’t impact the virus a person has, it can definitely lessen the effects of it,” added Kewish.

For those already inoculated with the annual immunization, they do not need to receive it again – only children who have never received a flu vaccine because they require a two-shot series the first year they get vaccinated. 

 

The US Centers for Disease Control and Prevention recommend that everyone, even those as young as six months, should get the influenza vaccine each year.  It is especially important for pregnant women and people with chronic diseases like asthma and diabetes, and those that have weakened immune systems. 

 

Dr. Dan Frederick, NHB Population Health and Forecasting expert, points out that the value of vaccinating the pregnant population is multiplied because of the cocooning protection to the newborn when mom (and other close household contacts) are vaccinated. Just as it is important for military personnel who live and work in close quarters to receive the vaccine, it is also highly recommended for school-aged children, as they come into close contact with each other and can easily spread the influenza virus.


“Flu cases have started to pick up in the last week. We have seen some who have been positive for flu in our Urgent Care Clinic. We always hope that as many people as possible take advantage of the week-long clinic we scheduled earlier, but it’s always better late than never to get their vaccination,” Frederick said.

 

Immunization remains the primary method of reducing seasonal influenza illness and its complications.  The seasonal influenza vaccine not only helps protect vaccinated individuals, but also helps protect entire communities by preventing and reducing the spread of the disease.

Influenza is not the common cold. Influenza can be a severe to life-threatening disease and getting an annual influenza vaccine immunization - either the traditional shot in the arm or the newer nasal spray vaccine - protects many people from getting the disease or becoming severely ill.

There are also multiple steps that can be done daily to mitigate the potential spread of the flu.  One of the most effective is hand washing.  

“We strongly encourage everyone to use basic common sense when it comes to personal hand-hygiene,” commented Cmdr. Annie Case, Quality Management Department Head.  “We want everyone, from staff to visitors to patients to use soap and water before they enter a room, upon exiting a room, and after every encounter. Also, our alcohol-based hand sanitizers are effective in eliminating the transfer of a virus. Anyone entering and leaving, or waiting by the elevators should use them.”

The reason why Case and others stress continuous hand-hygiene in not just a hospital setting but in the everyday routine is that influenza is thought to spread mainly from people touching something with influenza viruses on it and then touching their mouth or nose. 

One of the challenging aspects of flu is that someone who becomes infected can infect others one day before they have symptoms and up to five days after becoming sick.  Influenza usually causes mild to severe illness, and in extreme, uncommon, cases can lead to death. 

Symptoms of influenza include fever, headache, extreme tiredness, dry cough, sore throat, chills, runny or stuffy nose and muscle aches. Stomach symptoms such as nausea, vomiting, and diarrhea also can occur but are more common in children than adults. Traditionally, seasonal flu impacts the elderly and the young.

According to the CDC, every year in the United States, more than 200,000 people are hospitalized from influenza complications and about 36,000 people die from influenza-related causes.   General information of seasonal influenza can be found at http://www.cdc.gov/flu/.   

The CDC considers the flu season to generally start in October and linger until May, with the peak months December to February. There were five confirmed adult deaths in Kitsap County during the 2014-15 flu season.

What can people do to protect themselves against the flu virus? 

Naval Hospital Bremerton follows CDC recommendations to:

·         Avoid close contact with people who are sick, when you are sick, keep your distance from others to protect them from also getting sick.

·         If possible, stay home from work, school and errands when you are sick.  You will help prevent others from catching your illness.

·         Cover your mouth and nose with a tissue when coughing or sneezing.  It may prevent those around you from getting sick.

·         Washing your hands often will help protect you from germs.

·         Avoid touching your eyes, nose or mouth.  Germs are often spread when a person touches something that is contaminated with germs and then touches his/her eyes, nose or mouth.

 

Naval Hospital Bremerton Staff Share the Legacy of Dr. Martin Luther King Jr

By Douglas H Stutz, NHB Public Affairs -- Naval Hospital Bremerton celebrated the birthday of Dr. Martin Luther King Jr. with a remembrance ceremony on Jan. 15, 2016 that focused on many notable attributes of his life and legacy.

 

The NHB Diversity Council coordinated a table display featuring multiple gift bags, from which a dozen staff members then randomly reached into and read an audio offering – a short statement on the meaning of the King holiday by Coretta Scott King - and the lingering heritage of the late, great Civil Rights leader and Nobel Peace Prize recipient.

 

Among the samples of text shred were; “The Martin Luther King, Jr. Holiday celebrates the life and legacy of a man who brought hope and healing to America. We commemorate as well the timeless values he taught us through his example — the values of courage, truth, justice, compassion, dignity, humility and service that so radiantly defined Dr. King’s character and empowered his leadership. On this holiday, we commemorate the universal, unconditional love, forgiveness and nonviolence that empowered his revolutionary spirit.”

We commemorate Dr. King’s inspiring words, because his voice and his vision filled a great void in our nation, and answered our collective longing to become a country that truly lived by its noblest principles. Yet, Dr. King knew that it wasn’t enough just to talk the talk, that he had to walk the walk for his words to be credible. And so we commemorate on this holiday the man of action, who put his life on the line for freedom and justice every day, the man who braved threats and jail and beatings and who ultimately paid the highest price to make democracy a reality for all Americans.”

 

“It is a day of interracial and intercultural cooperation and sharing. No other day of the year brings so many peoples from different cultural backgrounds together in such a vibrant spirit of brother and sisterhood. Whether you are African-American, Hispanic or Native American, whether you are Caucasian or Asian-American, you are part of the great dream Martin Luther King, Jr. had for America. This is not a black holiday; it is a peoples’ holiday. And it is the young people of all races and religions who hold the keys to the fulfillment of his dream.”

 

The unique approach of having multiple members each share a statement was not only positively received from staff and visitors in the audience but also from Diversity Council participants in the ceremony.

 

“I thought it was really cool to be involved in this. It was an excellent opportunity for everyone,” said Hospitalman Craig Spearman, an Ill. native assigned with NHB’s Main Operating Room.

 

Dr. King was a leading proponent of the U.S. Civil Rights movement in the 1950s and 1960s and was awarded the Nobel Peace Prize for his efforts in 1964.

In honor of King's unfinished efforts, President Ronald Regan established Dr. Martin Luther King, Jr. Day in 1983. In 1992, President George H.W. Bush proclaimed the Dr. Martin Luther King, Jr. federal holiday would be observed every year on the third Monday of January.

 

“Martin Luther King, Jr. Day is not only for celebration and remembrance, education and tribute, but above all a day of service. All across America on the Holiday, his followers perform service in hospitals and shelters and prisons and wherever people need some help. It is a day of volunteering to feed the hungry, rehabilitate housing, tutoring those who can’t read, mentoring at-risk youngsters, consoling the broken-hearted and a thousand other projects for building the beloved community of his dream,” shared Lt. Keleigh Anderson, NHB Judge Advocate General.

 

Hospital Corpsman 1st Class Robert Alisasis, Director for Surgical Services Leading Petty Officer echoed the call to service by noting that the national holiday's traditional theme to ‘remember to act’ was more than just part of the celebration. 

 

“It’s a day on, not a day off. This is a day of service,” said Alisasis, advocating that staff members should try and get involved in community service projects and offer support wherever there are others who need help.

 

NHB has a long history of providing support in the surrounding Kitsap Peninsula. The holiday season had NHB staff members volunteering to help out at assisting at the Bremerton Foodline in assembling approximately 600 food baskets for needy families, and there are a number who are looking forward  in volunteering to support the upcoming Washington State Special Olympic Basketball Tournament.

 

NHB was also recently recognized by the American Red Cross serving King and Kitsap Counties as a recipient for their Commitment to Community award.  The recognition was part of the Annual Real Heroes Breakfast.

 

NHB was specifically noted for not only serving the command’s primary mission of supporting patients at home and troops overseas, but also “performing the mission of the heart to serve and respond to disasters all over; responding to missions of compassion, like the many in the local communities.”

 

NHB personnel have also had a very strong influence in the local community by volunteering countless hours in support of more than 40 local non-profit organizations or projects.

 

Shine Some Light on the Winter Blues with Navy Medicine

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Got the wintertime blues? You’re not alone.


Navy Medicine attests there are ways to shine some light to prevent and cope with the dark days of winter.

 

According to Dr. Anthony Hwang, Naval Hospital Bremerton Clinical Psychologist assigned to the Mental Health Department, when a person’s individual mood is normally okay, but come fall and winter is consistently or predominantly low, they could be experiencing the winter blues which affects approximately 10-20 percent of the U.S. population.

 

Then there is another five percent of the population that suffer from Major Depressive Disorder (MDD) with a seasonal pattern, a condition once referred to as Seasonal Affective Disorder (SAD).

 

“There is a difference between being down and experiencing MDD with a seasonal pattern.  The pattern is consistent and research indicates it’s tied to light, or lack thereof.  The further from the equator during the winter months, the more prevalent the condition can be. There can be a reluctance to admit its existence and there are certainly a lot of different specifiers for MDD, but we know it’s there and there are ways to deal with it,” said Hwang.

 

Hwang notes that the warning indicators – low energy, fatigue, tiredness, low mood, decrease in activity, difficulty concentrating - are usually there, and the more people are aware of them then they can prevent and fight the winter blues.

 

Other possible signs of an onset of the winter blues are feeling apathy; being sad most of the day, nearly every day; pessimistic attitude; excessive sleep and/or poor sleep; irritability; changes in appetite; and change in weight.

 

“I have experienced it.  Low vitamin D and lack of sunshine made me down in the dumps.  I also talked to several others and they mentioned that they had the same symptoms of having a gloomy feeling. Then when the rains stopped, the clouds were gone and the sun came back out, I felt like a new person,” said Lt. Shawn Redmon, Navy Chaplain Corps attached to NHB’s Pastoral Care Department.

 

If there are concentration problems, feelings of worthlessness or excessive or inappropriate guilt, psychomotor agitation or retardation or recurrent thoughts of death, that’s when someone needs to be completely honest with themselves and seek help.


“If someone is experiencing suicidal thoughts, self-harm behaviors, violent tendencies or unhealthy behaviors involving alcohol and/or other drugs, seek help. At the very least, consult,” said Hwang, explaining that alcohol is a stimulant and a depressant and that stimulant sensation goes away quickly.

 

Beneficiaries can contact their Medical Home Port team, Mental Health and Pastoral Care departments for consult assistance.

 

“People turn to a number of ways to detach and alcohol is a big contributor. It’s obviously not a good way to go to deal with any issue. Being active and adventurous is much more fulfilling,” Hwang added.

 

Awareness is key in handling personal mental wellness.

 

“Prevention is always better than having to do intervention. Recognizing the signs early helps as does knowing personal habits and patterns,” stressed Hwang, citing that a person’s attitude is vital in dealing in trying to shake the doldrums.

 

“Attitude is huge,” continued Hwang. “When trying to control what we can’t, like the weather, we don’t like it. We can get resistant. Changing your attitude makes a difference. That’s always easier said than done, yet there are options. Changing the way we think and learning to adapt, being flexible and trying new things is great. The paradox of depression is that it perpetuates itself. We have to force ourselves, even starting small and learning to build from that.  Learning something new can be good.”

 

An underlying premise to MDD is that a person’s moods can be tied directly to the weather, with those moods impacting their habits.


“Some stop doing what they enjoy because of winter conditions. They become a lot more sedentary, don’t socialize as much, and resist even getting out,” said Hwang. 

 

There are risk factors to also be aware of, states Hwang, such as being younger and female; living/working far up north; a family or personal history of mental health issues; having a hectic, chaotic work schedule; and limited light exposure.

 

“Light is a good remedy to prevent winter blues. This may sound silly to some, but light can make a huge difference. Keep your home bright during the day, tone down at night. Having multiple light sources such as overhead and lamp light, is helpful,” shared Hwang, adding that even reading, listening to music, watching TV in a dim, dark, gloomy place can lower a person’s mood.

 

Then there is dealing with annual, traditional events from Thanksgiving to New Year. There are some who undergo a post-holiday ‘letdown.’  “There can be a feeling like a ‘letdown’ after the holidays are over that is associated with a dip in mood. When that is experienced, little things we normally do fall off. We miss exercising, talking to friends, getting out. That’s when the things that normally keep us going in other seasons are needed and are just as important if not more so,” Hwang said.

 

December 22 was the Winter Solstice, the shortest day for 2015. Also the longest night. A number of cultures around the world celebrate the event, but if viewing the aurora borealis (northern lights) in Alaska or visiting Stonehenge in England are not options, a person can simply make their own tradition in conjunction with the season and the climate.

 

“Where we live, there’s going to be winter and there’s going to be weather conditions that are not ideal. That’s just a fact of life. I have decided to embrace it. I hike in the mountains, I run in the local trails, I enjoy the abundance of beauty that this part of our country has to offer. Yes it rains, and the climate gives us the green forests and snow covered mountains. I love it,” Redmon said.

 

Naval Hospital Bremerton Welcomes First Baby of 2016

BREMERTON, WASH.  – It took Isabella almost the entire day into the New Year to join her parents, but make she did as the first baby born at Naval Hospital Bremerton for 2016.

 

Naval Hospital Bremerton’s Northwest Beginnings Family Birth Center assisted in the delivery of Isabella Rose Kraften at 11:23 p.m. to Shawnee and Jason Kraften on Jan. 1, 2016.

 

Isabella weighed six pounds, 14.2 ounces and is 19 inches long.

 

New born Isabella and mother are doing well.

 

“I came in around 8 p.m. but wasn’t completely ready. But then two and an half hours later I was. The water broke and she was here,” said Shawnee.


The Northwest Beginnings Family Birth Center staff were busy helping with deliveries throughout December. There were 48 new babies for December. Overall, Naval Hospital Bremerton recorded 710 births for 2015, an average of approximately 59 per month.

 

“The staff here were excellent. I couldn’t have asked for any better. They were very helpful and patient with me,” Shawnee said.

Naval Hospital Bremerton Sailors Help Provide For Those in Need 

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – Hunger does not take time off.  Trying to alleviate it can be a daunting notion locally as well as globally.

 

Naval Hospital Bremerton Sailors helped those less fortunate to cope with their personal food shortage on Dec. 19, 2015, by assisting at the Bremerton Foodline in assembling approximately 600 food baskets for needy families. 

 

“What we’re doing as volunteers is producing very tangible results in the fight against hunger. I helped out last year and being here for me feels like a good way to give back and support the community,” said Hospital Corpsman 3rd Class Hannah Pickett, a Forest Grove, Ore. native assigned to Branch Health Clinic Bangor.

 

Pickett was one of two dozen staff members from NHB’s Second Class Petty Officer Association (SCPOA) and Junior Enlisted Association (JEA) who helped out along with other local community volunteers on the Saturday before Christmas.

“Hunger happens every day in our community. We thank the Naval Hospital Sailors for volunteering. What they’re doing helps our community, helps our neighbors and helps those who need help,” stated Mr. Earl Burt, Bremerton Foodline Board of Directors President.

 

Hospital Corpsman 2nd Class (Fleet Marine Force) Christopher Spangler, of NHB’s Staff Education and Training Department and SCPOA president explained that the SCPOA organized the event with HM2 David Manthei as the volunteer chairman took the lead by contacting Patti Peterson, Bremerton Foodline Executive Director, to work out the time and date to assist.

 

“As SCPOA President, I assisted in the event coordination and volunteers with the JEA. The response from others was tremendous! As soon as the opportunity arose for us to volunteer, we had a lot of individuals wanting to take part. What was really impressive is how genuine the volunteers were after hearing about the opportunity. They wanted to give back in a big way. They did it because they genuinely care about the community and those who are less fortunate, especially during the holidays,” said Spangler, adding that every year the SCPOA looks for volunteer events around the holidays in which to give back to the community.

 

According to Burt, the volunteers worked in preparing and organizing the hundreds of food baskets which were in a variety of sizes, with some put together for families with up to seven members. Putting together the baskets is always a labor intensive, time-consuming process.

 

“We love it when the Navy comes in waves like this to help. We have had Sailors from the (USS) Nimitz (CVN 68), Chaplains office (at Naval base Kitsap) and Naval Hospital Bremerton. They are hard-working, friendly, and love being part of the community and doing their part to help out. They are amazing,” exclaimed Tracy Denham, Foodline operation supervisor.

 

There were containers of produce from salad ingredients like celery and carrots to potatoes and onions, crates of apples and oranges, canned vegetables and canned fruit, and cases of turkey, chicken and ham.

 

No donated food goes to waste.  Even the portion swept off the table from preparing the celery and carrots not considered for human consumption are gathered to contribute to local farmers for their livestock.


“Every little bit helps,” Denham said.

 

The Bremerton Foodline  is part of the Kitsap Food Bank coalition with seven other sites forming a network with the overlapping goal of ‘working hard to alleviate hunger throughout the county.’

 

The past few years the SCPOA has worked closely with the local food lines to assist during the holidays and it has turned into a tradition to assist with the Bremerton Foodline around Christmas.

 

“As command representatives we hope to make an impact in the community by giving back especially those who have fallen on hard times. In the Navy we move around every three years to a new state, city, community, and each time we’re accepted. This is our way of saying thank you and giving back. Kitsap County is unique in that we have a huge military presence here and lots of prior service members retire here. Some of the retirees have fallen on hard times and this gives current active duty members an opportunity to thank them for their service by volunteering their time to give back to them,” Spangler said.   

 

 “It’s neat that we make a difference. We are a safety net. We see a variety of clients from elders to even those in the military. We’re their resource if all else is not there. We have those who come all the time and there are others that we help two or three times a year. November and December are always a focal point, not only because it’s the holiday season but also because the weather can turn severe. The donated supplies we get we hope can be extended to March and April, but as we all know, hunger is every day,” added Burt.

The Bremerton Foodline vision is to strive to nourish and enrich the lives of neighbors in need and their mission is to provide food assistance and other services to reduce hunger and improve self-sufficiency for those within our community.

Research compiled across the U.S. showed that there were approximately 17.5 million families who struggled to afford food. The 2013 study revealed that those households were food insecure, meaning that they had difficulty at some time during the year providing enough food for all the household members.  Of that number 6.8 million households had very low food security, and faced the difficult choice between food and housing, food and medicine, food and childcare, and food and heat. 

“The most difficult aspect of doing this is knowing that there are families, children, and retirees, all lacking everyday food essentials,” said Spangler. “This also makes it gratifying being able to show them the real meaning of Christmas.”  

 

Making Sure Every Drop Counts at Naval Hospital Bremerton for the Armed Services Blood Program

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- When Naval Hospital Bremerton holds the next Armed Services Blood Program military blood drive on Dec. 23, 2015, the majority of the donated blood will again support deployed service members.

 

Jeffrey Woods, of NHB’s Third Party Collections and a regular donor recognizes that fact. Since 2000, he has routinely donated at NHB’s quarterly military blood drives that are held in conjunction with the Armed Services Blood Bank Center - Pacific Northwest. When he gives on Dec.23, it will be the 52nd unit he has shared.


“I do it because it’s the right thing to do. Supporting our Armed Services Blood Program means that we’re directly giving to those in uniform during their time of need,” said Woods, who started giving during his 12 years in the U.S. Marine Corps.

 

Compiled statistical evidence shows that approximately one patient out of seven who enter a hospital like NHB will need blood. That’s stateside-relevant data, not related to forward operating bases, combat outposts and trauma team settings in Afghanistan, where NHB still has staff members on Individual Augmentee status.

 

Recipients from a military blood drive remain primarily unknown, especially down range. It’s the nature of the collection process. There are, however, some beneficiaries of the needed life-giving and life-saving product who unwittingly become a vivid example of how vital blood and blood products are in keeping a wounded servicemember alive.

 

One such is Cpl. Mark Fidler, who deployed with 3rd Battalion, 7th Marines, in September 2011. He was just six days into his deployment in Helmand Province, Afghanistan when his entire world was blown asunder.

 

His is a harrowing, bloody story. Fidler was severely injured by an improvised explosive device. He lost both legs. Complications followed after multiple surgeries. The doctors amputated up to his pelvis.  He received 120 units in one day and another 68 units the day after. Twenty units of blood were prepared for him every time he went into surgery, and there were multiple surgeries during his initial recovery period.

 

He was not expected to survive.  But he did. The doctors who worked to save him remarked, “Without people donating blood, he would not have lived.”

 

“Our primary mission is to support contingency operations. After meeting that requirement, then whatever is remaining goes to military treatment facilities and VA hospitals. Every drop helps,” said Mr. Victor L.  Shermer, Armed Services Blood Bank Center - Pacific Northwest Donor Recruiter and Public Affairs officer.

 

More than 150,000 units of blood have been transfused on the battlefield in the last 12 years. Along with battlefield needs, blood and blood products are needed to support all active duty, retirees and military families, from cancer patients to surgical patients. Forty or more units of blood may be needed for a single trauma victim.

 

NHB has collected 155 units so far for 2015 and holds a unique significance with the program. According to Shermer, NHB is special because the Armed Services Blood Bank Center - Pacific Northwest was originally in Fort Ord, Calif., but when Fort Ord closed, the center relocated to NHB for a short period before being moved to Madigan Army Medical Center in 1993. 

 

“We have a 20-plus year history with NHB. There are many employees at NHB that donate on a regular basis with us,” Shermer said.

 

HM3 Sabrina Brooks took over as NHB’s current Blood Drive coordinator in 2014, in charge of coordinating and handling all communication requirements on a pending blood drive. She visits clinics and wards, posts notes and flyers, shares with department heads and division officers, and even engages in a constant word-of-mouth campaign.

 

“These blood drives are crucial. Blood is needed daily to support local medical military operations as well as deployed operations. Giving blood saves many lives by separating the unit of blood into different products to administer. So you are not only saving one life but many lives by donating a unit of blood,” stated Brooks, a Marion, S.D. native and Laboratory Department Technician.

 

One pint (or unit) of blood can save up to three lives, and that unit can be separated into several components: red blood cells, plasma, platelets and cryoprecipitate. The red blood cells carry oxygen to the body’s organs and tissues. Plasma is a mixture of water, protein and salts, and makes up 55 percent of actual blood volume. Platelets promote blood clotting and give those with leukemia and forms of cancer the chance to live. Cryoprecipitate is collected from plasma that has been frozen, then thawed, and acts as a coagulation agent.

 

The overall mission of the Armed Services Blood Bank Center is to operate a Tri-Service staffed regional blood donor center which collects, tests, and distributes blood and blood components in support of contingency and peacetime operations worldwide. Brooks and others assigned to NHB Laboratory Department, as well as the actual donors, are helping to make that happen.

 

“The most gratifying part of this duty is that I am supporting my brothers and sisters who are deployed by getting the blood donations they need as well as taking care of their families blood supply needs while they are away,” said Brooks.

 

The Armed Services Blood Bank Center - Pacific Northwest is also planning a Donor Appreciation Day event for January, 2016 and Naval Hospital Bremerton will help with behind the scene preparation.


“About 100 donors plus the commands we recognize are invited to attend the Donor Appreciation Day ceremony,” said Shermer.

 

Woods attests he has received invites in the past, but has demurred each time.

 

“It was nice of them to ask, but this is not about recognition. I donate because it’s always going to be needed,” Woods said.

 

NHB’s support of the Armed Services Blood Program was recognized in 2014 when two members of the Laboratory department - Hospital Corpsman 2nd Class Roberto Mangahas and Hospital Corpsman 3rd Class Matthew Naffin – were acknowledged for their volunteer efforts.

 

The actual steps in the entire process start with going over a donor’s medical history; then a quick physical; followed by the actual donation; wrapped up with a brief rest.

 

“Helping to organize blood drives means the world to me, because I could be that one person that gets an O-negative donor to donate and that could save anyone. When I see the units I see lives that are being saved,” Brooks said. 

 

For the upcoming NHB Blood Drive, 9 a.m. to 2 p.m. on Dec. 23, those who wish to donate can simply walk in that day, or even go to www.militaryblood.dod.mil and set up a profile and make an appointment.

 

Shermer notes that a person can donate every 56 days.

 

“Every drop helps,” reiterated Shermer.

 

 

Urgent or Emergency? Naval Hospital Bremerton Urgent Care Clinic Explained

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- What’s the difference between an Urgent Care Clinic (UCC) and an Emergency Room?

Where, when, and why should Naval Hospital Bremerton (NHB) beneficiaries go for care?

NHB doctors, nurses, hospital corpsmen and support staff understands that there may still be some confusion associated with the October 1, 2014, change from an Emergency Department to an Urgent Care Clinic.

Beneficiaries should start by trying to make an appointment with their Primary Care provider or Medical Home Port team.

NHB’s Medical Home Port teams deliver basic care for common ailments and illnesses, minor injuries and routine health exams, as well as help every patient manage their health care.

Patients are encouraged to use their Medical Home Port team to schedule appointments for common illnesses such as flu and fever; minor injuries such as sprains and strains; and regular physicals, prescription refills, vaccinations and screenings.

When it’s after hours or on the weekend, and someone’s regular health care provider isn’t available, the Urgent Care Clinic is available for patient’s needs to handle non-life threatening medical concerns and health issues, that do not pose an immediate and serious threat to life or limb.

“If a patient is uncertain, by all means come in to our UCC, and we’ll triage them appropriately.” said Capt. David Collins, Naval Hospital Bremerton Executive Officer.

The Urgent Care Clinic is open 24 hours a day, seven days a week, for walk-in availability for such needs as;

n  Minor injuries such as strains and sprains, back pain, minor cuts and burns, minor broken bones, and minor work and sport-related injuries.

n  Common illnesses such as colds, fever and/or flu symptoms, sore throats and coughs/bronchitis; migraines, allergies, rising temperature and rashes.

NHB encourages patients to only use any hospital emergency room for life threatening or serious health problems. Head to an emergency room – or call 911 – immediately if there is someone who could experience serious harm or potentially die without timely medical care for conditions such as chest pain; severe abdominal pain; coughing or vomiting blood; severe burns; deep cuts or bleeding that won’t stop; sudden blurred vision; shortness of breath or difficulty breathing; sudden dizziness, weakness or loss of coordination or balance; numbness in the face, arm, leg; sudden severe headache; seizures; high fever(s); or any other condition believed to be life threatening.

Naval Hospital Bremerton is working along with Harrison Medical Center to accommodate every need for emergency care services at the East Bremerton location – 2520 Cherry Avenue, and at the Harrison Silverdale campus – 1800 NW Myhre Road.

Another great resource for patients is the Nurse Advice Line that is also available 24 hours a day, seven days a week and can be reached with a toll-free number at 1-800-874-2273, and then select option one.

For patients who wish to be able to contact their Medical Provider, they can sign up for the free, secure message system RelayHealth on the following links:

http://www.med.navy.mil/sites/nhbrem/pages/MedicalHomePort.aspx

https://app.relayhealth.com/security/login/default.aspx?BID=nhbrem

Important phone numbers:
TRICARE Regional Appointment Center     1-800-404-4506
United Health Military & Veterans                1-877-988-9378
NHB Pharmacy Refills                                   (360) 475-4217
NHB Primary Care Clinics
Family Medicine Clinic                                   (360) 475-4379
Internal Medicine Clinic                                 (360) 475-4206
Pediatric Clinic                                               (360) 475-4216
Branch Health Clinics
BHC Bangor                                                   (360) 315-4391
BHC Everett                                                   (425) 304-4060
BHC Puget Sound Naval Shipyard                (360) 476-2508

TRICARE Law requires Beneficiaries to use Military Pharmacy and/or Home Delivery

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- There is an important change coming to the TRICARE Retail Pharmacy benefit that will impact all beneficiaries except active duty service members.

 

Naval Hospital Bremerton’s pharmacy staff is ready to help.


Starting on October 1, 2015, federal law (the 2015 National Defense Authorization Act) will require that TRICARE beneficiaries who currently get select maintenance medication at a network pharmacy will have to switch those prescriptions to TRICARE Pharmacy Home Delivery or a military pharmacy such as Naval Hospital Bremerton.

 

Maintenance medications are those used for chronic, long term conditions taken on a regular recurring basis, such as used to control cholesterol or blood pressure. The law does not apply to drugs that are prescribed for short-term condition, such as antibiotics.

 

Beneficiaries can check www.Health.mil/SelectDrugList or call Express Scripts at 1-877-363-1303 to determine if their prescription medications are affected by the upcoming change.

 

Last year NHB filled approximately 509,130 outpatient prescriptions for nearly 31,000 TRICARE enrollees in the West Puget Sound area of the greater Kitsap Peninsula, and another 5,150 enrollees in the East Puget Area serviced by NHB’s Branch Health Clinic Everett.

 

The impact is for the better, says Lt. Cmdr. Eric Parsons, NHB Pharmacy department head, citing that the NHB Pharmacy and the TRICARE Pharmacy Home Delivery are both excellent, money-saving alternatives for beneficiaries.

 

“We’ve been advocating the Home Delivery option for several years. It offers our TRICARE beneficiaries excellent care and service in addition to lower out-of-pocket costs when compared to obtaining chronic maintenance medications from the retail network,” said Parsons.

A beneficiary
can save up to $240 a year for every brand name formulary medication ($96 per year for each generic formulary medication) moved to the secure and convenient TRICARE Pharmacy Home Delivery service. The TRICARE Pharmacy Savings Calculator on
www.TRICARE.mil/pharmacy can help project how much can be saved by switching.

 

Parsons attests that Naval Hospital Bremerton has an extensive formulary of medications available for beneficiaries. Home Delivery is also an excellent option for TRICARE beneficiaries to get their maintenance medications, especially for those who live farther away from a military pharmacy.

 

“These choices are both less expensive than the TRICARE Retail network, and Home Delivery offers the convenience of having maintenance medications delivered directly to your home. A beneficiary will pay more to get their prescription filled at a non-network pharmacy, and they very well might need to pay up front and then file a claim for reimbursement,” said Parsons, adding that if someone decides to try the Naval Hospital Bremerton or BHC Everett pharmacy, they can call ahead for a new prescription at 360-475-4425 to make sure their medication is available.

 

“We are available to assist,” Parsons stressed.  


NHB’s formulary listing is also available online at http://www.med.navy.mil/sites/nhbrem/patients/Pages/pharmacy.aspx.


Beneficiaries who continue to get select maintenance drugs at a network pharmacy will pay 100 percent of the cost. This does not apply to active duty service members.


Patient costs vary based on where a beneficiary gets their prescription filled and the type of drug: generic, brand name or non-formulary. Beneficiaries can save on cost by asking their doctor to electronically-submit prescriptions for formulary medications to the NHB pharmacy for subsequent filling instead of to a network pharmacy.

A beneficiary must do one of the following to avoid paying 100 percent of the cost for medication:


Option One is to transfer select maintenance drug(s) from a network pharmacy to a military pharmacy like Naval Hospital Bremerton or BHC Everett. Call the NHB pharmacy at
360-475-4425 to see if they carry your medication. If they do, ask your provider for a written prescription or send an electronic prescription to NHB Pharmacy for filling.

 

Option Two is to transfer select maintenance drug(s) from a network pharmacy to TRICARE Pharmacy Home Delivery. This option is safe, convenient and costs less than a network pharmacy. To get started, call the Member Choice Center at 1.877.882.3335 or visit Express-Scripts.com/TRICARE.

 

Option Three is for a beneficiary to have their network prescriber send an electronic prescription to the TRICARE Pharmacy Home Delivery Service. To get started, visit https://www.express-scripts.com/TRICARE/safety_savings/prescribing.shtml

 

Option Four is for beneficiaries to ask their doctor about using a generic drug instead of a brand-name drug. Most generic drugs are still available at network pharmacies. Beneficiaries can get up to a 90-day supply of formulary generic medications at TRICARE Pharmacy Home Delivery at no cost.

 

For those who prefer to obtain select maintenance drugs(s) at a network pharmacy after October 1, 2015, they will receive a letter from Express Scripts reminding them of the new policy. For anyone who continues to get their select drugs at a network pharmacy, they will pay the full cost.

 

There will be a process to get a waiver due to personal need or hardship, emergency or other special circumstances, such as living in a nursing home. Express Scripts will consider waiver requests on a case-by-case basis. For those beneficiaries who have Other Health Insurance with a prescription benefit, they can continue using a network pharmacy.

 

Active duty service members, beneficiaries living overseas, and beneficiaries with other health insurance are not subject to this requirement.

 

For beneficiaries seen by civilian providers and in need to get a prescription filled, the electronic prescription - or e-prescribing – offers a perfect solution.

E-prescribing started at NHB in March, 2014, and other Military Treatment Facilities (MTFs) are now following suit to currently accept and fill prescriptions written outside MTFs from civilian providers.

“The process has been very well received by NHB patients, network providers, and pharmacy staff. This capability allows civilian providers to securely send their prescription and associated instructions electronically to Naval Hospital Bremerton for any of our NHB beneficiaries. Additionally, patients whose network provider utilizes eRx no longer have to worry about losing a paper prescription between obtaining it from the provider and delivering it to the pharmacy. Correct use of the eRx functionality offers near instantaneous transmission of the prescription information from the prescriber to pharmacy,” Parsons said.


According to Parsons, the electronic prescription initiative is part of a Congressional mandate that centers on ‘meaningful use’ of the Electronic Healthcare Record (EHR) system.

“This initiative has helped civilian healthcare providers meet that standard by using the EHR for what’s it’s designed to do which is eliminate paperwork and electronically connect a provider with a pharmacy such as ours,” explained Parsons, citing that if all hardcopy prescriptions were to be sent electronically, based on the past 365 days, that would be 47,375 prescriptions annually.

“We were so happy to find out that NHB was doing this. We love it. This is much more convenient for patients and much more cost efficient for providers,” commented Ms. Laurie Kehler, Clinic supervisor at Harrison Medical Center, Bremerton, Wash.


Prior to implementation of the e-prescribing capability, if a beneficiary went to see a doctor outside of NHB and as part of the overall treatment had to pick up medication(s), the provider would have to hand write the prescription for the patient to then hand deliver to fill at the NHB Pharmacy.


“Receiving the prescription electronically helps to clarify the dosage, quantity, and actual medication, increasing patient safety. It also prevents the potential for losing a written prescription,” stated Parsons, adding that once a script has been sent to NHB’s Pharmacy, it can ‘sit’ for up to a year before being filled once the patient actually shows up to request the medication.

Parsons notes that once the initial electronic prescription has been sent, received and filled by NHB, future refills remaining on the prescription can then be simply phoned in by the beneficiary and picked up at the drive-through option if so desired.

The ideal-future state cites Parsons, is that all hard-copy requests for any prescription will become accomplished by electronic means.

However, the system is not set up to handle any controlled substances such as Percocet or Vicodin. All controlled substances must be via hand written prescription.

Parsons also stated e-prescribing is not only a secure method for transferring prescription data which means better accuracy, increased patient safety and less prescriptions lost or misplaced, but as the pharmacy staff has gotten used to processing the eRXs, the familiarity has translated into more timely processing of the prescription than the old method of transcribing a written script.


The electronic prescribing address for NHB’s e-pharmacy is

DoD Bremerton ePhcy,
1 Boone RD Code 08RAZD,
Bremerton WA, 98312,
Phone: 360-475-4425,
Fax: 360-475-4786.


Shaken but not Rattled – earthquake preparation standard at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – Naval Hospital Bremerton has already been shaken.

Rattled?

Not so much.

Fourteen years, four months and 22 days before the recently published New Yorker article, ‘The Really Big One,’ on July 20, 2015 about a massive earthquake impacting the Pacific Northwest, NHB experienced strong seismic activity and has prepared for future tremors.

 

The Nisqually, Wash. quake at 10:54 a.m. on Feb. 28, 2001 registered 6.8 on the Richter Scale and was felt throughout the greater Puget Sound region. That quake gave staff members a forewarning of what it was like to experience a sizable seismic shaking, as the epicenter is just 50 miles south of Bremerton.

 

Staff members working on upper floors vividly remember the shaking that lasted up to 45 seconds. Books, plants, coffee cups and other office gear were tossed like so much ticker-tape.

Patients were alarmed, staff members uncertain, and friends and family concerned.

 

Dan Frederick, then officer in charge of Branch Health Clinic, Puget Sound Naval Shipyard, was attending a training class on the sixth floor when the quake hit.

“I remember it very well. Everything started to shake. I was able to see outside and could notice how much the building was moving in relation to the trees. And the movement kept going. It was scary the amount of movement taking place. I was thinking that this structure can’t take much more because the force will cause it to break apart. Being on one of the top floors and feeling and seeing the motion was quite the ride,” said Frederick.

Because of that quake and where the command is situated, NHB completed a unique seismic retrofit project in 2007 which vastly improved the structural ability of the facility to withstand a large earthquake.

 

NHB became the first Navy medical facility to undergo this type of seismic retrofit project, says Russell Kent, NHB Facility Manager.

“Our hospital has to be operational immediately after an earthquake and we retrofitted it to stringent criteria to be better able to withstand a sizable quake in the future,” Kent said. “We did experience damage and inconvenience when the Nisqually quake hit. That event helped to accelerate the need for a much more secure and stable structure. Our hospital building itself is quite strong and flexible. We had no structural damage. But even with the tremor about 50 miles away and deep below the earth’s surface, the ground motions, and intensity of the seismic shaking caused significant nonstructural damage, especially at the upper floors. Rigid materials such as drywall, window panes and piping do not perform well when suddenly required to bend.”

 

 

Then, as now, there are two old adages shared in the greater Puget Sound area regarding earthquakes. One is that it’s not a matter of ‘if’ as much as ‘when.’

The other states that if there’s a sizable earthquake in the region, there are two structures that need to remain standing and functional. A hospital is one of them. The other is the jail.

History has shown that the entire area is prone to quakes, with notable seismic events such as a magnitude 6.5 quake widely felt on April 29, 1965 and a measured 7.1 quake on April 13, 1949.

According to Terry Lerma, NHB Emergency Preparedness Coordinator,  the NHB Facilities Management department has done a great job to safeguard the core building with the seismic retrofit - shock absorbing inertia dampeners - to prevent the upper floors from transitioning from the initial shaking to the rolling circular motion experienced in the 2001 Nisqually Quake.  

“We were also the first naval hospital to be wired with sensors throughout the building and have our own seismograph that will tell us immediately after a quake if the hospital building is safe to stay in, or if we should evacuate,” said Lerma.


Lerma attests that ‘if’ such a sizable quake happens again, NHB’s role in handling such an emergency situation becomes a crucial component for humanitarian assistance and disaster relief efforts.

 

“Our duties are three fold. One, our primary mission is to provide health service support to the fleet and active duty forces, and they will be the primary focus for medical support.  Second, routine medical appointments will most likely be deferred for rescheduling until the extent of any damage is known at NHB, or the community begins to return to a degree or normalcy in the recovery phase.  We would focus on accounting for all our staff and family members, and focus on performing the level of service our infrastructure, provided it hasn’t been compromised, will allow us to do. Our third duty is our role as a healthcare provider in the local Kitsap County community. We have practiced on the scenario that if the right combination of bridges, overpasses and/or streets collapse or are damaged, a good portion of Kitsap County civilians may not be able to access Harrison Medical Center in Bremerton or Silverdale, or go elsewhere. We would then have the additional requirement to not only provide medical care if needed, but additional security, and we would work with local Kitsap County Department of Emergency Management and the American Red Cross to provide assistance after we complete their medical care,” said Lerma.

 

As with any emergency, preparedness is the key to prevent it from becoming a disaster. 

 

After a major earthquake, structure or utility systems may be compromised or inoperable for weeks or longer.  Having supplies for up to 10 days, a communications plan, an emergency plan that all family members know and have practiced, and a method by which to contact not only family members but a work center/command will help. Staff should also know how to update, use, and access the Navy Family Accounting and Assessment System (NFAAS) if/when we are given the “order to account” so we can quickly assess which staff are and aren’t accounted for.  NFAAS was born out of previous hurricane events and has been successfully used to account for Navy staff and family members during/after the San Diego wildfires of 2007, the Japanese earthquake and tsunami in 2011, and the Boston Marathon bombings in 2013,” Lerma said.

 

If the next big one hits right now, then what?


The immediate action for staff after drop, cover, hold, would be “not to run outside,” Lerma stressed.

“We would then have to immediately check all work spaces for any damage and make any structural damage and/or injury to staff/visitor/patients reports,” said Lerma, also citing that the command would then have to secure any leaking water, gas, air, suction, or oxygen lines, and not use any elevators until NHB’s Facilities Management department ensures they are safe and operational.

 

“We would also have to check the outside grounds for any buckled pavement, cracks, leaking water mains, or any smell of natural gas and notify Security. We would report any fires, and be prepared for possible aftershocks,” added Lerma, also noting that a phone muster would be started of all work center staff to ensure they are safe and accounted for.


Part of NHB’s overall command readiness and emergency response plan is to effectively and rapidly handle the natural disaster, provide medical care and prepare for mass casualties.

 

“Our staff should always be aware of such a possibility. We have at least two major and three minor earthquake faults running through and/or near Kitsap County. Geographically, the Kitsap Peninsula is essentially an island if the Tacoma Narrows and Hood Canal Bridges were closed.  Many geologists say we are overdue for ‘the big one,’ so the possibility of a significant seismic event is possible at any time,” Lerma said.

(Editor’s Note: The subduction zone earthquake that the New Yorker article featured was not related to faults associated to the Kitsap area)


Lerma insists that all staff should prepare their home, work space, and personally owned vehicles with emergency preparedness kits along with structural preparations such as securing furniture from falling over, making sure the water heater is safely strapped, and knowing how to shut off their utilities.  Staff should also prepare their families with a communications plan such as an out of state contact person and a rendezvous point in case the streets are blocked or closed.  

 

“We must prepare ourselves and family. NHB staff might very well need to provide care for an extended timeframe until relief arrives or we’re back to normal operations. We have to have the ability to sustain ourselves, and also need peace of mind that our families are okay and can sustain themselves for any such interim period.  As a hospital, we must be ready to serve not only the active duty and beneficiary population, but also the ‘perfect storm’ of circumstances that has wounded civilians show up at the front gate needing care due to the inability to transit to a civilian hospital. If needed, we have backup utility systems that will provide power, heat, and water for approximately a week after a significant seismic event,” Lerma said.

 

Lerma notes that NHB has routinely held mass casualty drills in conjunction with an earthquake scenario. Oneof the main objectives is to run a mass casualty exercise and rapidly test and evaluate damage assessment to the facility itself; assist patients, visitors and staff with injuries; and track patients through treatment areas and assess for 72 hours, if necessary.

 

“We think outside the standard mass casualty scenario box and have drilled with local Fire/Emergency Medical Service (EMS) on how we would evacuate patients from the upper floors if NHB was structurally compromised. We challenge staff with incomplete scenarios to see how they react and what we learn from them. This September, we are drilling with Operational Health Support Unit and the local Fire/EMS volunteers in another hospital evacuation scenario so that a quake were to hit on a reserve drill weekend, we would have them trained to ‘buy us’ that 30 to 60 minutes we need to recall staff back to NHB and then work side by side with them to continue caring for any other additional casualties along with accounting for our staff,” said Lerma.


Doctors, nurses, hospital corpsmen and support staff also get tested and evaluated on their ability to set up, activate, triage and transport ambulatory and non-ambulatory trauma patients to correct treatment areas, as well as provide medical care for a variety of injuries atypical to an earthquake, such as abrasions, lacerations and contusions.

 

NHB’s Evacuation Plan priorities are to provide immediate assistance to visitors, outpatients, and non-essential staff; support ambulatory inpatients, stable newborns and mothers; help non-ambulatory inpatient, stable post-anesthesia care unit patients, and beneficiaries in early stage of labor; and handle critical care patients, OB patients in third stage of labor and intra-operative cases.

The NHB Evacuation Plan also contains a check list with such information as preparing bed ridden patients by ward staff for using the Evacu-Sled; check all spaces for patients, visitors, or injured staff, some of whom might be hiding in closets or under furniture and ensure that they are evacuated before able bodied staff; ensure a safe route for evacuation - avoid elevators - and destination; and provide for evacuee physical and emotional care, including facilitation of communication to loved ones/family members.

“It’s about preparedness, practice, and maintaining supplies.  The time to stock up from the store is not right after the ground stops shaking.  There is a lot of information available on what kinds of supplies, food, water, medications, pet food, to stock up on and rotate so someone does not have to spend a lot of money at one time.  The time taken now to prepare and maintain supplies, the time taken to make a plan and review it with all family members is now. Hopefully, it will never have to used, but even in a severe winter weather event, the preparations or supplies just might pay off,” Lerma said.

Holding earthquake drills helps NHB maintain the high standard of readiness for serious conditions such as disaster, weather, and mass casualty situations.  

Because shaken is one thing. Rattled is another.

Kitsap County Department of Emergency Management (KCDEM), recommends the following for dealing with a major natural disaster such as an earthquake, flood or severe weather storm:

  • Know the safe spot in each room: under sturdy tables, desks, or against inside walls.
  • Be aware of danger spots such as windows, mirrors, hanging objects, fireplaces and tall furniture.
  • Conduct practice drills. Physically place yourself and family in safe locations.
  • Learn first aid and CPR (cardiopulmonary resuscitation).
  • Create a Family Earthquake Plan and decide where your family will reunite, if separated.
  • Keep a list of emergency phone numbers.
  • Choose an out-of-state friend or relative who family members can call after the quake to report your condition. Carry emergency contact cards with out-of-state contact phone numbers.
  • Develop a portable/auto survival kit for work and travel

Earthquake Descriptors

There are micro earthquakes (approx. 8,000) every day that are not felt and measure less than 2.0 on the Richter Scale.

Earthquakes measuring between 2.0 and 2.9 are considered very minor, and are generally not felt (by humans). They are about 1,000 a day.

Minor quakes in the 3.0-3.9 range are often felt but rarely cause damage, It’s estimated there are 49,000 a year.

Light quakes of 4.o to 4.9 cause noticeable shaking of indoor items, rattling noises. Significant damage is unlikely. There are an estimated 6,200 per year.

Moderate quakes of 5.0-5.9 range can cause major damage to poorly constructed buildings over small regions. At most slight damage to well-designed buildings. Example: The 1987 Whittier Narrows quake in southern San Gabriel Valley, Calif. caused $358 million in damage. There are 800 per year.

A strong quake in the 6.0 to 6.9 range can be destructive in areas up to about 100 miles across in populated areas. Example: The 1994 Northridge, Calif. earthquake, registered 6.7, considered a moderate quake, but the ground acceleration (earth shaking) was the highest ever instrumentally recorded in an urban area in North America. There are about 120 per year.

Major quakes measure 70 to 7.9 and can cause serious damage over larger areas. Example: The 2010 Haiti earthquake with a magnitude 7.0, caused an estimated 316,000 people fatalities, 300,000 more injured and one million made homeless. U.S. Navy assets, immediately after and still to this day provide support. There are 18 per year.

A great earthquake in the 8.0 to 8.9 range can cause serious damage in areas several hundred miles across. On Sept. 29, 2009, U.S. Geologic Survey reported an 8.1 earthquake off Samoa Islands. The resulting tsunami flattened villages in Samoa and American Samoa which killed 189 civilians and displaced over 10,000 people. The frequency of occurrence is one per year.

A rare great earthquake of 9.0 or greater can (and does) cause devastation in areas several thousand miles across. Example:  Dec. 2004: The Indian Ocean quake, which registering a magnitude of 9.1-9.3. The epicenter was off the NE coast of the Indonesian island of Sumatra, caused a series of gigantic tsunamis that caused more than 229,000 fatalities and impacted many nations along the Indian Ocean. U.S. Navy involvement was in-depth, from Operation Unified Assistance on Banda Aceh Province, Sumatra, to Sri Lanka and Thailand.

 WI-FI available in designated locations at Naval Hospital Bremerton

Compiled by NHB Public Affairs -- Free Wi-Fi is now available for patients and visitors in at Naval Hospital Bremerton.

 The wireless internet access will allow beneficiaries and guests at NHB to use their own wireless enabled personal computer/tablet, smartphone or PDA (personal digital assistant) with provided high-speed internet and network connections in designated hot-spot areas.

The hot-spot areas currently are the Pharmacy waiting area, medical/surgical and labor/delivery wards, Quarterdeck, second floor of the main hospital (Building One), Urgent Care Clinic and surrounding area.

 Expanded coverage throughout the entire hospital will commence in October.

“This is a phased approach and is a great service to provide to our patients,” said Lt. Travis Kelley, Information Management Department assistant department head.  The service is the result of a directive from Capt. Christopher Quarles, NHB Commanding Officer to add the complimentary Wi-Fi service for patients and visitors. 

To connect to the Wi-Fi service, patients and guests will need to view their list of available networks and select the Wi-Fi connection name of  "NHBPatientWifi"  (5G and 2G available).  There is no password required. They will then see a Naval Hospital Bremerton welcome page where they need to review and accept the Terms of Service agreement.  Once accepted, they will be connected to the Internet.

 TeamSTEPPS a Preparation Process for Patient Safety at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton PAO – When Sim Lab Junior came into Naval Hospital Bremerton’s Main Operating Room (OR) for a routine appendectomy operation; it turned out to be anything but a normal procedure.

Under the on-scene tutelage of Anesthesiology Department provider Lt. Cmdr. Shawn Bowdoin, Main OR surgeons, nurses, surgical technicians used TeamSTEPPS to train on handling the emergency case of pediatric malignant hyperthermia, a serious complication that statistically happens one in 10,000 to 40,000 surgical cases.

But happens it does.

The Main OR staff not only honed their craft in handling such a time-sensitive emergency, but improved on their TeamSTEPPS ability, which is a teamwork-based program designed to improve patient safety, enhance performance, augment overall communication and advance teamwork skills.

“This was a good TeamSTEPPS training evolution. We stopped when a definite problem was noticed. There was communication and there was solicitation for input which was very good because it’s easy to get tunnel vision when dealing with an emergency like this,” said Cmdr. Brent Bushey, Anesthesiology Department and training coordinator for the exercise.

 According to Cmdr. Annie Case, NHB Quality Management Department head, The Main OR environment is a high risk area that relies on every member to function as a efficient part of the team. 

 “Communication is key to the success of each surgery. Teamwork is essential to ensure that not only is the correct equipment and instrumentation available and ready for the procedures, but also communication of any information that could assist or alter the procedure due to the patient’s condition or availability of items.” Case said. 

On-going communication is a central tenet of TeamSTEPPS where information is clearly and accurately exchanged amongst every team member. Every member of the team is involved, especially so when it’s an emergency.

Bowdoin immediately noticed complications setting in when administering anesthesia to the patient. He immediately called out to hold off on the surgery. He called out to the ‘floor walker’ that there was a concern. He verbally took stock of the patient, checking off what had was done, what needed to be started, and which potential steps would be rapidly required.

"Can anyone think of anything else we need to do? What am I missing?” Bowdoin asked to the assembled team in a quick huddle as the rapid sequence of events unfolded concerning their patient.

Verbalizing questions out loud by Bowdoin is considered a significant strategic part of Communication by exchanging information clearly and accurately between team members. It is also one of the key principles of TeamSTEPPS that includes team structure; leadership; situation monitoring and cross monitoring; and mutual support.

“Leadership is also needed, as their support is required when staff members need to raise concerns and come up against team members who disagree or won’t listen to the concerns.  Mutual Support and Situation Monitoring are equally important concepts, as each demonstrate the need to work together to ensure that teamwork is the driving concept and safety is the utmost goal for each and every patient and surgical procedure,” said Case.

 The TeamSTEPPS Communication principle is patterned on what is known as SBAR, the acronym for Situation (what’s going on with the patient?); Background (what is the clinical background or context?); Assessment (what is the problem thought to be?); and Recommendation/Request (what needs to be done to correct the problem?).

“All team members are aware of a patient’s status.  Everyone knows who is on the team. A combination of the anesthesia, surgeon, and perioperative nurse work together to ensure that the surgical environment is in the top notch condition for the patient; the right environmental/facility factors are in place, the right team members have been trained, and the right equipment and right paperwork is in line.  Everything works together towards the safest care possible,” explained Case.

 

The acknowledgement of a time sensitive order is a prime example of TeamSTEPPS communication used in the Main OR. Acknowledgment is also known as the ‘call-back’ tool.  When an order is given, team members respond and then call-back when completed. The call-back process ensures that the information conveyed by the sender is understood by the receiver as intended.

 

An example of a call-back would have the sender initiating a message with the receiver who accepts the message and provides feedback. The sender then double-checks to ensure that the message was received.

“Call-backs are encouraged. A call-back helps make it clear that an order was understood and is being taken for action. This is especially important during communication when an order is shared out loud and immediate delegation is needed,” said Lt. Cmdr. Jeffrey Peterson of NHB’s Main OR.

 

In dealing with pediatric malignant hyperthermia, which is potentially a fatal metabolic disorder, the aim for medical providers is to keep treating until the case is proven otherwise.

“This is why Main OR has a cart reserved specifically for malignant hyperthermia. Resuscitation and treating for this condition is very labor intensive. It takes a lot of people. Everyone has to help and that help is vital. That’s why everyone communicating – listening and acknowledging – is so important,” Bushey said.

 

Just as the Main OR staff uses the Team STEPPS format of always having a check list in place to go over before surgery, there is also another check list with references affixed to the malignant hyperthermia cart.

 

“We take nothing to chance. That check list is our friend and very important,” Bushey said.

 

Bowdoin attests that TeamSTEPPS is also ‘all about recognizing risk factors and then immediately sharing on what needs to be done.’

 

“Knowing signs and symptoms is critical but also so is being able to be part of the team,” Bowdoin said.

 

The TeamSTEPPS concept of team structure revolves around assembling the team; establishing a leader; identifying the team goals and vision; assigning roles and responsibilities; actively sharing information and holding everyone accountable.

 

Leadership as a performance tool includes utilizing resources to maximize performance; balancing the workload within the team; delegating tasks as appropriate; conducting briefs, huddles and debriefs; and empowering the team to speak freely and ask questions.

 

Case attests that an effective TeamSTEPPS leader is also a strong patient advocate. 

“Someone who, regardless of rank or position or job title, is cognizant and aware of each team member, respects their roles and contributions, and recognizes when someone who needs to say something, but is too shy to say it,” Case said.


Situation monitoring fosters communication to ensure that all team members are on the same page and know what is going on around them. The patient and family are also included in the process.

 

Mutual support provides task-related assistance; provides timely and constructive feedback; effectively advocates for the patient; encourages team collaboration; and uses such available as the two-challenge rule to resolve conflict.

 

Case stressed the importance of situational monitoring and cross monitoring noting that during a surgical procedure, at all phases, from pre-operative to post-operative, there is a lot going on in various sections. Anesthesia nurses is prepping the patient for induction of the anesthetic state; the surgical techs are setting up the sterile field and the surgeon is reading over the chart to verify the surgical plan.  Multiple systems are going on at once. 


“Each team member is focused on their section, but also keenly aware of the other aspects of the room and what the various teams are doing, and most importantly, how they are doing.  An urgency or question from one will divert the essential team members to that aspect of the patient’s surgical care to ensure things are addressed,” said Case, adding that thanks to the openness concepts within TeamSTEPPS, problem solving happens as a group through teamwork.

 

The two-challenge rule – which empowers all team members to stop action if they sense or discover an essential safety breach - can come into play when an initial assessment is ignored. If that happens to a team member, they have the responsibility to assertively voice their concern at least two times to ensure they have been heard. The team member being challenged must acknowledge. If the outcome is still not acceptable, a stronger course of action must be taken by utilizing the supervisor or chain of command.

 

Case says that putting TeamSTEPPS principles into practice lessens any stress in an emergency scenario and helps achieve a successful outcome. Patient-safety is the bottom line of TeamSTEPPS with everyone is part of the team, not only the Main OR staff, but also the patient and even their family.

 

“TeamSTEPPS is extremely important for the staff and even more so for the patient. Patient safety succeeds with programs like TeamSTEPPS to ensure that the right thing is done each and every time,” said Case. “By having everyone on the same page the patient is in the best situation possible.  If something is out of place, the patient can rest assured that someone will speak up, so corrective actions can be taken and safety maintained.”

NHB’s Quality Management team conducts periodic training in TeamSTEPPS, a three-step process that initially starts with a pre-training assessment, followed with training for onsite trainers and staff members that segues into actual implementation and sustainment of the program with the main goal of maintaining the continuous culture of patient safety.

Prep Work to Testify for Navy Medicine Sexual Assault Medical Forensic Examiners

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- From the clinical to the courtroom, the initial Sexual Assault Medical Forensic Examiner (SAMFE) training held at Naval Hospital Bremerton switched to the military justice process for the final day on July 24, 2015.

Several members of the Navy Judge Advocate General Corps’ were on hand to share their professional experience, insight and information with the examiners and their specific role at trial. The goal was to educate, inform and perhaps even alleviate any pre-trial jitters that could arise if and when any of them gets called upon to testify. 

“There is a reason why some in Navy Medicine don’t want to do SAMFE and that’s because of nervousness from having to go into court and testify. This training today gives us the opportunity to go through a mock direct examination and cross examination process. We’re learning hints and tips from Navy legal experts in going to court,” said Lt. Cmdr. Lacy L Gee, Nurse Corps, Certified Nurse Operating Room, Main Operating Room division officer, Sexual Assault Nurse Examiner and organizer of the SAMFE training at NHB.

Naval Hospital Bremerton’s Legal Officer, Lt. Keleigh Anderson, opened the Military Justice Brief by going over Uniformed Code of Military Justice articles, the difference between rape and sexual assault, the step-by-step process how an allegation becomes a case and where a SAMFE fits in the judicial scheme of things.

“As a SAMFE you are there to teach the judge and jury what you know. You are an educator. You are not there to determine if the case happened but to help make an informed decision,” said Anderson, adding that the examiner’s priority is always the health and well-being of the patient since a SAMFE is a medical provider and not a law enforcement agent.

The bottom line, according to Anderson, is that any SAMFE who does get called to testify has got to realize that not only is their credibility at stake, but also that of the official evidence. There are several common sense steps to follow when testifying. They are,

Be prepared. Review the medical records and all documentations and photos (if applicable).
Be precise. Use terminology correctly. Sloppy wording can be problematic on a cross examination.
Be concise. Only answer the question asked.
Be plain-spoken. Medical jargon gets lost in the dialogue.

“A SAMFE is supported by medical experience, science and practice. They are not there to make the case. The medical testimony is only one aspect of a sexual assault case,” stressed Anderson.

A viable resource that the Navy established to help those dealing with the traumatic effects of sexual assault is the Victims’ Legal Counsel Program that was started in 2013.

The program offers attorney-client relationship with privileged communications and duty to represent the client. Active duty and reservists are assisted anytime and anywhere. Dependents, retirees and certain civilians when assaulted by active duty members are also helped.

“It’s important to share that in my capacity as a victim legal counsel I don’t work for the prosecutor, defense or command. I work solely for the victim and form that attorney-client relationship directly with victim(s) of sexual assault,” explained Lt. Cmdr. Steven Meredith, Judge Advocate General Corps and Victims’ Legal Counsel assigned to Naval Base Kitsap Bangor, who covers all of the West Sound region/greater Kitsap Peninsula area.

Meredith provides legal advice, assistance and advocacy related to alleged sexual offense. He give clients a ‘voice and choice,’ protects a client’s privacy, and advances and advocate a client’s interests

“Any time there is any sexual assault case, the sooner I can meet with the victim the better,” continued Meredith. “I can help with their concerns, such as explaining the process so they can make informed decisions. I also can advocate for them in court; be with them doing an interview with NCIS; and if they are worried about collateral misconduct, such as underage drinking, their sharing is confidential and (falls under) restricted reporting.”

“One thing to also remember is that if a victim legal counsel is involved as soon as possible, it lessens the victim having to retell their story a million times,” Anderson added.

Testimony strategy was then shared by Lt. Cmdr. Travis J. Owens, Senior Trial Counsel assigned to Region Legal Service Office Northwest and Lt. Julie Sherman-Dumais of the Military Justice Department, Region Legal Service Office Northwest.

“As a SAMFE, you are not there to give your personal opinion. You will be called upon to admit the Sexual Assault Forensic Exam (SAFE) report and to explain the report,” stated Owens, sharing such practical strategies as reviewing documents, protocols, exam procedures and other issues all part of the process to make sure a SAMFE and counsel are on the same page.

Owens and Sherman-Dumais went through a mock filed report of a simulated sexual assault, peppering called-forth examiners with queries to test their response ability.

Lt. Matthew Landon from the USS Boxer (LHD 4) calmly handled and explained every question from Owens.

“That’s what we’re looking for,” commented Owens on Landon’s performance, explaining that direct examinations rely on open-ended questions whereas cross-examination questions differ stylistically from direct by using leading questions that are usually answered by a ‘yes’ or ‘no.’

“The long and short of it is that a SAMFE doesn’t have to sweat it. We will prep beforehand. We’re here today to show the concepts,” Owens said.

According to Cmdr. Gregory Freitag, Navy’s Bureau of Medicine and Surgery (BUMED) Sexual Assault Medical Program manager, historically the sexual assault medical forensic examiner role has been seen as an arm of law enforcement.

“When a provider presented themselves as a law-enforcement proxy, a lot of the time their testimony would be discounted. We’re going over the cross examination skills needed and refining how to be objective witnesses,” Freitag said.

Judicial expertise and medical experience aside, there was one common assessment throughout the training scenario that linked everyone together in combatting sexual assault.

“Victims…look like everybody,” stated Owens.

NHB held the SAMFE training for the week of July 20-24 for experienced Navy Sexual Assault Medical Forensic Examiners.

The training featured enhanced curriculum to augment the command’s response ability in preventing and eliminating sexual assault, as well as continuing to provide timely patient-centered care to any victim in need.

“This training is very important to the Navy. It has the attention, alignment and purpose of all the service surgeon generals. Congress has called for the uniform training and this is our beginning. We will deliver patient-centered trauma support and care. The focus of the course is that the victim comes first,” said Cmdr. Gregory Freitag, Navy’s Bureau of Medicine and Surgery (BUMED) Sexual Assault Medical Program manager.

Freitag is part of the BUMED team directing the advanced and enhanced training, with an emphasis on policy, headquarters oversight, and being able to address questions and provide insight to how the training relates to Navy Medicine.

NHB was the initial stop on the training itinerary that is the culmination of months of behind the scenes work by the three services – Navy, Army, and Air Force – to have uniformed standard training to expand provider knowledge and comprehension of medical-forensic care to sexual assault patients.

The SAMFE curriculum had multiple disciplines share, including Fleet Family Support Center, Sexual Assault Prevention and Response (SAPR), Victim Advocates, Pastoral Care, Mental Health, law enforcement, Naval Criminal Investigative Service, as well as the representatives of the Navy Judge Advocate General Corps.


Freitag attests that the biggest difference between the civilian sector and the military is that in the armed forces, sexual assault is a more broadly defined concept. Any type of unwanted sexual contact can be considered a crime and will be investigated as such.

“Our nation’s military works sexual assault differently. Every report is investigated. Every allegation is taken seriously,” Freitag stressed.

The release of the FY15 National Defense Authorization Act (NDAA) increased the training requirement for a qualified SAMFE stating that they needed to hold either a Sexual Assault Nurse Examiner Adult/Adolescent certification or equivalent, or have training and clinical/forensic experience in sexual assault forensic examinations similar to that required for certification.

“To have the senior leadership and surgeon general’s concurrence and endorsement is very gratifying. As we continue to practice in the fleet, we will ensure robust delivery of care is in alignment with the Chief of Naval Operations, Adm. Jonathan Greenert goal for the program,” Freitag said.

Sexual Assault Medical Forensic Examiner Training held at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – It’s enhanced and advanced training that qualified providers need, yet hope they never have to use.

It’s also standardized instruction for all military branches, subject matter expert driven, and required by law.

Naval Hospital Bremerton held Sexual Assault Medical Forensic Examiner (SAMFE) training for the week of July 20-24, 2015 that was attended by experienced Navy Sexual Assault Forensic Exam providers.

The SAMFE training features enhanced curriculum to augment the command’s response ability in preventing and eliminating sexual assault, as well as continuing to provide timely patient-centered care to any victim in need.

“This training is very important to the Navy. It has the attention, alignment and purpose of all the service surgeon generals. Congress has called for the uniform training and this is our beginning. We will deliver patient-centered trauma support and care. The focus of the course is that the victim comes first,” said Cmdr. Gregory Freitag, Navy’s Bureau of Medicine and Surgery (BUMED) Sexual Assault Medical Program manager.

Freitag is part of the BUMED team directing the advanced and enhanced training, with an emphasis on policy, headquarters oversight, and being able to address questions and provide insight to how the training relates to Navy Medicine.

NHB is the initial stop on the training itinerary that is the culmination of months of behind the scenes work by the three services – Navy, Army, and Air Force – to have uniformed standard training to expand provider knowledge and comprehension of medical-forensic care to sexual assault patients.

The SAMFE curriculum has multiple disciplines sharing that include Fleet Family Support Center, SAPR, Victim Advocates, Pastoral Care, Mental Health, law enforcement, Naval Criminal Investigative Service, and Navy Judge Advocate General Corps’ victim legal counsel.


Freitag attests that the biggest difference between the civilian sector and the military is that in the armed forces, sexual assault is a more broadly defined concept. Any type of unwanted sexual contact, from breast to genitals, can be considered a crime and will be investigated as such.

“Our nation’s military works sexual assault differently. Every report is investigated. Every allegation is taken seriously,” Freitag stressed.

The military focused training is addressing overlapping areas of training requirements.

“We have subject matter experts here to share best practices and up to date information. This is a valuable experience for us all because we can learn from each other, network, and help to further the science of sexual assault medical forensic work,” said Lt. Cmdr. Lacy L Gee, Nurse Corps, Certified Nurse Operating Room, Main Operating Room division officer, Sexual Assault Nurse Examiner and organizer of the SAMFE training at NHB.

Gee notes that the SAMFE course is not focusing on teaching about performing medical forensic exams. The ability to perform such is a service that the providers enrolled in the course already are able to handle to beneficiaries, whether stateside, at sea, or forward deployed down range. They already know a forensic exam is not the same as a physical exam and the principles behind proper evidence collection and forensic photography. The 26 course modules for this week are increasing their ability to interact with patients that have experienced sexual assault trauma.

“By training examiners and assistants here, we provide them the opportunity to carry this skill with them throughout the Navy, regardless of their assignment. We're committed to providing exceptional care to all our patients,” Gee said.   

Guest lecturers in their recognized fields such as toxicology experts and professionals on behavioral healthcare for sexual assault patients are on the schedule for such topics as,‘Victim Advocacy and Sexual Assault,’ ‘Intimate Partner Sexual Assault,’ ‘Healthcare Implications of Sexual Violence,’ ‘Informed Consent,’ ‘Patient Centered Care,’ ‘Military Criminal Investigative Officers (and) Investigative Aspects of Sexual Assault,’ ‘Legal Considerations/Reporting Options/Payment Under the Violence Against Women Act,’ ‘Sexual Assault Medical-Forensic Exam,’ ‘Forensic Evidence Processing and Analysis in Sexual Assault Cases,’ ‘Alcohol and Drug Facilitated Sexual Assault,’ ‘Medical-Forensic Documentation,’ ‘The Male Sexual Assault Patient,’ ‘Sexually Transmitted Diseases Evaluation and Treatment,’ ‘Pregnancy Risk Evaluation and Care,’ ‘Discharge Planning and Follow-up Care,’ ‘Suspect Examinations,’ ‘Sexual Assault and Contingency Operations,’ and ‘Compassion Fatigue.’

“I think one of the best aspects of this entire course is that we all get to share our experience, knowledge and use that better ourselves and each other in this discipline,” said Lt. Sarah Huley, NHB SAFE examiner and Critical Care Nursing division officer, who is teaching several modules in the week-long course.

The training will wrap up on Friday with the emphasis on the military justice process and the role of the SAMFE at trial.

Freitag notes that historically, the sexual assault forensic examiner role has been seen as an arm of law enforcement.

“When a provider presented themselves as a law-enforcement proxy, their testimony a lot of the time would be discounted. We’ll go over cross examination skills needed and refine how to be objective witnesses,” Freitag said.

“I used to work in trial settings taking notes as part of my job so I was used to being in court. But once I got called up to testify and that was entirely new. I almost couldn’t help but be nervous. It can happen to anyone. This training will definitely help,” added Peter Medina, NHB Paralegal Specialist.

With the SAPR providers already trained in forensic exam protocol, the added insight from the course syllabus will enable them to deliver a high standard of compassion, care and concern to any sexually assaulted victim. Just understanding the physiological reactions of sexual assault will help the providers in turn help their victims.

Using the ‘fight or flight’ analogy for someone to respond to trauma, Freitag pointed out that there’s also a third option – ‘freeze’ – with which a person can react to a shock to the system like being sexually assaulted. Recall can be delayed. Memory of events can be disorganized.

“Victims often appear unable to comprehend and remember. As a result, in the past, there was been case attrition with snap decisions being made because an attorney or law enforcement officer didn’t think there was any chance for a case. It’s not a question of contact; it’s a question of consent. In every case, the victims will need compassionate patient centered care which is vital for their recovery and resiliency,” Freitag said.

According to the Department of Defense Sexual Assault Prevention and Response 2014 Annual Report, the estimated number of service member sexual assault victims in Fiscal Year 2014 was 18,900, compared to an estimated 26,000 in FY 2012. There were 6,131 reports of sexual assaults in FY 2014. 

“We did 342 total exams in the Navy for Fiscal Year 2014, with 11 taking place on a ship. Getting a DNA swab during the forensic exam is part of the process but it isn’t the real importance. Providing the best medical care that we can to the patient is our best way to provide for them, assist in their healing and in getting them back to where they need to be,” said Freitag.

BUMED directed the establishment of a multidisciplinary team three years ago - made up of doctors, nurses, physician’s assistant, independent duty corpsmen - to be able to handle any such need at a military treatment facility like NHB with staff trained and available to ensure timely and appropriate medical care is available to sexual assault victims as soon as possible.

The release of the FY15 National Defense Authorization Act (NDAA) increased the training requirement for SAFE, now SAMFE, trainers stating that they needed to hold either a Sexual Assault Nurse Examiner Adult/Adolescent certification or equivalent, or have training and clinical/forensic experience in sexual assault forensic examinations similar to that required for certification.

NHB’s SAMFE, as well as Sexual Assault Prevention and Response (SAPR), are both comprehensive programs staffed by trained personnel to reinforce a culture of prevention, response, and accountability for the safety, dignity, and well-being of Sailors and Marines. The Department of the Navy does not tolerate sexual assault.

“We in the military have to be good stewards of public trust. In our diverse community we have to be adaptable and responsive to the needs for patient centered care. Having a structured program in place that includes such core responsibilities as Victim Care Protocols are important to every command with SAMFE and tailored to each military treatment facility,” Freitag said.

Victim Care Protocols are MTF specific. At NHB they include a safe (exam) room in the Urgent Care Center, victim advocate availability, as well as having professionally trained staff member(s) to guide through the entire forensic exam process.

Under the leadership of Lt. Angela Sadosky, Occupational Therapist and SAPR Program Coordinator, NHB ensures that sexual assault education is provided to every Sailor on a regular basis. Drills and awareness events are held. There is an informational photo board on the first floor displaying the command’s victim advocates, so staff as well as beneficiaries are aware of who they can turn to in case they have questions or need help. Additionally throughout the entire hospital, DoD Safe Helpline posters are affixed so everyone knows where to turn for increased professional help if needed.

 “To have the senior leadership and surgeon general’s concurrence and endorsement is very gratifying. As we continue to practice in the fleet, we will ensure robust delivery of care is in alignment with the Chief of Naval Operations, Adm. Jonathan Greenert goal for the program,” Freitag said.

Naval Hospital Bremerton’s Deputy Comptroller is Navy Medicine Accountant of the Year By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- The work of a Navy Medicine comptroller impacts the entire command as they administer the myriad acquisitions, logistics, and manpower issues throughout the fiscal year.

 

A little innovative thinking can help to assist in the overlapping process of such budgetary management, and Naval Hospital Bremerton’s (NHB) deputy comptroller can readily cite an example.

 

“A project that I implemented when I first came aboard at NHB was the monitoring and right-sizing of contract execution. At NHB, we track anywhere from 150 to 200 contracts for goods and services on any given fiscal year. This is everything from lab reagents to contracted Labor and Delivery nurses. The risk in renewing or creating a new contract is that we must set aside command funds for the life of the contract - no more than one year - because our funds expire every year until we receive new allotments every October. The problem was that several contracts were being over or under funded on the front end and no one would realize we had overshot or undershot a contract until the contract expired,” said Lt. Matthew Ozanich.

 

According to Ozanich, there was a lab services contract to start Oct. 1, 2015 with the contract expiring on Sept. 30, 2016. The command’s Resource Management Directorate had to estimate how many funds had to be allotted for that specific contract. The awareness for Ozanich was that they could set aside a certain amount but then only get billed for half of the lab services for the year. If such was the case, the funds that went unused would also expire at the end of the year instead of being shifted elsewhere to cover other needs during that time. The goal in any such scenario is to ensure that does not happen.

 

“What we developed over the last couple of years is a system to track and monitor all of our active contracts for any given fiscal year. If a contract is underperforming, we touch base with the department that uses that contract and see if we can reduce the contract award to be redistributed to other needed areas,” explained Ozanich, a Medical Service Corps officer from San Antonio, Texas.

 

For his work on this and other duties in his position, Ozanich was recently recognized as Accountant of the Year ‘for outstanding achievements in accounting operations, standard operating procedures sustainment and financial statement audit readiness.’

 

The accolades are nice, but Ozanich attests that he did not expect to see his name listed amongst the Calendar Year 2014 Department of the Navy Bureau of Medicine and Surgery (BUMED) Financial Management Award winner.

 

“It was a complete shock to me. I feel humbled and honored to have been chosen and it definitely wouldn’t have been a possibility without help from several individuals. But in all honesty, I did do a few fist pumps when I found out,” said Ozanich, who graduated from Sandra Day O’Connor High School in 2005.


Ozanich grew up in San Antonio and completed his Bachelors and Masters in Health Administration at Texas State University. He gravitated towards the Navy soon after.

 

“My father was retired Army and almost every healthcare experience I had ever had was at Lackland Air Force Base in San Antonio. Choosing it as a career possibility was always in the back of my mind going through college. Entering grad school, I started communicating with recruiters and discovered that Navy Medicine was by far and away the best career choice for me. It has also given me the opportunity to serve my country and give back to the military health system,” said Ozanich, adding that being in the Resource Management field has been a very rewarding experience in his career that has taken him from Newport R. I. to Washington D.C. to his current assignment at NHB.


The fact that he grew up within the military health system provided insight to start his own military career.

 

“I was (also) fortunate enough to have the opportunity to specialize in Resource Management as a health care administrator coming right out of officer development school,” Ozanich said.

 

Ozanich insists that the best part about his Navy Medicine career has been watching programs, policies, and practices he has had a hand in developing have a meaningful impact on the command and BUMED.

 

When asked how important it is to be the command’s comptroller, Ozanich cites the quote “No margin. No mission,” from Sister Irene Krause, the former chairman of Baptist/St. Vincent's Health System in Jacksonville and one-time head of one of the nation’s largest Catholic health systems who passed away in 1998 at age 74. She strongly believed that strong fiscal management is what modern hospitals need to fulfill their mission.

 

Aside from keeping the books balanced and ensuring that there is proper funding to make the command mission, Ozanich also helps determine that all the command’s fiscal responsibility are in accordance with appropriation laws and policies.

 

“I don’t think a lot of people grasp just how many different rules and regulations are in place guarding the tax payer’s dollars. It makes our job difficult at times because we are usually the bad guys telling everyone ‘no, we can’t do that.’ Also, Department of Defense is undergoing an external financial audit in a couple of years. It has been a very challenging process to become audit ready. We are in the middle of that journey right now and it will ultimately be the responsibility of the Comptroller to ensure that the command will pass the audit when it comes,” Ozanich said, noting that the most gratifying aspect of his job is the people that he works with every day.


“It has been a surprising, rewarding, and challenging journey so far,” stated Ozanich, when asked to sum up his Navy Medicine experience in one sentence.

Dress Exchange provides Formal Support

By Victoria G. Quarles, Naval Hospital Bremerton Assistant Public Affairs -- From formal to flowing, and all free, there was a Dress Exchange held to help out any women that were looking for a dress for the Corpsman Ball on June 19. The event was coordinated by the Naval Base Kitsap (NBK) Ombudsman Assembly.

Megan Henry, NBK Ombudsman Assembly Chair, explained that the assembly consists of “ombudsmen who volunteer to host the completely free event for all Naval Base Kitsap – Bremerton area families.”

“The purpose of the Dress Exchange was to help those in need of a dress for the Corpsman Ball. The Dress Exchange was for all Department of Defense spouses and ID card holders. The event was one that many ombudsmen partook in to help out the spouses and family members of those in our command,” said Shannon Afarin, Naval Hospital Bremerton (NHB) Ombudsman, adding that when they previously held the event in the fall and the spring it was also a success to providing such a needed service.

One individual who used the Dress Exchange for the Corpsman Ball, also referred to as the Formal Fashion Swap, was Porsha Lee, a military spouse.

“I used the dress for the Corpsman Ball because I didn’t have time to go and purchase a new dress and I did not want to wear the same one I wore last year. I was very happy with the dress I chose and all the selections that were available in my size,” Lee said.

In response to being asked how she heard about the Formal Fashion Swap Lee said, “I was told about the Formal Fashion Swap by another woman, Tammy McClellan. I was very happy I chose to get a dress from the dress exchange because I had got a lot of compliments at the Corpsman Ball and I had a lot of fun.” 

According to Afarin, the concept of having dresses available to share with others was started by a group of ombudsmen who saw a need and worked to fill it. The Ombudsmen Assembly of NBK noticed that there were smaller individual groups who were partaking in similar exchanges, but the range of customers excluded the participation of military spouses and families in the NBK area.

This inspired the Ombudsman Assembly to open their own event to eligible Navy active-duty and dependents, making sure to target individuals attending any sort of formal event. Even though the Formal Fashion Swap merchandise primarily consists of ball gowns, the range of dresses included cocktail gowns and various dresses for other military functions.

In addition to dresses, the Formal Fashion Swap also had shoes, jewelry, new undergarments, shawls, new makeup, gloves, formal dress jackets, and various other accessories available. Vendors were also invited to share tips, tricks and suggestions for makeup, hair, and jewelry. Vendors in attendance at the event were not permitted to sell any products. The dresses, shoes, jewelry, makeup, shawls, and other accessories were all donations.

According to Henry, anyone who wanted to make a donation was asked that the condition of the dress be gently used, undamaged and clean. Donated dresses did not have to be dry-cleaned prior, but any extra effort was highly appreciated by the volunteers.

The first Dress Exchange was held in April 2014, followed by the second in September and then again in February 2015.

“The next dress exchange has been booked for August 8 and will be held at the old gym on Naval Base Kitsap - Bremerton,” said Henry.

Since February the number of dresses provided has doubled from the 60 participants that left with dresses.

“We have seen around 250 dresses come through the dress exchange since we started in the spring of 2014,” said Henry, adding that anyone who wishes to provide a donation should contact their Ombudsman to make it happen.

When asked why they chose to do the Dress Exchange, Henry replied, “the purpose was to acknowledge that attending military formal functions can become costly for anyone, no matter what rank they are. Many of us have formal wear gathering dust in the back of our closet that we may never wear again. So why not pull them out, dust them off and let them find a new life with someone in need? The exchange is all about promoting, sharing, networking, and being an overall morale boosting activity through giving.”

 Presenting and Receiving of Coins a priceless commodity for Navy Nurse Corps officer
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Some coins are simply worth more than money.

The face-value is measured not in monetary worth, but with professional significance, personal sentiment and at times even historical relevancy.

For Lt. Cmdr. Carmelo Ayala, Naval Hospital Bremerton Internal Medicine Department head, the best example he can readily share is to reach into a uniform pocket and proudly display the coin of the 25th Navy Chief of Naval Operations, Adm. Jeremy Michael Boorda.

The coin worth to Ayala lies in the fact that Boorda was the first Sailor to rise up from the ranks – from enlisted to officer – to become the top Navy officer. Like Boorda, Ayala also started out as an enlisted Sailor and has found his niche in the Navy Nurse Corps.

“I just love getting and also giving coins. I have received a few over the years from mentors, hospital corpsmen, IDCs (independent duty corpsmen), Navy Nurse Corps officers and others. I am a firm believer that a coin is just a great way to say thanks you to someone for going that extra mile to help out,” said Ayala, a Camden, N.J. native with over 28 years of naval service under his belt.

Ayala notes that his personal coin collection has grown to over 3,000 although an accurate figure isn’t really available.

“I haven’t actually counted them in a while. I get coins all the time from friends, co-workers and beneficiaries from everywhere. Just this week there’s 13 new ones,” Ayala said.

That baker’s dozen of new coins also includes a very special addition that came about by happenstance. Ayala struck up a conversation on the elevator on the way up to his department with a beneficiary. They exchanged small talk on their military service.

“The gentleman shared that he had been in some wrong places at the wrong times because at some of those places, people didn’t return,” related Ayala, adding that he was also told that the care and concern provided was very much appreciated and at that point, a very distinctive coin was presented to him as a thank you.

The coin came from Lt. Col. Bruce P. Crandall, who received the Medal of Honor in 2007 for his heroic actions in the Battle of Ia Drang in 1965 with A Company, 1, 229th Assault Helicopter Battalion, 1st Cavalry Division (Airmobile).

“Just goes to show you that if you treat others the way you want to be treated that they will appreciate it. What an honor! How often does one get a coin from a Medal of Honor recipient? The least I could do is return the favor and give him one of mine,” said Ayala, who started his Navy career as an undesignated seaman assigned to fleet oiler USS Cimarron (AO 177), from 1987 to 1990.

The origin of the military (or challenge) coin goes back to the days of the early Roman Empire. Militaries throughout history have presented such a token with the unit’s logo or insignia on it to someone deemed worthy by a special achievement on their part. The practice also includes exchanging coins during exercises, collaborations and assignments.
Yufeng Miller of NHB’s Internal Medicine department had witnessed active duty personnel accept a coin but never thought that she would receive one, until Ayala presented his coin to her last month.

“I never thought that I’d get one. It’s great. It makes me feel more appreciated in our department. I now have a few more and I even have a little display that was made for me on my work desk,” said Miller.

Ayala attests that the best thing about any coin, for both the recipient and the presenter, is that the simple gesture is a morale builder and is all about service. His philosophy centers on treating someone they way you want to be treated and they will return the favor.

“If you tell someone you got their back, they will remember that. Whether it’s helping with paperwork, getting an appointment, conducting a diagnosis, whatever the case may be, people can tell when someone cares. As a part of Navy Medicine, and as a Navy Nurse Corps officer, I’m in the caring business. It’s what I do. It’s what we do,” said Ayala, citing an example from several years earlier of helping an aviation maintenance administrationman first class petty officer get into the Medical Enlisted Commissioning Program (MECP) for nursing.

“We needed her commanding officer’s endorsement on her submission package, but he was on leave with explicit instructions not to be disturbed unless for an emergency. Since I had helped her put her package together at the branch health clinic I was at, I took the liberty of phoning him and respectively explained why his assistance was needed as soon as possible due to the deadline. He asked if she was qualified as a candidate for our Nurse Corps and after ensuring him she was, he readily came in to give his endorsement. That AZ1 later on sent me a coin as a way of saying thank you after being accepted. That made my day, knowing that I could help her get where she wanted her career to go and then have her share that she made it,” related Ayala.

There is also power in a coin says Ayala. A coin can spark motivation along with boosting morale.

“It’s a small gesture but it goes a long ways. The only thing better than getting a coin is giving one,” Ayala said.

The most recent coin that Ayala presented was to Personnel Specialist Seaman Josephine Fabia in NHB’s Human Resource Department for her work in expediting needed paperwork for Ayala and his wife, Michele. He was anticipating that it would take several days to complete the necessary administration requirements. Twenty minutes later, Fabia contacted him to say his documents were ready.

“That service was so professionally prompt and courteous that I immediately tracked her down to say ‘thank you’ and present her with a coin,” said Ayala.

For Fabia, it was her initial coin.

“It was awesome to receive my first! I keep it in my car. It’s good luck,” Fabia said.

Ayala’s self-designed coin has embossed raised lettering around the edges on one side that states, ‘I did it the hard way I earned it,’ and ‘the price of greatest is integrity.’ The middle portion revolves on two hinges, with one side showcasing the Navy Nurse Corps emblem surrounded by the words, ‘Nursing Excellence Up Through the Ranks.’ The flip side of the middle features a mustang horse, the icon representing a commissioned officer who started out in the enlisted ranks, along with the caduceus, the symbol of the Navy hospital corpsmen.

Despite all the coins he currently has, there is one that has at least so far eluded him. One from USS Cimarron. He had the opportunity, but as a young Sailor he could not justify the reasoning to purchase the coin from the ship’s store at the time.

“I remember back then thinking why would anyone want to buy this little piece of brass? But as I’ve gotten older I realize that there is such a connection to history and camaraderie. For the past 20 years I’ve been trying to locate one. But what’s really cool is someone, and I don’t know who, made this wood carving replica of the Cimarron coin for me. No one is taking credit for it and it’s great,” Ayala said.

Just as Ayala has been persistent in collecting coins, his career has also been an study in perseverance. After high school, he wanted to get into the state’s Licensed Practical Nursing school but due to fiscal uncertainty in the program he decided to join the Navy. He set his sights on becoming a corpsman. On the Cimarron he logged hours under instruction in the ship’s small medical bay. Then a freak accident conducting preventive maintenance had him transferred to a base clinic. Fate intervened as his skill was noted by an admiral being seen who helped get him selected for corpsman school, where he excelled. After reaching the rank of senior chief hospital corpsman, he then decided to continue his Navy service in the Nurse Corps.

“Although nursing was my original goal, the main reason why I went the commissioning program was to be able to better provide for Michele. The added schooling and training has increased my knowledge and allowed me to be better able to care for her and care for my patients,” said Ayala.

As his career winds down, Ayala feels he has made an impact not only in the field of medicine, but as a caring coin giver and receiver, which in some ways is just as priceless.

Behavioral Health Consultation Service available at Branch Health Clinic Bangor

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Overall good health and wellness has been defined as combining equal measures of mind, body and spirit.

Naval Hospital Bremerton’s Branch Health Clinic Bangor is helping patients achieve that balance by implementing an Internal Behavioral Health Program in the Family Health Clinic and offering behavioral health consultation service to those enrolled with the clinic.

The new service offers assistance when habits, behaviors, stress, worry, or emotional concerns and issues about physical or other life problems interfere with someone’s daily life.

“As a consultant to the provider, I am part of our clinic team. I am someone on the team a patient can talk to. We work as an integrated team thus being able to provide a more holistic approach to care. The benefit of me here is that…I’m here,” said Ms. Chalice Ledet, Internal Behavioral Health Consultant (IBHC), a licensed clinical social worker with specialty training working as a member of the primary care team.

Having a consultant like Ledet adds an extra component of addressing the emotional health, habits and behaviors of a patient. IBHC are licensed professionals trained at assessing functional impairment in work performance, work relationships, family relationships, social activities, recreational/fun activities and exercise due to mental/emotional issues.   Behavioral interventions and psychoeducation are provided at visits and statistics show that a patient's overall functioning improves.  In many cases, the work of the IBHC serves as good preventative medicine by addressing a problem before it gets out of hand and cost savings to the government are a plus. 

A big plus is that a patient can walk in any time without a referral for a quick consult by the IBHC to address their problem. Patients also benefit with the more holistic approach by not having to wait on a Specialty Care appointment. 

“The patient can see the IBHC approximately four to six times for one issue, then as needed for different problems, without a referral from the primary care manager (PCM).  If a patient has deep seated or complicated issues and the patient needs more help, they will then be referred to Specialty Care,” Ledet said, noting that the PCM can give a warm handoff to the IBHC and they can be seen that same day or scheduled accordingly. 

Many times the IBHC visits with the patient in the exam room with the PCM for a quick assessment and the process begins from that initial interaction.  Because Ledet is embedded internally as part of the team, the PCM does not have to put in a consultation/referral note in the electronic medical records system (Armed Forces Health Longitudinal Technology Application (AHLTA)). The IBHC keeps the PCM informed of the findings and the plan after a visit, generally same day.

“I’m working to help the doctors so they can better care for their patients. Say a patient comes in to see the doc and there’s something else – anxiety or depression – going on. I can come in and be that someone to talk with and I can give them tools to help cope,” said Ledet.

Ledet attests that there are overlapping benefits having an IBHC right there during any appointment.  The PCMs benefit by having the expertise of the IBHC being able to evaluate any concerns they encounter during an examination. The IBHC assists with giving their patients additional education and skills to increase coping with daily stressors and adherence to the PCM's treatment plans, among the many other benefits.

“(An) IBHC is here to take the load off of a PCM by stepping in to address those who need that extra time in dealing with their physical and mental issues; who are needy and make repetitive PCM appointments; or are noncompliant and have behaviors that are blocking their progress.  IBHCs are trained at probing deeper into underlying issues affecting overall health and can coach the patient toward wellness or at least let the PCM know where the lack of progress is coming from.  This saves the PCM time and energy.  Clinical pathways are being designed and will add the IBHC to the PCM's electronic medical record template for various maladies aside from such problems of anxiety and depression,” Ledet said.

IBHCs can help reduce symptoms associated with various chronic medical conditions, or help patients cope better with such conditions as migraines and headaches, chronic pain, diabetes, asthma and COPD (chronic obstructive pulmonary disease), hypertension, and irritable bowel syndrome.

IBHCs can also assist with developing plans for behavioral change programs or lifestyle modifications such as smoking cessation, weight loss, alcohol use, and exercise and healthier eating.

IBHCs are also capable of helping with emotional or behavioral programs that include family or relationship problems, stress, depression and bereavement, anxiety, and anger problems.

An appointment with Ledet will last approximately 30 minutes and her goal is to provide brief, solution-focused interventions. BHC Bangor hours are 7:30 a.m. to 3:30 p.m. The appointment line is (360) 315-4384.

“Clinic hours are wide open now. I’m not overbooked. We want our patients to know that I’m here for them and they can either call or walk in for an appointment,” Ledet said.

Naval Hospital Bremerton providing for Feverish Flu Season

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – The New Year finds not only football fervor in the greater Pacific Northwest, but also a feverish flu season.

This particular flu season has already made headlines. So far there have been 16 laboratory confirmed fatalities attributed to influenza reported in the state of Washington.

“Most of the deaths have been in middle to older aged people who have had medical conditions that made them more likely to develop pneumonia. While the current influenza vaccine may not provide full protection against the drifted virus it will help reduce severity of illness and symptoms. It is really very important to emphasize that all age groups should be protected by receiving the influenza vaccinations, whether young and healthy or older with chronic illness,” said Tom Shirk, NHB Infection Control coordinator, adding that this influenza season is somewhat unique due to an unexpected genetic drift in one of the primary circulating flu viruses.

Genetic drift in a flu strain is due to natural changes in the circulating virus the last few months, explains Capt. Mark Malakooti, NHB Preventive Medicine physician.

 “If someone has been vaccinated with the current 2014/15 flu vaccine, there is no need to get another one for this season, not until next fall when next year’s vaccine becomes available. It is true that one of the three current vaccine components, the H3N2 one, does not exactly match the H3N2 strain that is making most people sick this flu season, but the vaccine will still provide some protection against H3N2, and some studies show that vaccination may reduce the severity of illness if someone gets infected with the influenza despite having been vaccinated,” said Malakooti, noting that the vaccine does provide protection against H1N1 and B strains of influenza virus, further reducing someone’s chances of getting a flu infection and illness.

“It’s also important to keep in mind that past experience shows that H3N2 dominated flu seasons like this one are more severe, have higher rates of hospitalization and more deaths, continued Malakooti. “Experts agree that vaccination is still the best protection.”

NHB’s seasonal influenza vaccine immunization program was held in October 2014 with a week-long Influenza Vaccination Clinic, specifically designed for Sailors and Marines, mission-essential healthcare personnel, and eligible beneficiaries. More than 4,500 took advantage of the clinic during that time, a 10 percent increase from the previous year.

For those who missed that opportunity, they can visit NHB’s Immunization Clinic at the main hospital and Branch Health Clinics that are offering both injectable and, for healthy patients between 2 years and 49 years of age, intranasal flu vaccine (while supplies last).

“We are still providing the flu vaccine to our beneficiaries. They do not need an appointment to go to the Immunization Clinic in Family Care Center between 8 a.m. and 4 p.m., Monday through Friday. While no vaccine is 100 percent effective, the current flu vaccine will greatly decrease the chances of influenza infection, and if someone does still become infected, they are less likely to have severe symptoms,” stated Malakooti. 

Malakooti cites US Centers for Disease Control and Prevention recommendation that everyone, even those as young as six months, get the influenza vaccine each year.  It is especially important for those at greater risk of severe infections.

“Anyone can become infected with the flu virus, but those in certain categories are more likely to become severely ill with influenza or even die from the infection. Children less than six months who are too young for flu vaccine and with not yet fully developed immune systems, are at high risk. Therefore, it’s very important for anyone who has contact with those children to be vaccinated, to reduce the risk of exposing the child to infection. Pregnant women are also at higher risk of severe influenza if they get infected, as are adults 65 and older and people who have medical conditions such as asthma and other lung diseases, heart disease, diabetes, weakened immune systems due to disease or medication and other chronic conditions. It is important for all these people to get their flu vaccine ever year,” Malakooti stressed.

Additionally, Dr. Dan Frederick, NHB Population Health and Forecasting expert, points out that the value of vaccinating the pregnant population is multiplied because of the cocooning protection to the newborn when mom (and other close household contacts) are vaccinated. Just as it is important for military personnel who live and work in close quarters to receive the vaccine, it is also highly recommended for school-aged children, as they come into close contact with each other and can easily spread the influenza virus.

For those with flu-like symptoms such as fever, sore throat, body aches and pain, Malakooti says they should stay home and rest to recover quicker and prevent spreading the infection. Drink plenty of non-alcoholic/non-caffeinated fluids, cover coughs/sneezes, wash hands frequently, and use an alcohol-based hand sanitizer.

“And get their immunizations! There are (also) prescription antiviral drugs that can be used to treat flu illness and prevent serious flu complications, especially for people in the high risk categories. If someone who is high-risk develops a fever during the flu season, even if they have been vaccinated, they should see their doctor/provider as soon as possible to discuss best treatment options. The sooner the oral antiviral is started, the more effective it can be,” said Malakooti.

Shirk attests that alcohol hand sanitizers are very effective against flu virus, but notes that most people in an attempt to conserve their bottle of hand sanitizer, often use too little to be effective.

“As a guide, enough hand sanitizer product must be spread thoroughly covering all hand surface so that the hand feels wet for approximately 10 seconds. If your hands immediately feels dry, then too little product was dispensed. And for the sake of all of us, we encourage everyone to please cover their cough, but not with their hands! Contaminated hands are one of the primary ways in which influenza is spread to surfaces that everyone then touches,” Shirk said.

Influenza is not the common cold.  Influenza can be a severe to life-threatening disease and getting an annual influenza immunization (either the traditional shot in the arm or the newer nasal spray vaccine) protects many people from getting the disease or becoming severely ill. Influenza is thought to spread mainly from people touching something with influenza viruses on it and then touching their mouth or nose.  One of the challenging aspects of flu is that someone who becomes infected can infect others one day before they have symptoms and up to five days after becoming sick.  Influenza usually causes mild to severe illness, and uncommonly can lead to death.  Symptoms of influenza include fever, headache, extreme tiredness, dry cough, sore throat, chills, runny or stuffy nose and muscle aches. Stomach symptoms such as nausea, vomiting, and diarrhea also can occur but are more common in children than adults. Traditionally, seasonal flu impacts the elderly and the young.

“I encourage parents to get a thermometer for home-use if they don’t have one already. If a family member is running a fever of 100.4 or greater has a cough and/or sore throat then it is very possible that they have influenza,” said Shirk. “If anyone is concerned that their symptoms are not consistent with a mild case of the flu, they should contact their medical provider and/or seek medical attention. For those with mild symptoms recovering at home with over the counter medications for symptom relief is usually all that is needed.”

Compiled statistics by CDC show that every year in the United States, more than 200,000 people are hospitalized from influenza complications and about 36,000 people die from influenza-related causes.  

According to Malakooti, the precise timing of any flu season’s peak is hard to predict, and can also vary in different parts of the country and each season. Seasonal flu activity in the U.S. can begin as early as October and usually subsides by April, with peak flu rates somewhere between December and February.

“This season we have seen the incidence increase rapidly in December with infections now widespread across the country,” said Malakooti.

“Our past experience with any type of flu strain reinforces the continual need to protect ourselves,” said Shirk, who also recommends for everyone to continue proper personal hygiene at all times. “It’s the little things that add up to the whole. We know it’s important and it’s up to us to not only set the example, but ensure our family and friends do the same.”

General information of seasonal influenza can be found at http://www.cdc.gov/flu/.   

What can people do to protect themselves against the flu virus? 

Naval Hospital Bremerton follows CDC recommendations to:

·       Avoid close contact with people who are sick, when you are sick, keep your distance from others to protect them from also getting sick.

·       If possible, stay home from work, school and errands when you are sick.  You will help prevent others from catching your illness.

·       Cover your mouth and nose with a tissue when coughing or sneezing.  It may prevent those around you from getting sick.

·       Washing your hands often will help protect you from germs.

·       Avoid touching your eyes, nose or mouth.  Germs are often spread when a person touches something that is contaminated with germs and then touches his/her eyes, nose or mouth.

 

 New Naval Hospital Bremerton Stop for Patient-Shuttle Service to Madigan
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – The pickup and drop-off site for the Madigan Army Medical Center and Naval Hospital Bremerton Patient Shuttle service at NHB has been relocated due to ongoing construction.

Instead of the service stopping and departing in front of NHB’s quarterdeck, the new location is outside the Urgent Care Clinic, in the Mount Baker Parking Lot.

Departure times from NHB remain 7 a.m., 10 a.m., 1 p.m. and 4 p.m. and from Madigan at 5:30 a.m., 8:30 a.m., 11:30 a.m. and 2:30 p.m.

The convenient new service is for ambulatory patients only and offers patients with a specialty care referral an option for transportation between the two military treatment facilities (MTF) at no cost. All Department of Defense beneficiaries with ID cards riding the shuttle must be able to move about and embark/disembark the vehicle with minimal assistance.

“Unfortunately the shuttle service is not wheelchair accessible. However, eight weeks after it began making eight runs a day between Naval Hospital Bremerton and Madigan Army Medical Center, the patient shuttle keeps gaining riders, saving money for the military health system and benefiting patients,” said Lt. Cmdr. Kirt C. Nilsson, of Business Planning officer with Strategy Development, the Puget Sound Military Health System, noting that well over 100 patients have used the service since its inception in October.

The Patient Shuttle pickup and drop off is (also) at Madigan’s Main Medical Mall North entrance. The shuttle is slated to run Monday thru Friday (except holidays). All shuttle rides are approximately one-hour long. However, they could run late due to traffic and other external factors.

Military Health System notes that there are more than 10,000 specialty care appointments each year at Madigan for active-duty Navy service members, family members and retirees from the Kitsap Peninsula and receive their primary care at Naval Hospital Bremerton. At the same time, there are numerous Joint Base Lewis-McChord service members who receive specialty care at NHB. The shuttle service, making eight runs per day, means patients don't have to pay for gas or tolls, worry about the drive, or put wear and tear on their personal vehicles. This service is also making the integration of medical services more convenient for patients.

If the Patient Shuttle is full, everyone who needs transportation service from one military treatment facility to the other will still have the opportunity to use the service even if that means another shuttle has to called for immediate backup help.

"We have the means to get every patient to their referral and back again. If there are 20 people waiting for the shuttle that only holds 16, we will triage who has priority and call for another shuttle for the others. We're not turning anyone away," said Nilsson.

Nilsson attests that the Puget Sound MHS is continually committed to providing the right care for its patients at the right time. 

“Madigan Army Medical Center and Naval Hospital Bremerton are staffed with skilled medical professionals who deliver quality care each and every day. The shuttle service makes it possible for patients to move between these facilities in order to access quality healthcare in a timely manner. A specialty clinic at Naval Hospital Bremerton may have an appointment available much sooner than Madigan. With the shuttle service running every three hours in each direction, a patient is able to conveniently travel between facilities and come back in an efficient manner,” Nilsson said.

Reservations will not be taken for the shuttle. Patients are requested to be at the designated stop prior to the scheduled departure time. Active-duty servicemembers will have priority, and all others will be transported on a space-available basis. The primary mission of the shuttle is to transport patients for medical care that have scheduled appointments. If space is available once all patients are embarked, escorts/guests may also ride. If an eligible beneficiary has a family member who is an in-patient at Madigan, they may take the shuttle is there is available space.

Washington State law also dictates children less than eight years of age must be secured in some form of child safety system unless the child is 4 feet 9 inches or taller.  Child seats are not available on the shuttle.  If a child will be transported, the parent/guardian must provide a child restraint seat. All children under the age of 18 must be accompanied by a parent. 

Additionally, eligible beneficiaries who are pregnant and receiving obstetrics and gynecology care at Madigan and NHB may use the patient shuttle up to the 36 weeks gestation period. Beyond that however, emergency medical services are not available on the shuttle and a care provider should be consulted for recommendation on any type of travel.

Naval Hospital Bremerton Pediatrics launches Reach Out and Read Program
By Mass Communication Zulema Sotelo, Naval Hospital Bremerton, Asst. Public Affairs Officer -- From their first steps to their first words, parents are there to assist their children during early developmental stages, and they now have literary assistance from Naval Hospital Bremerton (NHB) staff members.

NHB recently brought back the ‘Reach Out and Read program’, which helps promote literacy at an early age by providing children with books when they visit the Pediatric Clinic. Children as early as six months can pick out a developmentally age-appropriate book during their wellness checks.

“I had taken over as the division officer and was looking through some paperwork when I noticed some stuff for the Reach out and Read program,” said Lt. Amy Bene, team nurse with the Pediatrics Clinic, “I knew that this is an early education program so I reached out to the (American) Red Cross office at NHB to see if they could start it back up here at the hospital.”

Even though NHB had taken part in the Reach Out and Read program back in June of 2009 but had been put on hold in 2011, the pediatrics staff expressed their eagerness and willingness to start the program up again.

 “I’m excited to have this program back at the hospital because it’s important that the kids we treat get every opportunity to succeed,” said Lt. Cmdr. Margaret Moffatt, Pediatrics Clinic staff nurse.

Approximately 9,000 books have been delivered to NHB thanks to the cooperation between the Red Cross, and Jessica Mortensen, Washington State Reach out and Read program director and the Pediatrics Clinic.

“We plan on not only giving these out during the wellness checks but also having them out in the waiting area and also doing a story time for kids to get them excited about books,” said Bene, “It’s great to be doing this since we do about 2,500 wellness checks a year and this helps us reach so many kids.”

“I’m hoping this program works well here in Pediatrics Clinic enough to expand to other departments,” said Lt. Bene.

A Naturalized New Year’s Resolution by Naval Hospital Bremerton Sailor

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- There are some resolutions that resonate as a compelling testament to Navy Medicine’s theme of a ‘New Year, New You.’

Personal Specialist Seaman Josephine Fabia, of Naval Hospital Bremerton's Human Resource Department, took the oath of allegiance to become a U.S. citizen at a Naturalization Ceremony on Jan. 8, 2015.

“I was so happy and filled with a lot of emotion after the ceremony was over. I had to run outside I was so excited and jumping for joy. I did this process on my own, worked towards it, and didn’t give up. This is a big step for me,” said Fabia, adding that she met others who had been trying for years to get their citizenship and have struggled to complete all the requirements.

For Fabia, a Republic of the Marshall Islands native, becoming a U.S. citizen is not just the culmination of her journey from the vast stretches of her island nation in the Northern Pacific to the continental United States, but it also demonstrated her determination to the task to make it happen.

 “There were a lot of steps involved in this process,” explained Fabia, who wanted to begin the process earlier but waited until after boot camp and she reported to her first duty station at NHB approximately 10 months ago.  “I was brought up knowing that in order to get something, you got to do it yourself, and be dedicated and determined.”

Almost immediately, Fabia contacted Navy Legal Service Officer Bangor and got guidance in how to proceed step-by-step, what paperwork was required and other pertinent details such as when and where to get fingerprinted as part of the process. After turning in all her paperwork and associated documents proving her citizenship with the Marshall Islands, five months past and then she received her appointment letter to go back to the U.S. Citizenship and Immigration Services (USCIS) office for an interview. After the interview, came the test, which for her, was more a formality.

“I came in prepared. I was ready. Next thing I knew, there was the ceremony at 12 p.m.,” Fabia said, who was joined by people from 27 other nations to take the oath, including another from her Marshall Islands, and seven others also in the military.

According to Peter Medina, NHB Paralegal specialist, the entire process used to be an arduous red-tape, bureaucratic task for many, including active-duty servicemembers. But since 9/11, military officials have worked the past 14 years with their USCIS counterparts to make the procedure less time-consuming and more streamlined.

According to the USCIS, members of the U.S. Armed Forces are eligible to apply for United States citizenship under special provisions of the Immigration and Nationality Act. 

There are certain requirements such as the service member has to be in good standing and serving honorably on active duty. Other qualifications to become a citizen of the United States include knowledge of the English language; knowledge of U.S. government and history (civics); and taking the Oath of Allegiance to the U.S. Constitution to show attachment to the United States.

“We are very proud for Seaman Fabia. She has been so dedicated. I would see her always studying, even walking going over her list of study questions. What she has accomplished is very special and noteworthy. There are those her age who don’t know what it means to put in that extra effort on top of her duties as a Navy Sailor. To get her citizenship really means a lot to her and I loved to see her get it,” said Personnel Specialist Chief Dawn Molinero, Human Resource department Leading Chief Petty Officer, adding that Fabia has her citizenship, she is able to have full computer access which will heighten her administrative ability and customer service skill.

Fabia joined the Navy to start her road to higher education, as well as strike out on her own to convince not only her parents Danny and Gloria Fontillas, but herself, that she could apply herself and be successful.

“I didn’t want to depend on my parents. I wanted to prove that I could follow in the footsteps of my dad, a retired boatswain mate senior chief,” Fabia said, adding that her parents are very proud and happy of her. “Now I really feel like an expert doing my job to the best of my ability. I like providing the best customer service I can to those who need help coming into HR and make sure they are happy. Just as I’m helping someone, everything I do now will also help me in my future.”

Building upon her notable accomplishment, Fabia is also starting on college-level core classes.

“My goal is to start my general ed classes and plan a route towards child development and becoming a business major,” related Fabia.

All foreign-born active duty personnel who have or are serving after September 11, 2001 are eligible to file for immediate citizenship under the special wartime provisions in Section 329 of the INA. This section also covers veterans of designated past wars and conflicts. For more information, please call NBK Bangor NLSO 360-396-6003.

Naval Hospital Bremerton staff members share their ‘Unwavering Strength’ for a New Year, New You

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- One risked everything – including death - to escape to freedom. One faced multiple ordeals – including loss - overcoming each with strong faith.

As Navy Medicine focuses on the theme of a ‘New Year and New You,’ there are two staff members at Naval Hospital Bremerton (NHB) who have gone above and beyond to share their stories on such a premise.

Silke Nied Sookbirsingh, certified medical assistant with 4/OB clinic  and Willie Tart, Information Management Department electronic health records trainer, have shared their stories of overcoming odds and weathering hardships in the best-selling inspirational book ‘Unwavering Strength.’

The book was released Oct. 3, 2014, in Toronto Canada.  Sookbirsingh, who went by just her maiden name Nied in the book, and Tart are featured with 30 other authors. Each author focuses on how they dealt with adversity by finding inner strength. From death to daring defections, these stories take readers through the author’s experiences and the sorrow, hurt, and tragedy associated with each.

Nied found out about the upcoming book from Tart and her harrowing chronicle is told in the chapter, ‘Escape from Behind the Iron Curtain.’

“There are a few people here at NHB who knew my story but there are a lot of others who did not and are now interested,” said
Nied, who made it back to Toronto for the release and associated book signing.

If there is one central theme or message from Nied’s story, it’s ‘never to take freedom for granted.’

Phrases like the ‘Cold War’ and the ‘Iron Curtain’ might be a generation removed, but for Nied who grew up in East Germany, the words form a legacy of liberty denied before freedom was found.

The release date of ‘Unwavering Strength’ coincidentally falls on the same date as the official reunification of Germany. The Berlin Wall came down in Nov. 9, 1989. That seminal moment marked the end of communist rule for many. But during the 45 years of the deadly divide between east and west, countless German’s had tried – in vain – to escape. Although no concise figure is known, hundreds of people died seeking their freedom and countless more suffered during that time. The barbed wire, machine gun, and land mines took a deadly physical and psychological toll.

 “The Berlin Wall was built officially to keep the enemy out, but everyone there knew it was to keep the East Germans in,” said Nied.

Several groups note that more than 1,100 people died trying to escape the heavily fortified and mined former East-West German border between 1961 and 1989. In addition, according to the Potsdam Centre for Historical Research, an estimated 100,000 people were also imprisoned in East Germany for trying to flee to the West.

“Nevertheless, many people tried to escape,” Nied said. “Some were successful. Some paid with their lives. Never in my wildest dreams did I think my parents would ever risk our lives. Why would they want to start over at their age? The answer was simple; Freedom!”

It was during a summer vacation in Bulgaria and Romania that the actual idea of committing to a family exodus to the West was solidified. At a camp ground one evening, Silke’s Uncle Dietmar from West Germany made a surprise appearance. Plans were discussed of actually trying to make a run for it, or in their case, a swim for it across the River Danube. But it was easier to talk about than make happen. Any short span across the river wouldn’t work even at night due to a full moon, making it impossible to elude border guards. They next tried to find a suitable place in Hungary to swim across, but found they couldn’t even get close to shore without getting shot. Discouraged, but not defeated, they drove back home and commenced to plan the next attempt.

“We knew we had to train to swim at least three kilometers (approx. 1.86 miles) across the river,” said Nied.

Necessary precautions would have to be taken against the elements. They also needed to ensure that all the required personal credentials were protected and would make it across the border.

In a scene straight out of a Cold War spy movie, important family papers were passed between Silke’s father Ulrich and her uncle at an autobahn rest stop, with her father placing them in one of the stalls and then the uncle going in to retrieve them.

But the hardest part of waiting was to keep the family intentions a secret.

“I couldn’t tell anyone about our plans,” related Nied. “Not to my best friend, not even to my grandparents. One word overheard and my parents would have been arrested and sent to prison for at least 12 years and I would have been placed in an orphanage.”

On July 19, 1979, after the several aborted attempts, numerous sleepless nights, and anxious days filled with trepidation, Silke and her family set out for the small Romanian town of Orsovo near the Danube. Their plan was to swim across the bay there to Yugoslavia and Uncle Dietmar, who would then whisk them to West Germany and freedom.

A common practice of the border patrol was to shoot first and maybe ask questions later. Bodies were commonly left where they fell, as a none-too-gentle reminder to all on the perils of trying to flee. “Needless to say, I was scared to death,” Nied remembered. “I wasn’t so sure anymore that I wanted to be free. But after a while I settled down.”

Their plan called for more subterfuge. Uncle Dietmar registered in the only hotel available to western tourists, and obtained a room overlooking the portion of the bay they planned to swim across. He was to stand outside his well-lit room on the balcony, and raise his arms to his side if the coast was clear.

With the fall of darkness, their uncle sent the signal and the time came. Despite a daylight temperature in the 90s, the evening chill added to the cold of the Danube.

As they glided into the water, adrenalin provided fuel for their freedom.

“Everything was so quiet, almost eerie and so unreal,” said Nied.

The lights behind them on the Romanian side grew smaller as they made their way to the shore of Yugoslavia, looking for one red light and one green light, the standard maritime signal markers for ships plying up and down the river.

“We could feel our wet clothes getting heavier and heavier,” Nied recalled.

Half way across, a Romanian patrol boat flashed on their search lights. Silke and her parents dove several times to avoid being caught in the glare as it passed over the river. Just as that nautical problem was handled, another rose. Instead of one red light and one green, there was two of each, with one set of lights moving.

“It was a ship. Something no one had thought of,” said Nied. “It could have been our death if we swam towards it and got caught in the propeller or ran over.”

Just as it seemed Silke had no strength left to make it, she felt her mother Ingrid drag her the final few meters to the other side. They had made it across. Right into handcuffs by patrolling Yugoslavian border guards.

For almost two weeks, they were kept under watch by the local police and constantly questioned as their uncle frantically searched the area for them, fearing the worst had happened. They were then transferred to the Yugoslavian capital of Belgrade where diplomatic intervention had them finally at the West German embassy, but not before ensuring it wasn’t an East German ruse. The emotions of the moment took over. “Mom and dad started crying and I couldn’t understand why,” she said. “But I then realized that we were free. We were on West German soil.”

In the meantime, Uncle Dietmar was still driving up and down the Danube trying to find any clue as to their whereabouts. “He spent two weeks trying to find us before he returned home empty handed,” Nied said.

Eventually he told family that they were lost, presumably forever. Three more Cold War casualties caught by the Iron Curtain.

But when Silke and her parents reached Frankfurt, her mother phoned ahead to let their family know they were coming. “My aunt was somewhat shocked, confused and ecstatic at the same time,” recalled Nied. “She then called my uncle and told him we were okay. He couldn’t believe it at first. Then he helped to bring out the champagne to celebrate.”

“I related my story to my children so they never take freedom for granted. It can be taken away in an instant. I will forever be grateful to my parents that they had the courage to be free,” Nied said.

Tart was the actual architect of their involvement in the book. He was the one who initially found out that the book’s publisher, Judy O’Beirn, were looking for true, inspirational stories and was told by friends that he needed to get in touch with the publisher. After he contacted the publisher and gave a brief synopsis, she called back intrigued and asked him to send his story.

“After she read it she asked if she could use it and I said absolutely. She said, ‘you need to be in the book,’ and explained how the proceeds would go to help families deal with cancer. I was glad to contribute to help others. There was a divine purpose in being a published author. I always wanted to do it. My church and my family noted the potential,” said Tart.

Tart attests that his goal sharing his story is that even though unfortunate things sometimes happen, people have a choice in how they deal with them. It can take a lot longer at times to deal with a situation that is mentally, emotionally and physically draining.

“How we choose to handle ourselves when bad things happen is something we need to deal with. It can make us have bad habits and impact our family or we can get good habits and make positive changes and show others they can make it,” Tart said, explaining that traumatic events can happen to when least expected and are not just confined to combat scenarios.

Taft deals with post-traumatic stress disorder (PTSD). He wakes up every day with it. He labels it the elephant in the room and used to have the perception that PTSD was just from hand-to-hand combat. Extreme emotional trauma is known to happen almost anywhere to anyone at anytime.

“But I refuse to be defined by it. Some days are easier than others. Others see you but don’t know what you battle. Overcoming that is one of the biggest challenges,” explained Tart, citing that what has helped him handle PTSD is his faith and love for family, as well as the positive and inspirational help that has reinforced his personal convictions and enabled him to help others cope with difficult life issues.

Tart’s chapter, ‘Matters of My Heart: True GRITT’ has him explaining how he has been able to work through life’s challenges is with what he calls, ‘true ‘GRITT,’ an acronym for ‘Godly Resolve in Troubled Times.’

A Laurinburg, N. C. native, preacher's son and 20-year Air Force veteran, Tart was taught how to find strength in troubling times marked with failure, sickness, sadness, and death by resorting to GRITT.

“I encourage anyone that if they have an issue to confront that issue and not just skim it. 

If what you’re doing isn’t working, I strongly support seeking others to help – pastoral care, social workers, counseling with mental health - It takes someone strong to step back and admit there’s a better way to handle things and check their pulse, pause to reflect and assess feelings,” said Tart, adding that he considers himself a little more transparent now.

“I didn’t believe in opening up and sharing, especially with a counselor. Sometimes people put themselves in a box and only allow certain others to help them. I refuse to restructure myself like that as I am committed to personal growth process and also helping others,” continued Tart.

Tart focused most of his story on dealing with three significant issues concerning loved ones. He has had to struggle to come to grips with health emergencies of his wife, a life-threatening condition with his father, and the huge spiritual and emotional challenge of losing his son.

“Jaquan was just 25 years old and struggled with kidney disease. I really didn’t know something could hurt so badly when he passed away. But the message I have learned is that when hurting, we have to heal ourselves and pick ourselves up and not let that hurt keep us down. We can’t let that hurt linger, especially when we’re vulnerable. There is strength in survival,” related Tart.

The reviews of the release have been favorable. Nied notes that the book has been a best seller in six countries. It has also sold out of a national book outlet on the Seattle side.

“It’s amazing. My wife and mom cried reading the stories. I do feel blessed by being in this book. This is a whole other level. There has been so much support, it has blown me away. Even before I actually saw a copy, Capt. Thecly Scott (Director for Surgical Services) came up one day and said, ‘I need you to sign my book,’” Tart said.

“I had always wished to be able to do something like this but never thought it would happen and then take off like it has. My family is very excited,” added Nied.  

 A New Year, a New You: Setting and Achieving Resolutions at Naval Hospital Bremerton
by Mass Communication Specialist 1st Class (SW/AW) Gretchen M. Albrecht Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton (NHB) is supporting staff members using the arrival of the New Year as a fresh start for new goals and resolutions.  Sailors spoke about embarking on their resolutions ranging from establishing a healthier lifestyle to working towards a college degree.

Hospitalman Samuel LaPorte assigned to Branch Health Clinic Bangor has aspirations on becoming a master baker and stated, “I already have my associate’s degree and am looking to start work on my bachelors. The first pastry I am going to make will be a bourbon cherry pie.  I also want to try learning French because a pastry chef who doesn’t know French is in a tight spot.”

According to Interior Communications Electrician Chief Lloyd Smith, NHB educational service officer, there are some Sailors getting ready to start on their college degree and they don’t know the ins and outs of tuition assistance (TA), or where to start looking to apply let alone the prerequisites for command approved. Smith is there to assist all those in need.

“People have to do web training online and have a degree plan with their school before they can get TA approved,” said Smith.  “They can go to Navy College to get help with picking out the right school for them and look into transferring credits. My job is putting them in contact with the right people as well as approving their TA requests or helping them trouble shoot online issues.”

Others have lifestyle improvement resolutions ranging from quitting smoking, losing weight, becoming a vegetarian, even working towards completing their first marathon.

Electronics Technician 1st Class Jenny Lane is continuing to improve her personal fitness, not only to do well on the Navy physical readiness test but to improve her overall health.

“I want to continue working on maintaining and improving my health starting with my physical fitness,” said Lane. “My end goal is to finish a half marathon and I am working towards that with daily runs, using a half marathon running guide and taking part in a few local 5Ks.”

Sailors have also been encouraged to take advantage of NHB’s Health Promotions and Wellness Department and the versatile workout opportunities they provide such as Yoga and Pilates. They can also sign up from a variety of offered courses such as the informative nutrition class, and even arrange for the opportunity to speak with a nutritionist and/or clinical dietician.

“Our nutrition classes are really informative. People can learn everything from meal planning to setting realistic goals and milestones to help them achieve their end goal and not give up,” said Hospitalman Ashley Wert.  “Hopefully with the New Year people will start coming more often to take advantage of the many resources and support we can provide.”

Even seasoned resolution planners continue to mark the New Year with new goals looking to improve their life both while on active duty and beyond.

“I am pretty good about accomplishing my New Year’s resolutions since my goal last year was to quit smoking and I have not smoked for the past nine months,” said Hospital Corpsman 1st Class Geoffrey Sims.  “This year I have decided to start my master’s degree in healthcare. I already have my roadmap set and college acceptance letter.  I am just waiting for tuition assistance to kick in so I can start. I am pretty excited!”

Naval Hospital Bremerton Welcomes First Baby of 2015

BREMERTON, WASH.  – The New Year celebration at Naval Hospital Bremerton’s Northwest Beginnings Family Birth Center officially began over 14 hours into 2015 with the arrival of the first baby born.

Proud parents, Kara and Ryan Andrew Dotts, celebrated the birth of their son, Andrew Carlo, who was born Jan. 1, 2015 at 2:43 p.m. Pacific Standard Time, and weighed 7 lbs, 2 oz.

Ryan, a machinist’s mate 3rd class is assigned to USS Nimitz (CVN 68). Both parents are natives of Delaware and currently reside in Bremerton, Wash.

New born Andrew Carlo and mother are doing well. “We expected him almost two weeks earlier, but we guess he didn’t want to cooperate with that timing. So we came in a few days ago to induce labor and ended up having a C-section,” said Ryan.

“He’s a healthy, beautiful little guy. He’s got all his hair and it’s so great he’s here,” added Kara.

Andrew Carlo, the first of three babies welcomed at NHB on New Years, is named after Ryan’s grandfather and Kara’s grandfather, both who have passed away.

“It means a lot to both of us to have him honor them by having their names his,” said Ryan.

The staff at Northwest Beginnings Family Birth Center was busy taking deliveries from the stork throughout December, especially on the last day. There were 52 new babies for December, with five births recorded on Dec. 31. Overall, Naval Hospital Bremerton recorded 720 births for 2014, an average of 60 per month.

Prenatal Group offers unique care for expecting parents at Naval Hospital Bremerton
by Mass Communication Specialist 1st Class (SW/AW) Gretchen M. Albrecht Naval Hospital Bremerton Public Affairs – Prenatal Group is a unique type of prenatal care set in a group format that is open and offered to all expecting parents at Naval Hospital Bremerton.

The group format encompasses all aspects of prenatal care one would normally receive and adds valuable education and social group interactions. Instead of a 15-20 minute appointment, a group meeting can turn into a two-hour dynamic and interactive learning session. “This is a less formal type of setting and involves a lot more education and knowledge with what is going on throughout the pregnancy,” Cmdr. Christine Larson, OB/GYN Certified Nurse Midwife. “In a typical 15 minute appointment we don’t have enough time to talk in depth about certain things where Prenatal Group offers us that time for hands on education, questions and answers and continuity of care.”

Continuity of care and time with patients is something Prenatal Group uses as its foundation of care allowing patients to see the same nurse and provider for every appointment.  It also allows for expecting mothers to plan around their partner’s schedules and their own since they will know the date and time of every appointment from the first meeting to the post pregnancy reunion.

“I find a lot of patients like having the same provider every time as well as the opportunity to know their appointment so far in advance without having to make follow up appointments through TRICARE since it is already set up,” said Larson.  “The opportunity to have spouses, partners and family members involved in the classes and learning process is also unique and beneficial as we talk about partner roles and support during and after the pregnancy as well.”

According to Larson, with the duties and responsibilities that come with being in the military, there are those who may not be present all the time during a pregnancy, which can potentially make that time more daunting and stressful at times. Prenatal Group helps cope with that due to the fun, social atmosphere.

“Being in the Navy you may not have the support system you normal would have,” said Larson. “Prenatal Group classes can bring moms together who are close in delivery date, who can give each other support they wouldn’t normally have.  They develop a support system that sometimes lasts after the birth of baby.  You practically have built in play dates!”

Annie Smick, Registered Nurse with the OB/GYN clinic stated, “Studies found that women who have a support system and are prepared have less of a chance of premature birth.”

Musician 2nd Class Patrick Pedlar attests that another handy aspect of the group is being able to learn with his wife as they both have been encouraged to attend the classes together.

“I am really glad we chose to do this because there is so much information to be learned,” said Pedlar.  “You can read a lot of this in a book, but actually being able to be hands on and have information taught to you has helped me get more out of it and it has been great at putting our minds at ease. ”

Participants readily admit that the Prenatal Group takes the ‘clinical’ aspect out of prenatal care by also including open forum classes offering and sharing on such topics as nutrition advice, pediatrician information, post partum adjustment, labor and delivery expectation without having to take any extra classes.  An all-stop shop for well-rounded prenatal care. 

“I would recommend this to everyone,” said Kelly Ann Pedlar, Prenatal Group participant.  “I was apprehensive at first but the open communication and detailed information made me very comfortable and confident in the care I am going to get when I go into labor.  It was so convenient to have so many representatives come talk to us and to have the chance to ask questions. The best part was it was all scheduled for us.  Being in the group was great too because sometimes I didn’t know to ask a question but another class member would ask it and it in turn helped me learn something.”

For more insight, please contact Naval Hospital Bremerton OB/GYN Nurse Line at (360) 475-4209 OPT #3 and leave a message.  A nurse will respond as soon as possible with all pertinent information.

Naval Hospital Bremerton provides effective respiratory protection to meet demands
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – There’s no use masking the fact that when it comes to emergency preparedness, supplies are only as good as long as they are available. Especially when dealing with a viral infection threat.

Naval Hospital Bremerton has been working in collaboration with Madigan Army Medical Center and Harrison Medical Center to ensure that all three facilities are ready.  The close-partnerships between NHB, Madigan and Harrison showcased the prior planning and the enhanced interoperability needed to help equip dedicated medical staff to be able to safely handle a specific outbreak without getting contaminated, by sharing the in-demand Powered Air Purifying Respirators (PAPRs). 

 According to Terry Lerma, NHB Emergency Preparedness Coordinator, the command loaned 20 of the PAPRs to Harrison and another 30 to Madigan, along with accompanying comfort strips and cuffs to enable both civilian and military community hospitals to also be ready to securely respond if hands-on emergency care is needed for a pandemic or epidemic situation.

“The PAPR is a very important piece of equipment in dealing with any infectious disease. It provides a high degree of protection, is comfortable enough to be used for a long period of time, and despite the futuristic look, is user-friendly and allows the user to present themselves to a patient more openly that using one of the masks,” said Lerma.

Lerma attests that the exchange of the equipment happened after Dr. Dan Frederick, NHB Population Health and Forecasting expert and Tom Shirk, NHB Infection Control coordinator shared at a national-level Emergency Management conference that NHB had stockpiled the PAPRs, which were not only cost-effective, but considered a very reliable and safe respirator for medical personnel to use over long periods of time.

“We were then approached by Madigan asking if we would loan them enough supplies to sustain them until they could fill their own order. It was certainly the least we could do. By being able to support both Harrison and Madigan readily shows that Naval Hospital Bremerton has the ability to respond and support when called upon,” said Lerma, adding that along with the PAPRs, NHB included battery chargers and associated gear to ensure Madigan would have complete readiness in using the respirators. 

Frederick noted that along with NHB providing the superior respirators, Harrison reciprocated the favor with sharing some of their orthopedic hood systems and Madigan has offered to provide NHB with an adequate supply of Tyvek suits.

“Which we will be definitely take them up on with our upcoming training visit,” said Frederick.

Five years ago, NHB dealt with overlapping H1N1 and Seasonal Influenza vaccinations that resulted in several patients admitted with H1N1 that quickly had staff using up most of the supply of disposable respiratory masks. It was immediately decided that there had to be a better way to manage such a need and have adequate, sustainable equipment in place.

“Our preparations and purchasing of the PAPRs several years ago gave our staff a greater degree of respiratory protection and a higher degree of comfort enabling longer, more comfortable work times in a H1N1 patient’s room. Because of the preparations we have made ahead of time, we’re well prepared to protect our healthcare provider staff directly treating our patients,” Lerma said, adding that NHB still stocks the disposable 3M N95 masks, but they generally are good for approximately 30 minutes of continuous wear and simply don’t provide as much extended protection as the PAPR.

The disposable 3M N95 masks have an efficiency grade of 95 percent and provide a high level of protection for staff members when treating patients, yet the PAPR has a 99 percent filter efficiency. The PAPR also has a 16-hour non-stop battery pack that creates positive pressure on the mask, keeps the face shield from fogging and the person wearing it cool.

NHB has strategically placed PAPRs in the Urgent Care Clinic, Multi-Service Ward, Internal Medicine Department and Pediatric Clinic.

“Fortunately we became aware of the PAPR several years ago. In 2008 we held an exercise and were following US Centers for Disease Control and Prevention recommendation and using full Personal Protective Equipment (PPE) in August. It was hot, the teams wearing the PPE suits were uncomfortably hotter and we could see them pulling on their masks to get air. I then remembered that Tom Davenport, our Respiratory Therapy supervisor, had this demo model for a PAPR and we decided to try it out. It turned out to be just what we needed. It was comfortable, didn’t fog up, and most important, provided excellent protection for staff,” related Shirk, also noting that the disposable masks are still stocked and considered excellent equipment when used for shorter durations – up to 30 minutes – and if a person has been properly fitted for them.

 “One of the other positive benefits about a PAPR is that a patient can see a staff member’s total face and see them talking, whereas if someone is wearing one of the (disposable) masks, it covers up half of the face. Plus, the mask can be uncomfortable to some after wearing it for 10-15 minutes. It can get damp, lose its shape and break down,” explained Shirk, stressing that the key aspect for using the PAPR instead of a disposable mask was the effectiveness it afforded staff members to do their jobs safely. Shirk and Frederick did their homework to ensure procuring such a piece of equipment was worth the while.

One of the studies they examined was conducted with the severe acute respiratory syndrome (SARS) outbreak in (southern) China in 2003 that infected more than 5,000 people and killed approximately 350 people (cited China Ministry of Health). During SARS, at one hospital there was a high level of staff absenteeism because they thought the leadership was not providing adequate safety measures for them to help handle potential SARS cases. At the other hospital, the absentee rate was much lower because the staff felt that they had received proper equipment to keep them safe as they rendered medical aid to those in need.

“That is exactly what we have done. We need to protect our staff so they can protect others. The PAPR give us the highest level of protection available and we have sufficient numbers of PAPRs to meet staffing needs,” stated Shirk.

Staff are given proper training on the PAPR, which is also included as part of the command’s Nursing orientation course.

“The training is helpful, but the product is really self-explanatory and almost self-guided. It’s very simplistic, and the bottom line is that we know the PAPRs are effective respiratory protection against infectious diseases,” Shirk said. 

OHSU Bremerton Change of Command held at Naval Hospital Bremerton
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Captain Julie Zappone turned over leadership of Operational Health Support Unit Bremerton to Captain Matthew A. McQueen during a change of command ceremony on Dec. 12, 2014.

For Zappone, a Spokane Wash. native, the ceremony marks the end of her three-year tenure as commanding officer of OHSU Bremerton from Dec. 2011 to Nov. 2014, as well as her direct involvement in the unit for approximately nine years. Her next assignment will be at Navy Medical Education Training Command, San Antonio, Texas.

“It’s customary for outgoing skippers to make remarks. Our tour is normally two years, but they thought I needed more time to get things done. I can speak to all the accomplishments we have done, but they’re not as important as our people, who are top-notch,” said Zappone, thanking her command leadership and Sailors for their ability and capability to take on multiple duties and responsibilities and perform above expectations.

Zappone was awarded the Meritorious Service Medal by President Obama for her exceptional leadership and meticulous management while leading 15 geographically dispersed detachments consisting of 409 members in achieving great results.  Her leadership culminated in the completion of 9,888 periodic health assessments and dental exams ensuring thousands of Sailors and Marines were deployment-ready and saving approximately of $1.3 million. Her command also produced an average of 91 percent medical and dental readiness, while delivering 102,000 hours of clinical and dental services to Navy Medicine West, for a combined total of $9.2 million in contributory medical support. 

Under Zappone’s direction, 74 Sailors mobilized to support operational requirements in Kuwait, Bahrain, Horn of Africa, Guantanamo Bay, Iraq, Afghanistan, and Germany.  Additionally, she launched the first Navy Medicine West combined field combat exercise at the Naval Expeditionary Medical Training Institute on Camp Pendleton, contributing to the enhanced mobilization readiness for 126 Reserve Component personnel across Navy Medicine.

Zappone wrapped up her comments specifically focusing on her family.

“We in uniform stand on our family’s shoulders,” she said, noting that her husband and three children continually provided strong support during her career. “I’m (also) happy to see and welcome Capt. McQueen to the Pacific Northwest. You have a group of outstanding Sailors and officers.” 

“It is my sincere appreciation to serve this command. I have been presented with an adept and capable command which speaks very highly of everyone here. We’re all volunteers and I appreciate everyone here and recognize the sacrifices, such as being away from family for sustained periods of time,” said McQueen, Navy Medical Corps, relocating from New Orleans.

OHSU Bremerton’s mission is to ensure all Sailors can rapidly respond to the needs of Naval Hospital Bremerton, Navy Medicine and the nation by keeping themselves and those assigned in a constant state of readiness; professionally, physically and mentally. OHSU Bremerton ensures force health protection of all Sailors by assisting Navy Operational Support Centers throughout three regions – Northwest, Midwest and Southwest -  by completion of physical health assessment’s and dental exams. OHSU detachments can be found in Anchorage, Alaska; Whidbey, Kitsap, Spokane and Everett, Wash.; Portland and Springfield, Ore.; Boise, Idaho; Helena and Billings, Mont.; Cheyenne, Wyo., Fargo, N.D. and Sioux Falls, S.D.; Salt Lake City, Utah; and Denver and Fort Carson, Colo.

Tree Lighting remembers Individual Augmentees at Naval Hospital Bremerton
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs Office --
The annual Tree Lighting Ceremony at Naval Hospital Bremerton on December 5, 2014, provided staff and family members the opportunity to actively take part in a remembering those deployed, are currently deployed and will deploy as Individual Augmentee (IA).

The purpose of the tradition is to bring staff members and families together to not only celebrate and share the season, but recognize those a long ways from home for the holidays on deployment.

“We rejoice for those who have returned, pray for those still currently deployed, and remember the sacrifices from all those who have served on deployment and been away for the holidays,” said Religious Programs Specialist 2nd Class Maricris Valdez of NHB’s Pastoral Care Dept, noting that as each ornament is placed on the tree by a loved one, co-worker, or friend it is emblematic of those serving overseas on deployment over the holiday season.

The ceremony was organized by NHB’s Pastoral Care Department featuring the commanding officer, executive officer and command master chief symbolically lighting the tree before the focal point of the event with the hanging of a bulb ornament for Individual Augmentees from NHB.

“I wish everyone a happy holidays. Having this important ceremony is part of that. It’s very special to pause to recognize the service and dedication of those deployed supporting our overall mission and serving with the Marine Corps. They are an example to us all and taking this time to remember them is part of who we are. I especially thank our Pastoral Care for putting this together and Naval Base Kitsap Fleet and Family Support Center for helping us out,” said Capt. Christopher Quarles, NHB Commanding Officer, addressing the packed quarterdeck at the ceremony.

The past decade has had hundreds of doctors, nurses, hospital corpsmen and support staff from NHB deployed on IA status, with the vast majority supporting Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq, others assigned to such locales as Bahrain, Horn of Africa, Kuwait, Germany, the Republic of Georgia and with ships, submarines, and squadrons.

This year NHB has four staff members currently on IA assignment in Afghanistan; Lt. Cmdr. Darlene Lao, Hospital Corpsman 2nd Class Vijorge Potal, Hospital Corpsman 3rd Class Kenneth Worth, and Registered Nurse Amy Salzsieder, deployed as an Activated Reservist.

As the Navy Band Northwest Woodwind Quintet softly played a medley selection, Religious Programs Specialist 3rd Class Kaleib Taylor read off the list of current as well as returned IAs with family, friends, and co-workers hanging a IA ornament for each. Returnees also took part in placing their own ornament.

“I remember getting photos from last year with a ornament being put on the tree for me and I thought that was really cool. To be back here a year later and able to do it myself is even cooler. The event ceremony is a very appreciative way to show support,” said Lt. Louis Sanchez, NHB Case Manager who just completed a year-old assignment on amphibious assault ship USS Bataan (LHD 5), with a eight-month deployment supporting operations in the U.S. Fifth Fleet Area Of Operations, including a multinational exercise in Jordan, plying the waters off the coast of Libya to be ready for a possible evacuation of U.S. personnel due to continued fighting, and being on station in the Arabian Gulf, setting a near record with a 135-day stretch at sea between port visits.

“No doubt about it, to be back home after that (deployment) feels great,” Sanchez said.

Naval base Kitsap FFSC, along with Ione Whitney from American Hero Quilts presented quilts for the returned IAs.

“We thought it was just a great idea to be included and able to pass on the “Quilt for Valor” to each individual deployer,” said Teresa Dibley, Regional Individual Deployment Support Coordinator.

Along with Sanchez, returned IAs are Lt. Cmdr. Christopher Bailey, Lt. Cmdr. Steven Sarro, Lt. Cmdr. Marc Silfies, Lt. Cmdr. Karen Woo, Lt. Lauryn Kramer, Lt. timothy Rutherford, Lt. Kenneth Sierleja, Lt. Gregory Mendoza, Lt. Justine Cisterino, Lt. Issac Hurley, HM2Patrick Barrantes, HM2 Alexander Zeisberg, HM2 Derek Kuzniar, HM3 Kayla Blum, HM3 Justin Schacht and HN Kendrick Young.

Perhaps the little known aspect of the tree-lighting portion of the ceremony is that the simple act acknowledges a trilogy – light, faith and hope – that embodied the entire ceremony. The lights that adorn the tree are reminders of how the light of faith can dispel the darkness of a person’s fears, uncertainty and isolation. The tree itself, with the branches arching towards the heavens, has been a sign of faith for many throughout the ages. As a ‘tree of life,’ it endures the seasonal cycle from life to death to life again, inviting worshipers to experience the spiritual renewal and hope that the holidays offer.

Chaplain Shawn Redmon opened the ceremony with an invocation and closed it with the benediction. The tree will remain lit throughout the holiday, leaving a light on for those still deployed and in harm’s way.

Frocking Friday at Naval Hospital Bremerton a Family Affair
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- It was a ‘Frocking Friday’ ceremony at Naval Hospital Bremerton as 54 Sailors advanced to E-4, E-5, and E-6 in front of family, friends and fellows staff members on Dec. 5, 2014.

There were 34 Sailors who pinned on their petty officer third class crow, 15 who became petty officer second class and five who advanced to petty officer first class.

“This is an outstanding number of Sailors across the board at our command to make grade and advance in their rate. It’s four times more than we had last time,” said NHB Command Master Chief Randall Pruitt, noting that the command’s advancement average for the September exam was above average across the board compared to the Navy-wide norm.

It was also a ‘Family Frocking Friday’ for Hospital Corpsman 3rd Class Alan Gil and HM3 Britany Gil, as the married couple took the opportunity to pin their new crows on each other to commemorate the ceremonial event.

“We hoped to both advance at the same time. We studied and prepped together for the exam. We did exactly plan on this,” said Britany, a Texas native who works in NHB’s Radiology Department.

When the results came out, it was Britany informing Alan, originally from Florida, that they both had indeed made rate.

“Alan works nights in Pharmacy, so I got to break the news,” explained Britany, adding that although family could not make the trek, they were proud and excited for them both.

There are approximately 620 enlisted staff members at NHB comprising a wide variety of rates, albeit predominantly hospital corpsmen who accounted for 46 of the 54 selectees. Also advancing were two information systems technicians, two personnel specialists, and one each from aviation support equipment technician, logistics specialist, master-at-arms, and religious programs specialist rates.

In the week leading up to the frocking ceremony, all selectees went through their specific new rank’s indoctrination course.

The petty officer third class selectees’ indoctrination focus was on leadership responsibility, and the petty officer first and second class selectees were given information and insight in handling additional responsibilities and expectations, as well as leadership duties with their added rank.

“I congratulate all of our selectees and thank all family members who made it here today for this great event. I look forward to congratulating more after the upcoming March exam,” said Capt. Christopher Quarles, NHB Commanding Officer.

In their respective formation rows, the petty officer first, then second, and then third class selectees received their pins by those they chose to do the honors, followed by each being presented their official frocking certificate by their commanding officer.

“Your appointment carries with it the obligation that you exercise increased authority and willingly accept greater responsibility. Occupying now a position of greater authority you must strive with a renewed dedication toward the valued ideal of service with honor,” read PSC John Archer of NHB’s Human Resources Department, from the standard Navy frocking letter to all those present.

Waves of applause washed over the new petty officers, selectees no more.

‘Tis the Sobering Season to Save Lives stressed at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- ‘Tis the sobering season at Naval Hospital Bremerton to showcase an eye-catching vehicle. Not so much the make and model. Just the overall condition.

Staff and visitors can glimpse the mangled remains of a 2010 Mazda automobile - twisted into such a wrecked condition just 90 days after being purchased - as they come and go from NHB. It’s the most visual reminder of the seasonal Holiday Safety Stand-down held Dec. 3, and a stark example of what does happen in Drinking and Driving accidents.

“This safety brief may be the most important hour anyone spends in the holiday. How many woke up this morning and thought, ‘I hope someone calls my parents to tell them when I’ve been killed because of drinking and driving.’ No one thinks that. It’s a tragedy to be part of. We don’t ever want to be in that position to have to do that. With drinking and driving, all lives are altered forever. Take all this information in and pray it does not happen,” said Capt. David Collins, NHB Executive Officer, addressing a packed Ross Auditorium.

The driver of the Mazda vehicle was a 22-year male, who had a .17 BAC (blood alcohol content), which is more than double the .08 BAC in Wash. State for being arrested for a DUI. He ended up being sentenced to 90 months for vehicular homicide, because his 20-year male passenger (with a .30 BAC), was killed in the resulting crash after speeding in excess of 90 miles per hour in the central Kitsap area.

According to Tony Stewart, Kitsap County Coroner, of the eight traffic fatalities in Kitsap County last year, half of them happened in December. Explaining his responsibilities gave those in attendance yet another example how impactful drinking and driving can be. Part of his duty as the county coroner is to investigate all deaths in his jurisdiction as well as notify a family afterwards. His job is not one for the faint of heart.

“Showing up on someone’s doorstep at 3 a.m., knocking on the door, then the dog barking, and outside lights coming on, before the door opens and a family member sees me and the fire department chaplain standing there is not an responsibility I like doing. Humans have been known to make poor decisions and staff members probably hear the same thing every year at this brief, but because there are still drinking and driving accidents and fatalities, we keep coming back. We come here to talk to Sailors because you are one of the responsible elements of society,” said Stewart, a retired Navy Master-at-Arms Chief who was previously stationed at NHB in the 1990s.

Other speakers at the brief included Candy Cardinal from Sexual Assault Prevention Coordinator; Hospital Corpsman 3rd Class Nicholas Lotito representing NHB’s Coalition of Sailors Against Destructive Decisions (CSADD); Marsha Masters with Kitsap County DUI Task Force and Mothers Against Drunk Driving (MADD); and Mike Pearson, NHB Safety Manager for all military and civilian staff. 

There was also special guest speaker Jessica Ricks, who recently got married and shared her story of growing up in a wonderful family and constantly following her mother wherever she went.

“I was like her shadow. She was my hero, my role-model. My mom and dad were crazy in love. People would ask all the time if they were newlyweds. They would kiss in the kitchen, which as a 7-year old I thought was kind of gross. My fondest memories are of the love from my mom,” Ricks said.

That all changed on March 14, 1999. It was a Sunday. One of her older brothers had just got his leaner’s permit and he and mom went out on an errand. It was the last time she was seen alive.

“The last thing on my mind was something happening. When she left it was the last time I saw her face. Now I can only see a tombstone,” said Ricks.

On a stretch of State Highway 3 outside Poulsbo, a drunk driver slammed his truck into the car with Ricks’ brother and mother in it. Her mom was killed and her brother was seriously injured.

“All because this one man got drunk, got into his truck and hit and killed my mom. That one man’s decision was to make the choice to get wasted and then drive,” stated Ricks. “The decision that needs to be asked is ‘are you going to cause irreparable damage or be smart and chose to protect everyone else?’ He didn’t.”

There were 440 traffic fatalities in Wash. State in 2013, with 182 alcohol related. Masters attests that the goal is to get that number to zero by 2030 with the Target Zero Task Force, an on-going proactive strategy by local law enforcement officials and the Kitsap County DUI Task Force and MADD.

“One life lost is one life too many. We want to reduce underage drinking, support victims, and step up drinking and driving patrols. Since Halloween, law enforcement is out in full force actively looking for impaired drivers,” said Masters.

There was also added focus on alcohol related incidents involving sexual assault.

“Sexual assault and alcohol do go hand-in-hand with each other,” shared Cardinal, citing that it’s not just men preying on women but can also be man on man assault. “We had 33 cases last year and nine were man on man. We are starting bystander intervention training to have Sailors comfortable and able to step in. This is an important tool for everyone because it can be difficult at times to help others. We want Sailors to make smart choices and good choices in what they do at all times and being aware is part of that.”

 CSADD representative HM3 Lotito reiterated the command’s ‘Safe Ride’ program, explaining that calling for a Safe Ride cab is a lot smarter than taking the risk of getting a DUI. Safe Ride cab can be reached at 360-782-2378. A staff member can also reach out to NHB command duty officer, officer of the deck, and quarterdeck if a ride is required to not drive while drunk or there is no designated driver.

“And having a designated driver means that one person is not drinking alcohol at all. It doesn’t mean that one person stops drinking two hours before driving,” said Mr. Jean L. Hallmark, Safety Division Safety Specialist, also noting that for those who could not attend from the branch health clinics, the video teleconference connections for the presentation were made available.

Happy 239th - Chaplain Corps Birthday held at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- When the command chaplains at Naval Hospital Bremerton were told by their religious program specialists (RP) that they had to convene on the command quarterdeck on Nov. 26, 2014, they knew better to question why.

After all, RPs not only provide physical security for Navy chaplains in combat environments, but also manage, support and coordinate many other aspects, including organizing the 239th birthday ceremony for the Navy’s Chaplain Corps officers stationed at NHB – Command Chaplain Cmdr. Bruce Crouterfield and Staff Chaplain Lt. Shawn Redmon - held in front of staff members the day before Thanksgiving.

“Religious program specialist and Navy Chaplain Corps are a close knitted community and I thank Religious Program Specialist 2nd Class Maricris Valdez and Religious Specialist 3rd Class (Select) Kaleib Taylor for putting this event together and inviting all of us,” said Capt. David C. Collins, NHB Executive Officer, noting that one of the most valuable traits of a Navy chaplain is their ability to be flexible in carrying out their duties and responsibilities.

“I have been to mass in the back of a Humvee, in the mud and in the rain. Our chaplains give amazing support and commitment to our Sailors, Marines and Soldiers. We have two of the best to work with here and we are blessed to have them,” Collins said.

The history of the Navy Chaplain Corps traces its beginnings back to Nov. 28, 1775 when the second article of the Navy Regulations was adopted. This article stated that, “The Commanders of the ships of the 13 United Colonies are to take care of that divine services be performed twice a day on board and a sermon preached on Sunday’s, unless bad weather or other extraordinary accidents prevent.”

Although chaplains were not specifically mentioned in this article, one can imply that Congress intended that an ordained clergyman be part of ship’s company, which happened with the establishing of the United States Navy Chaplains Corps.

The Chaplain Corps consists of ordained clergy who are commissioned naval officers. Their principal purpose is to “promote the spiritual, religious, moral, and personal well-being of the members of the Department of the Navy.” Additionally, the Chaplain Corps also provides chaplains to the U.S. Coast Guard.

“Special thanks to our RPs and their insistence we do this. This is a great dedication to our corps and heritage. I think back to the heritage and legacy we inherited by those who came before us. It’s important to reflect on those who have established the standard of service before us. Throughout our history, chaplains have influenced the Navy. It was chaplains who got the Navy to stop flogging. It was (also) the chaplains who got grog off Navy ships,” shared Cmdr. Bruce Crouterfield, NHB Command Chaplain, citing that the history of the Chaplain Corps includes two distinctive members – Capt. Joseph T. O’Callahan and Lt. Vincent Robert Capodanno – both awarded the Medal of Honor.

According to Crouterfield, O’Callahan was serving onboard USS Franklin (CV13) off the coast of Japan when the carrier came under attack from Imperial Japanese aircraft in 1945. He calmly braved flames and twisted metal to aid his men and ship, as he made his way through smoke-filled corridors and on the open flight deck with exploding ordnance all around. He ministered to the wounded and dying, comforting and encouraging men of all faiths; he organized and led firefighting crew into the blazing inferno on the flight deck; he directed the jettisoning of live ammunition and the flooding of the magazine; he manned a hose to cool hot, armed bombs rolling dangerously on the listing deck, continuing his effort, despite searing, suffocating smoke which forced men to fall back gasping and imperiled other who replaced them. Serving with courage, fortitude, and deep spiritual strength, he inspired others to fight heroically and with profound faith in the face of almost certain death return their stricken ship to port. O’Callahan was presented with the Medal of Honor at the White House by President Harry S. Truman on Jan. 23, 1946 and passed away in 1964.

It was three short years later that Capodanno died. He was born on Feb. 13, 1929 and killed in action on Sept. 4, 1967, in Quang Tin Province, Republic of Vietnam, when attached to 3rd Battalion, 5th Marines, 1st Marine Division.

In response to reports that the 2d Platoon of M Company was in danger of being overrun by a massed enemy assaulting force, Capodanno (also Fleet Marine Force qualified) left the relative safety of the company command post and ran through an open area raked by fire directly to the beleaguered platoon. Disregarding the intense enemy small-arms, automatic-weapon and mortar fire, he moved about the battlefield administering last rites to the dying and giving medical aid to the wounded. When an exploding mortar round inflicted painful multiple wounds to his arms and legs, and severed a portion of his right hand, he steadfastly refused all medical aid. Instead, he directed the corpsmen to help the wounded, and continued to move about the battlefield providing encouragement by voice and example. Upon encountering a wounded corpsman in the direct line of fire from an enemy machine gunner approximately 15 yards away, he rushed to aid and assist the mortally wounded corpsman. At that instant, only inches away, he was struck down by a machine gun burst.

Fast Frigate USS Capodanno (FF 1093) was named in his honor, as USS O’Callahan (FF 1051) recognizes Chaplain O’Callahan.

There are also four other ships honoring Navy chaplains; USS Rentz (FF-46) named after World War Two Navy Chaplain George S. Rentz (1882-1942), destroyer escort USS Kirkpatrick (DE 318), named in honor of Chaplain Thomas L. Kirkpatrick, killed in action aboard USS Arizona; USS Schmitt (DE-676/APD 76) a Buckley-class DE named for Father Aloysius H. Schmitt; and Guided Missile Destroyer USS Laboon (DDG 58), named for Father John Francis Laboon, a captain in the Chaplains Corps.

“We couldn’t do what we do without our RPs, two of the best any chaplain could ask for. Our entire Pastoral Care Department, and our command, has made my family and I very welcomed and happy to be stationed here,” shared Lt. Redmon.

The Chaplains Corps’ four core capabilities are providing religious ministry and support to those of your own faith; facilitating the religious requirements of those from all faiths; caring for all service members and their families, including those subscribing to no specific faith; and advising the command to ensure the free exercise of religion.

Since 1775, Navy chaplains have answered the call to serve, bringing their own spirituality and faith perspective to their ministry of presence.

Chaplain Crouterfield, Chaplain Redmon and the entire Navy Chaplain Corps continue to offer a message of hope that continually reinforces the value of human life and a sense of belonging and purpose within the military community, with the RPs there to help coordinate.

Naval Hospital Bremerton holds Native American heritage celebration

by MC1(SW/AW) Gretchen M. Albrech -- Naval Hospital Bremerton (NHB) held a Native American heritage celebration in conjunction with National Native American Heritage Month Tuesday, Nov. 18.

The celebration was part of a month long campaign towards Native American awareness keeping with this year’s theme ‘Native Pride and Spirit: Yesterday, Today and Forever.’

“We wanted to give recognition to the Native American community and all they have done helping to shape our nation’s history,” said Hospital Corpsman 2nd Class Jerome Boyance.  “Our goal was to present a bit of the Native American culture and history to the command through reading and visual displays.”

Hospital Corpsman 1st Class Joseph Montes spoke about the history and major impact of Navajo code talkers and their numerous achievements during WWII including the code origins and the amazing fact that it was the only unbroken code in modern military history helping to win the War in the Pacific.

“Code talkers had a significant impact on our military and I feel their efforts should be recognized,” said Montes.

Guests listened to a reading of President Barrack Obama’s message on this year’s celebration as well as information on the Pawnee Tribe given by special guest speaker Wynter Stewart, Pawnee Tribe member.

I just recently moved here so I was missing the closeness and being involved in the tribe so when my brother [Hospitalman Ben Stewart of NHB’s Orthopedic Department] mentioned this event I wanted to help any way I could,” said Stewart.  “It was a great opportunity to give information about my small tribe to the people here because although we are not a large tribe we have a strong and proud history.”

The Stewart family also helped bring a taste of the Native American culture to the ceremony by spending hours the night before baking Indian fry bread, a traditional food passed down generation to generation.

“It was nice to share a bit of our history and bake the bread which represents our tribe and family,” said Hospitalman Ben Stewart. “Teaching others about our history is very important.”

Implemented efficiencies improve services and savings at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton Facilities Management Department has directly taken to task the Navy Surgeon General’s priority of Value in implementing a revised and streamlined facility services contract that improves service and is expected to save approximately $1 million annually. 

NHB’s Facility Operations Division partnered with Naval Facilities Engineering Command  to develop a new Base Operating Service Contract (BOSC), which took effect on Oct. 1, 2014.  The new contract is structured significantly differently with regards to medical facility maintenance and repair services. There is now an additional and separate part of the contract addressing the particular needs of a medical facility, such as infection control and noise regulation, increased equipment testing and maintenance, and outage management. 

According to Mr. Mitch Hailey, NHB Facilities Operations Manager, one of the command’s major objectives during the preparation phase was to develop a specification section that was distinguishable from the overall contract, yet still able to take advantage of the entire contract.

“We can now clarify and specify specific health care and hospital requirements for facility work, and allow a means to calculate NHB costs using actual BOSC cost for our services rather than a cost that is based upon a calculated percentage of the overall contact costs. This was more in line with expected costs,” explained Hailey, adding that modifying the contract actually began several years ago because the day-to-day functions at a military treatment facility (MTF) differ substantially from a non-hospital setting.

“We were finding it increasingly difficult to assess performance when our requirements were intertwined within the predominately non-healthcare annexes. We longed for where all of our requirements could be located quickly and easily in one section of the contract. What is now known as Annex 1502010 BUMED was born. We can now measure and substantiate the vast majority of our coats, predict out year costs to a finer degree and concentrate on managing one specific section of the contract rather than parts and pieces from several annexes,” Hailey said, citing that the revised contract was team effort by all in the Facilities Department team and is now available for use by Navy Medicine MTFs.

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Hailey notes that this process also lets the contractor have a trained team dedicated to exacting hospital standards and The Joint Commission requirements.

Additionally, the contract requires, for the first time, that the supervisor of the hospital maintenance effort be specifically credentialed as a Certified Hospital Facility Manager (CHFM). 

“As an example, enhancements to the requirements not previously included as a part of the global BOSC that are in the new specific BUMED annex are specialized hospital environment training requirements for all BOSC employees working at the hospital. There are also increased fire door and fire wall inspections, increased airflow monitoring and testing, substantially shorter completion time-frames for repair work, an integrated maintenance program that focuses on repair before fail, increased reporting requirements for The Joint Commission records and management of all JC required documentation by the contractor. There is also after-hour work for scheduled elevator maintenance to reduce elevator down time during business hours, tighter maintenance windows in accordance with The Joint Commission periodicity definitions, increased maintenance and updates to the infant abduction alarm system and nurse call system(s), and the requirements for the contractor to have a full time Certified Healthcare Facility Manager for all work oversight,” Hailey said.

CHFM testing and certification is provided by the American Hospital Association. Successful certification requires passing a proctored exam along with minimum education requirements and previous experience associated with engineering in a health care setting and management, supervisory or administrative experience in the healthcare industry.

“While there are many positive results, in my opinion the most gratifying result is to have a peer CHFM employed by the company that performs our maintenance and repair. This CHFM compliments the existing two working in the Facilities Department, the most at any BUMED location. This enables us to collaborate on the same page so we can quickly and effectively resolve faculties in the right direction the first time without creating any unintended consequences that may be contrary to The Joint Commission or code jurisdictions,” stated Hailey, adding that the CHFM requirement in the BOSC is key to separating healthcare facility requirements from non healthcare requirements and is instrumental to successful JC survey visits.

Along with the inclusion of the CHFM, another positive – and initially unanticipated result - of this contract approach is that contractor costs for delivery of services are more closely allocated to the location where the services are delivered.  Combined with the service level changes, a net savings of nearly $5 million have been estimated over the course of the five year contract.

Whether ‘Coffin’ or Cured – Naval Hospital Bremerton Tobacco Cessation a Year-Round effort
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – Heard the old joke that there once was a Navy nicotine user who asked his provider one day during a routine physical examination, “What’s the end result of having a smoking habit?”

“Coffin,” replied the physician.

 The smoker didn’t get it.

There’s too many who don’t get it...even when it’s too late and they have a sudden epiphany that’s lost in emphysema.

Such goes the never ending, on-going awareness campaign and commitment to tobacco cessation for staff and beneficiaries carried out by Pat Graves, Naval Hospital Bremerton’s Tobacco Cessation Facilitator. 

The Great American Smoke Out this year is on Nov. 20, and Graves again will use the designated date to focus on the perils of puffing, the danger of dipping, and hazards to health from e-cigarette toxic vapors. Dispelling stubborn smoke-screens can be strenuous. Old habits die hard. But Graves is persistent, patient and passionate to help anyone quit.

“The purpose and intent of holding this event is to have those who use tobacco to at least consider quitting for the day. From just one day can come the empowerment to hopefully quit for a lifetime. Quitting is a process that is not always easy. It requires time, patience and a desire to change. We have the tools and experience to help anyone succeed,” said Graves, who has creatively provided encouragement for over seven years at NHB, such as the fun-filled ‘Mileage to Freedom Challenge.

“Several years ago we did a ‘Mileage to Freedom Challenge’ for our staff who convinced a tobacco user to quit for 24-hours. They then participated as five-member teams having each member compete on a stationary bike, elliptical machine or treadmill for an overall total of 10 minutes.

Why the ten minutes? According to Graves, just 10 minutes of moderate intensity exercise can reduce the desire to smoke or dip.

“It’s about moving more and smoking less. Exercise can diminish nicotine withdrawal symptoms and help avoid relapse. Exercise can also reduce the intensity of withdrawal symptoms,” Graves said.

The year NHB’s recognition of GASO features a 5K Fitness Run, static displays on the Quarterdeck and ‘Ciggy Butt’ making the rounds to remind people on the perils of tobacco usage.

The newest fad amongst smokers are e-cigarettes that are sold as a “safer” way to enjoy nicotine, but despite the marketing efforts, there is evidence being documented that like any other tobacco-related product, it is not what it is meant to be. 

Graves states that according to information and article published on the Centers for Disease Control and Prevention website and in 'Chest Journal, official publication of the American College of Chest Physicians,’ E-cigarettes may sound like a better alternative to tobacco and are marketed as such by claiming the “vapor” in e-cigarettes to be simple water vapor.  Not entirely true.  There are commercially available e-cigarettes made with a base solution of PG or VG (propylene glycol or vegetable glycol), or the material commonly used in theater productions or haunted houses to make “smoke” effects, never intended to be a daily, frequent, directly inhaled substance.

Further, E-cigarettes are perceived by some and marketed as “safe” compared to regular tobacco.  A study published in the Chest Journal notes that evaluations of the nicotine solution and vapor content of e-cigarettes found primary components of propylene glycol, glycerin, and nicotine, along with other chemicals identified in trace amounts include N-nitrosamines, diethylene glycol, polycyclic aromatic hydrocarbons, anabasine, myosmine, and β-nicotyrine. Many of these compounds are carcinogenic and harmful to humans.

 “One of the main concerns is that the toxins from tobacco smoke or e-cig “vapor” are going directly into someone’s lungs. And every cigarette or e-cigarette that is smoked, the chemicals in the smoke cause mutations in the body and more significantly (directly) into the lungs. So basically a person’s ingesting cancer causing agents with the lungs acting as the main filter,” explained Graves.  “Add to this, e-cigs were only invented 10 years ago, so there are no long term e-cig users to really know what kind of health impact they might have, long term.”

For Graves, the annual Great American Smoke Out provides an strong reminder that anyone who uses any tobacco product can quit with a little help from him and other resources at NHB like Health Promotion and Wellness Department.

“We want users to make a plan and commit to seeing it through. They can set themselves up to succeed with professional support and support from family and friends. They need to
remember why they wanted to quit in the first place and why quitting is important. They can write down the reason or reasons why they want to quit and then visually remind themselves why they are stopping the nicotine habit.”
 
Graves notes that tobacco usage can also compromise the mission of any service member. Quitting improves a person’s night vision, mental activity; decreases the need for water; increases lung capacity; decreases injuries and accidents; increases stamina; improves fine motor coordination and increases the ability to manage stress.

There are any number of reasons why a person started using tobacco. There’s also a host of rationalizations that a user will fall back on to convince others, as well as themselves that it’s okay to still go ahead and smoke or dip.

Graves cites several common sense reasons why a person should quit using tobacco products.

“We all know the downside of smoking and chewing. It’s been well-documented. Is there any upside?” said Graves, sharing that tobacco use is the single most preventable cause of disease, disability, and death in the United States. The Center for Disease Control and Prevention estimates that each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and another 8.6 million live with a serious illness caused by smoking. Despite these risks, approximately 46.6 million U.S. adults smoke cigarettes. Smokeless tobacco, cigars, and pipes also have deadly consequences, including lung, larynx, esophageal, and oral cancers.

Additionally, the harmful effects of smoking impact more than just the smoker. An estimated 88 million nonsmoking Americans, including 54 percent of children aged 3–11 years, are exposed to secondhand smoke. Even brief exposure can be dangerous because nonsmokers inhale many of the same poisons in cigarette smoke as smokers.

The life a smoker saves may be their own. Or that of a family member or friend,” said Graves.

 If smokers know about the negative health risks and still continue to use and abuse, perhaps another way to get through is to remind them that the addictive habit is just their hard-earned money going up in smoke. A smoker can give themselves over a $3,000 a year raise by quitting. The average cost of cigarettes per pack in Washington is $9.30, which is up from $8.31 last year. Multiple that amount by daily use and the monthly cost is $279.00 or about the difference between E4-E5 over 6 years - an astounding annual total of $3,394.50. 

And what if medical reasoning and fiscal benefits don’t do the trick to break through the addictive shield?

“The goal as I see it is to never give up on anyone. Maybe I can explain to them that no one really likes kissing an ashcan, or being in close proximity with someone who smells like a chimney. There are also intangible benefits such as setting a good example for family, friends and co-workers.  A person can live longer and healthier. Really!” stated Graves, adding that a person has to stick with it. “They got to prepare for challenges. They can even practice what to say and do when someone offers them a cigarette or dip or invites them to join in the old habit. The cravings will pass but a person has to resist the urge to use tobacco. The cravings usually last about three minutes. A person can help themselves by changing their thoughts about giving in to the old habit. They can call me, call a friend, have a drink some water, or simply take a walk. I also recommend that a person can just reaffirm to themselves why they quit and the benefits they’re getting.”

The American Cancer Society coordinates the Great American Smoke Out every year on the third Thursday of November. From the initial event in the 1970s when smoking and secondhand smoke were commonplace, the goal remains to reach smokers across the nation to use the date and make a plan to quit, or plan in advance and then quit smoking that day.

NHB follows the format and uses the annual event to educate, entertain and challenges people to stop using tobacco and helps people know about the many tools they can use to quit and stay quit. ACS research shows that smokers are most successful in kicking the habit when they have support, such as
what NHB offers – “in one variety/form or another!” states Graves - Telephone smoking-cessation hotlines; Stop-smoking groups; Online quit groups; Counseling; Nicotine replacement products; Prescription medicine to lessen cravings; Guide books; and Encouragement and support from friends and family members. Using two or more of these measures are advocated to help anyone quit smoking.

NHB Tobacco Cessation has the resources to help anyone to quit and stay quit. For an appointment with Tobacco Cessation please call:  360- 475-4818. For NHB Health Promotion programs for command or military community group please call: 360-475-4541.

‘Many Views with One Vision’ highlights Radiologic Tech Week at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton's (NHB) Radiology Department was acknowledged for the many contributions of radiology technicians during National Radiologic Technology Week which annually commences the first week of November.

The week brought attention to the important role of medical imaging and radiation therapy that the 49 Radiology staff professionals - five officers, 24 enlisted, 16 civilians and four students – bring to patient care and health care safety.

The American Society of Radiologic Technologists theme for this year was ‘Many Views with One Vision,’ and Hospital Corpsman 1st Class Benjamin Larson, leading petty officer of NHB's Radiology Department, said of those views can’t be understated and each vision is the basis of a diagnosis in many medical situations.

“Support from Radiology Department is absolutely vital to the health and well being of our patients.  In many cases our services are life saving or have a significant positive impact on patient outcomes.  The Radiology Department is geared towards providing the most efficient radiological health care and optimal imaging services for patients to receive quality services that will assist health care providers in determining the best course of action to improve and/or sustain the health and vitality for all of our patients,” said Larson, a radiology technologist for 10 years.

That collective views come from the seven divisions that make up Radiology Department;  Computed Tomography (CT), Diagnostic Radiography/Fluoroscopic Imaging, Mammography/Breast Imaging, Magnetic Resonance Imaging (MRI), Nuclear Medicine, Radiation Health and Ultrasound.

“The Radiology Department provides medical imaging services to the majority of the hospital, including the Urgent Care Center, Operating Rooms, Labor and Delivery, MS5 Inpatient Ward, Intensive Care Unit, Orthopedics, Branch Health Clinics Bangor and Puget Sound Naval Shipyard.  Our services are provided 24/7, including weekends and holidays,” Larson said.

According to Cmdr. Mark M. Morton, Radiology Department head, the active duty and civilian radiology technologists at NHB and Branch Health Clinics at Puget Sound Naval Shipyard, Naval Base Kitsap – Bangor and Naval Station Everett routinely handle radiology examinations, including 43,097 examinations in Fiscal Year 2014. 

"These valuable technologists provide life saving diagnostic services around the clock in direct support of patient care,” said Morton. 

There are also sub-divisions found within radiology that require specialty skills, training, and certifications that are associated with each area in order to provide the best care in accordance with the standards and guidelines of the Joint Commission, the American Registry of Radiological Technologists, the Nuclear Medicine Technology Certification Board and the American Registry for Diagnostic Medical Sonography.

“NHB has some of the brightest and highly motivated radiology technologists available.  On their own initiative, three of NHB's radiology technologists attained national certifications in computed tomography in fiscal year ‘14, one is closing in on a mammography certification and one maintained dual certification in radiology and nuclear medicine.  This remarkable professional drive is key to NHB's success, because we routinely call upon our technologists to cross train and become proficient in multiple imaging sections, for example, x-ray, CT, mammography and fluoroscopy, in order to meet the demand for our services,” explained Morton.  

Morton also attests that NHB’s successful implementation of new SPECT/CT and CT scanners in FY14, two enormous projects collectively costing more than $2.5 million, was in large part due to the versatility and dedication of the technologists who worked diligently to become qualified to independently and safely operate the new units in a timely fashion. 

“It was their efforts that allowed us to continue the high quality medical imaging services that our healthcare providers and patients enjoy.  We are taking this week to recognize the vital role that our radiology technologists have in the delivery of exceptional patient-centered care,” Morton said.

Our job is all about customer service; but it goes beyond more than just providing the services that we have to offer.  Instead, sometimes a patient needs to know that you really do care about them.  I would have to say that the most important aspect (of my job) is being an attentive listener, regardless of the reason(s) that a patient is there for.  Our patients are our family. We want them to feel safe and secure in the knowledge that we are there for them at all times,” said Larson, adding that it’s gratifying to be able to help patients and knowing that they can make a difference in their patient’s lives for the better.

The most common form of support provided by NHB's Radiology Department is with an x-ray, a type of photographic process done with electromagnetic radiation. An x-ray machine sends individual x-ray particles through the body and the images are recorded on a computer or film. Diagnostic radiography uses x-rays passing through the body to create a 2-D image that allows the radiologist and health care provider to see a general image of the anatomy in order to determine if there are any clues about a medical condition that may or may not exist.

The MRI utilizes a strong superconducting magnet and radiofrequency coils to influence the protons that are found throughout our bodies.  Specific tissue types and pathologic processes respond differently in the MRI environment, which allows the radiologist to then make a diagnosis and assist the healthcare provider in developing an appropriate treatment plan.

The CT is a diagnostic tool that utilizes x-rays passing through the patient to produce contiguous 2-D slab images.  As a result, the fine details of anatomical structures can be visualized in slices of varying thickness.  Afterwards, a 3-D reconstruction of the cross-sectional anatomy allows the technicians to view a rotating model of the internal organs and skeletal system, which enhances understanding of the patient’s condition without having to expose the patient to additional radiation.  “This is an essential part of cancer detection,” noted Larson.

Nuclear Medicine delivers radiopharmaceuticals internal to the patient and images are made by detecting the radiation that is emitted from the patient.  This shows the staff where in the body that the radioactive substances are accumulating, which helps us study the functionality of the internal organs, to detect cancer and to look for any other abnormalities.  This service offers diagnostic examinations and therapeutic treatments.

Another key component to the Radiology Department are the radiation health technicians who are responsible for ensuring that our entire staff are properly wearing their Thermoluminescent Dosimeter (TLD) devices in order to document the amount of radiation that each technologist and radiologist receives throughout their career.  Their department helps maintain the accuracy and accountability of each member’s radiation exposure levels,” Larson said.

Hospital Corpsman 2nd Class Geoffrey Sims is a radiation health technician who is seemingly always on the go, handling such responsibilities as radiation monitor, radiation surveys, gas and liquid analyses with knowledge of the medical aspects relating to personnel exposed to ionizing radiation. Along with Hospitalman Apprentice David Stott and Hospitalman Andre Stovall, Sims also directs and administers NHB’s personnel dosimetry program and maintains radiation exposure records as part of the health records.

“Our motto is to ‘trust but verify.’ Helping to maintain the safety of our staff is something we do as effectively and efficiently as possible. There is no second guessing in our jobs. I love my job and think that we have a great team here at NHB. Couldn’t ask for a better division officer in Lt. Cmdr. (Jesse) Puryear who really knows his stuff. I’ve also heard that NHB is one of the best in respects to radiation safety. This really is a great place to work. There is proper guidance, shared knowledge and strong support in our department,” said Sims.

Lt. Cmdr. Joel McFarland, Radiology assistant department head, praised his entire staff, underscoring a common theme of appreciation for everyone on the staff.

“I feel very fortunate to be part of such a dedicated, hard-working, and patient-focused Radiology Department.  Our staff truly goes the extra mile to make sure that every exam is done right and every patient is taken care of, with exams ranging literally from head to toe. We pride ourselves on patient-centered care - rather than reflexively just completing every exam requested, we speak with every patient and review every request to ensure that every patient is getting the best imaging to address their health care needs.  Without our dedicated, professional staff of radiology technologists, our department would be dead in the water,” stated McFarland.

 The weekly observation also coincides with the anniversary of the x-ray discovery by German Physicist Dr. Wilhelm Conrad Roentgen on Nov. 8, 1895. Roentgen would later win the Nobel Prize in 1901 for his work in the fields of x-ray technology.

Naval Hospital Bremerton provides perfect venue for ‘The Energy Guy’

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs --
When it came to arranging a suitable location for ‘The Energy Guy’ to share information and tips, Naval Hospital Bremerton proved to be the perfect setting.

Walker Armstrong, aka the “the Energy Guy’ set up his informal talk-shop on Nov. 4 to field questions from staff and beneficiaries about energy conservation, and share advice on simple, cost effective ways they could save money at work and at home. 

“For our first effort, this event was a smashing success! Walker spoke with about 10 people, answering in depth questions about how they can save energy in their homes. He spent 20 to 30 minutes with each person, individualizing the steps they can take at home to reduce their energy bills,” said Robert E. Mitchell, M.Ed., HEM, NHB’s Environmental Sustainability Program Manager and Command Energy Manager.

The project was the brainchild of Armstrong, of Naval Facilities Engineering Command who also works for NHB, in an effort to come up with new and creative ideas to increase awareness of energy conservation.

 The questions asked ranged from how to save energy in a home with three kids to recommending best practices to lower the monthly power bill to how to make a house built in the 1930s more efficient in using and saving energy.

“Those types of questions were exactly what I was expecting and hoping for. This has been very encouraging,” said Armstrong.

According to Mitchell, The goal was to increase awareness of energy use and the Navy's focus on energy conservation, and to increase awareness that energy use impacts the Navy's ability to execute the overall world-wide mission.

 “Naval Hospital Bremerton has a concentrated population which provides a venue that can potentially reach a greater cross section of people, and right now we're planning on having this as a monthly event,” Mitchell said, adding that as the single largest energy user in the Pacific Northwest, the Navy has a responsibility to use energy wisely.

“That means that each department, each directorate, and each person needs to think about energy use, and how they can positively impact our consumption,” stated Mitchell.

NHB has a Command Energy Policy that engages all personnel daily to enhance energy efficiency consciousness. The policy encourages every staff member to take the necessary steps to save energy such as keeping windows and doors closed, turning lights off when not in use, and prohibiting the non-essential use of personal refrigerators and heaters.

During the month of October that was designated by the Navy as ‘Energy Action Month,’ NHB staff members daily shared examples of how they reduce energy usage at home and in the workplace.

Reduction in water usage, enhanced recycling efforts and turning off equipment at the end of the day were all popular command-wide examples.

For those with any questions on how they can augment their already existing efforts, they have ‘The Energy Guy’ available for any and all insight.

“People are starting to recognize me as ‘the Energy Guy,’ and as a result, we’re getting the word out and sharing with people our knowledge and also that of the Navy on how to save energy. That’s what I’m here for,” Armstrong said.

Naval Hospital Bremerton Volunteers Help Embrace Ability not Disability

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – From the opening ceremony to the day’s final frame, infectious smiles, overflowing enthusiasm and competitive camaraderie were right up the alley in the Special Olympics Washington 2014 SW Region Bowling Tournament held on Nov. 2, 2014.

Dozens of volunteers from Naval Hospital Bremerton came in shifts over the course of the full-day of games to lend a hand at Silverdale’s All-Star Lanes that hosted over 400 athletes from participating teams in the annual fun-filled event. Athletes represented Bainbridge Island Golden Eagles, BKAT (Bremerton Kitsap Athletics Teams), Clallam County Orcas, Port Townsend Warriors and South Kitsap Hi-Rollers.

“I want to thank Naval Hospital for volunteering yesterday at the region bowling tournament at All Star Lanes. The volunteer assistance was tremendous,” said Scott A. Friberg, Special Olympics Washington SW Region Manager, Sports and Programs.

Friberg attests that if not for the support from the local community, an event like this for the athletes simply could not be pulled off.

“It’s the volunteers that make it happen. We’re so happy to have the support from Naval Hospital Bremerton staff. They are essential helping from everything from lane keeper to score keeper to presenting medals and it is really just as rewarding for the volunteers as it is for the athletes,” Friberg said, adding that his job is primarily behind-the-scenes and having the volunteers do so much on the actual day of the event makes not only his job much easier, but boosts every aspect of the day for the athletes.

“This is such a great way to help everyone here. I did it last year and as soon as I heard that the event was coming up again, I shared the word and got a number of our clinic staff to come along also,” said Hospital Corpsman 2nd Class (Fleet Marine Force) Michael J. Pulkrabek, of NHB’s Branch Health Clinic Everett and a Bremerton native.

Hospitalman Cory Boles, Labor and Delivery Corpsman, has volunteered before and was a driving force this year to get staff involved. His interaction with the athletes during the first of three shifts for bowlers had the South Kitsap Hi-Rollers team request him to help them on a regular basis.

“I was asked to come and help them and become a mentor and coach, which is very flattering and a great way to stay involved in our community now on a regular basis,” Boles said.

 For Barbara Pool, BKAT program coordinator, the knowledge of knowing that NHB volunteers are at the event is a definite plus as she manages all her athletes on various teams that participate in singles and doubles competition, along with unified doubles and as 4-member teams. BKAT brought 188 athletes for the tournament, a sizable group to supervise and support.

“We embrace ability not disability with our athletes and we can’t do an event like this without volunteers such as those from NHB. One of the most important jobs that the volunteers do so well is that their support helps to open doors by simply developing a bond between the volunteer and the athlete, which lets the athlete know they are accepted. The interaction helps them succeed and that interaction also carries over after the event is over,” said Pool, citing that the athletes are committed to doing their best and thoroughly enjoy sharing their time and experience(s) with the volunteers.

Hospitalman C.J. Rangel, laboratory technician, even found himself providing more than just lane help and score keeping during the first shift of the day. He used his training to provide immediate medical support and assist Alicia Antonio, Intensive Care Unit nurse, in stemming a minor bloody upper lip sustained by one of the athletes.

“I was just glad I was there to provide on-the-spot help. We actually had a few more bumps and bruises doing the ‘Haunted Ship’ on USS Turner Joy on Halloween night,” Rangel.

NHB Blue Jacket of the Year recipient HN Teresa Perkins of radiology department noted that as the NHB volunteers were keeping the energy levels up of the athletes, so were the athletes also returning the favor.

“Their spirited energy is just so much fun. They love to compete and interact. It’s great being part of,” said Perkins.

Naval Hospital Bremerton’s Physical Therapy department hosts open house

by Mass Communication Specialist 1st Class (SW/AW) Gretchen M. Albrecht Naval Hospital Bremerton Public Affairs – In conjunction with National Physical Therapy Month, Naval Hospital Bremerton’s Physical Therapy department hosted an open house for providers, staff and patients Oct 30.

The main goal of the open house was to inform others of the many therapies and treatments provided as well as the numerous preventive self treatments people can do on their own.

“This is a yearly event the physical therapy staff does to let patients as well as hospital staff know what we can offer,” said Lt. Cmdr. Kim Musa, Physical Therapy department head. “We tried to highlight specific therapies and treatment strategies like aquatic therapy and trigger point therapy and make the event fun and informative.”

Physical therapists and physical therapy assistants were readily available to share insight and teaching about proper posture, trigger point therapy, aquatic therapy, shoe insoles, grip therapy and more to the continuous stream of visitors. 

“Our goal today was to inform people about the different treatments for pain management and rehabilitation available because our ultimate goal is to get out patients back to or as close as possible to their previous pain-free level of function,” said Angelica Obregon, a physical therapy assistant. 

Open house guests received a questionnaire about specific presentations and went station to station, static display to static display to learn about different therapies. The completed questionnaires were entered into a drawing for a gift card.

Hospital Corpsman 3rd Class Nina Merrill said, “We wanted to make this fun so we all brought in some kind of finger food or dessert and made quizzes about each presentation so it would be an interactive learning experience.”

The physical therapy staff added a healthy dose of competition between themselves with a pumpkin decorating contest featuring fan favorites like a Seattle Seahawks 12th Fan and Cookie Monster pumpkin.  Guests voted on their favorite with the Cookie Monster pumpkin coming in with the most votes.

“This is a really great team here who came together to make this a fun and informative event for everyone,” said Musa.  “I am very happy with the complete team effort that went into this event from working together making the static displays and decorating pumpkins for visitors to voting on to donate snacks for visitors and being here to inform them about great preventative treatments and therapies we offer.  I really think it was a success for everyone involved.” 

For more information or a referral for physical therapy services speak with your primary care manager.

Navy’s Senior Pharmacist of the Year awarded to Naval Hospital Bremerton pharmacist

by Mass Communication Specialist 1st Class (SW/AW) Gretchen M. Albrecht Naval Hospital Bremerton Public Affairs  Constantly working behind the scene to continually put patient’s needs in the front, Naval Hospital Bremerton’s Pharmacy department head has been named Navy Pharmacy Senior Pharmacist of the Year award for 2014.

Lt. Cmdr. Eric Parsons dedication and devotion to duty catapulted him above his Navy-wide pharmacist peers to earn him the distinguished award.

The award is annually open to more than 130 Navy pharmacists, lieutenant commander and above, who have demonstratively shown high standards in customer care and service. The completion was as steep as ever. 

According to Cmdr. David Hardy, Director, Clinical Support Services, what set Parsons’ above his peers was his year-long efforts to enhance patient services, reduce wait times, as well as his foresight and efforts to upgrade current pharmacy workflow and standards. He also played a vital role in the implementation of a Department of Defense (DoD) wide electronic prescription initiative.

“Lt. Cmdr. Parsons has been at the command for just over one year and in that time he has proven himself to be a strong and highly capable leader,” said Hardy, Parsons’ nominator for the award.  “There are none better to represent Navy Pharmacy and Naval Hospital Bremerton than Lt. Cmdr. Parsons.  His dedication to our patients, his staff and our mission are evident in his daily operations and in his strategic planning.”

“The electronic prescription initiative was a big process. Naval Hospital Bremerton was the initial test site for making our job extremely important.  We had to work out the bugs, create training for our staff from scratch, and develop scenarios,” said Parsons. “This is now going live DoD wide and will allow us to receive and accept prescriptions from doctors at non-military treatment facilities streamlining our work and our patient’s time.”

Parsons and the NHB Pharmacy staff remain available as consultants for training and trouble-shooting to ensure the developed scenarios are working properly with other Military Treatment Facilities s as they transition to the e-prescription program rolling out throughout DoD.

Parsons’ deflected accolades and chose to focus on the entire Pharmacy. The 2003 University of Iowa graduate praised his staff for their support, teamwork and technical expertise making the Pharmacy department shine for patients and allowed him to implement changes in procedures.

“We have a great team comprised of three different pillars; an amazing supply staff, technician staff and pharmacist staff that enables us to run smoothly and do a great job providing,” said Parsons.  “The staff’s proactive support, expertise and team mentality really enabled me to do my job.”

Parsons is very humbled and honored by the award, noting his past and current mentors and leaders who gave him the tools to succeed stating, “I have been continuously learning throughout my career and this (recognition) is the cumulative effort of the great mentors and teachers I have had.” 

Capt. T. V. Ha, Navy Pharmacy Specialty Leader, presented the Navy Pharmacy Senior Pharmacist of the Year award to Parsons, citing him, “For outstanding service to the DoD and Navy Pharmacy community from October 2013 through September 2014. Lt. Cmdr. Parsons demonstrated strong leadership in DoD Pharmacy and the Pharmacy Department, showcasing his diverse talents in the delivery of $15 million in pharmacy benefits annually to 88,000 beneficiaries, development of future plans and implementation of paperless prescribing from non-Military Treatment Facility providers.

Ha noted that Parsons’ directed beta testing for DoD’s new electronic prescribing software, created 230 unique test scenarios, and identified and eliminated 55 programming issues, ensuring patient safety. He provided live training to over 280 Tri-Service personnel on the software, which will be deployed DoD-wide and is estimated to save up to $7.4 billion annually. 

Parsons has also helped achieve savings with Defense Health Agency guidance by advocating for the addition of 13 drugs to the formulary to recapture prescriptions being filled in the retail network, which has saved the Defense Health Program $1.7 million per year. 

“A strong leader in the Puget Sound Enhanced Multi-Service Market, he led development of a business case analysis, providing workload based justification for new and renovated pharmacies to generate up to $6 million in savings. He redesigned workflow and obtained much needed automation and renovations for the command’s busiest branch clinic pharmacy that had previously had none, a major enhancement for patient safety,” read the citation.

Naval Hospital Bremerton takes active role in Navy Wounded Warrior - Safe Harbor commercial production

by Mass Communication Specialist 1st Class (SW/AW) Gretchen M. Albrecht Naval Hospital Bremerton Public Affairs

 BREMERTON, Wash. (NNS) –Bright spotlights shown on Naval Hospital Bremerton (NHB) during a recent video production session highlighting Navy Wounded Warrior Safe Harbor services on Oct. 22.

The video production will be edited into a commercial showcasing the non-medical support given to injured and sick Sailors and Coast Guardsmen and will be shown worldwide on the Armed Forces Network (AFN), base theaters, social media websites and DVD handouts.

“Our goal with this commercial is to show the entire continuum of care and services provided to sick and injured Sailors and Coast Guardsmen,” said Patricia Babb, Navy Safe Harbor marketing specialist. “Too many service members don’t know if they qualify for services, how to obtain them or what is out there to help them.  Being part of Fleet and Family Readiness (FFR) gives us a direct link to many non-medical programs like housing and childcare and many other quality of life programs so the sick or injured service member has a knowledgeable person to get them the benefits they deserve.”

Wounded, ill and injured Sailors and Coast Guardsmen face a multitude of challenges throughout their recovery process.  To ensure they can concentrate on their recovery Navy Wounded Warrior - Safe Harbor provides assistance with a plethora of non-medical issues many do not think of until they are dealing with them such as pay and personnel issues, housing adaptation, lodging, childcare services, transportation, legal and guardianship issues to name a few.

Hospital Corpsman Senior Chief Joe Paterniti was a reserve Sailor activated for full duty to fill the vital role as one of the Pacific Northwest non-medical case managers.  He meets with sick and injured Sailors and Coast Guardsmen to start the process and helps them through until care is no longer needed. It’s a job he takes very seriously.

“I really don’t know how our shipmates can do this without help because it can be difficult to navigate while dealing with a major illness or injury,” said Paterniti.  “These major medical events happen without notice.  It is the servicemembers job to focus all of their energy on getting well. It is my job to help them with anything non-medical they may need from how to get to rehabilitation session to getting their family to their bedside from across the country.  We are here to solve the problems that pop up helping to alleviate stress and keep the member focused on getting well.”

Marketing directors chose NHB and the Pacific Northwest Region for their exemplary support of Navy Wounded Warrior - Safe Harbor, service to Sailors and Coast Guardsmen and overall knowledge of services provided.

“This region and Naval Hospital Bremerton has shown such great support for the Navy Wounded Warrior - Safe Harbor so when choosing where to film this area and hospital stood out to us,” said Babb.  “There are so many here who not only support our mission and are willing to help but who truly understand the program and are actively working to getting the word out about our services.”

Babb also acknowledged the difficult conditions in place when videotaping in a military treatment facility with providing patient-centered care and support services to continuous training and clinical responsibilities stating, “This hospital and staff has always been accommodating and willing to help and today was no different.  It is always a pleasure working here.”

Sailors and Coastguardsmen can go to http://safeharbor.navylive.dodlive.mil or call 1-855-NAVY-WWP (628-9997) for more information on the Navy Wounded Warrior - Safe Harbor and services provided.

The Importance of Mammography

By Mona I. Sherlock, RT, (R)(M) A.R.R.T. and Dr. Joel McFarland, CDR, MC, USN.

Did you know that Breast Cancer is the second leading cause of cancer death in women?

The American Cancer Society estimates that 232,000 new cases of invasive breast cancer will be diagnosed in women in 2014. Add that number to the approximately 62,000 new cases of carcinoma in situ, and you can see the need for early detection. The American Cancer Society recommends monthly self-breast exams and annual screening mammograms starting at age 40, a policy followed by all US Naval Hospitals.

Many women want to know why a breast ultrasound cannot be used instead of a mammogram. Unfortunately, breast ultrasound can only differentiate a solid mass vs. a fluid filled mass, and is unable to pick up micro-calcifications which are commonly found in breast cancer lesions. A recent case two years ago here at NHB comes to mind.

A woman in her late 30’s presented with a palpable lump in her left breast and both the patient and her provider only wanted a breast ultrasound to be performed. As per our policy at NHB, a diagnostic bilateral mammogram and left breast ultrasound was performed. The palpable lump in her left breast turned out to be a simple cyst, however, calcifications in her left breast subsequently biopsied demonstrated Ductal Carcinoma in Situ. Had the patient only received a breast ultrasound, that cancer diagnosis would have gone unchecked until it developed into a large palpable mass or the woman obtained a screening mammogram.

The risk of getting breast cancer increases as a woman ages. Research has found that cancers discovered during early screening exams are often smaller in size and more likely to be confined to the breast. When considering these two factors (the size and likelihood of spread), the importance of early detection becomes obvious.

Finally, a bit of good news: while a woman has a 3 percent chance of dying from Breast Cancer, incidence rates have been declining since 2000. This is likely due to earlier detection through screening mammograms, increased awareness, and improved quality in treatment.

The Mammography Department at Naval Hospital Bremerton is proud to provide exceptional breast imaging to our valued patients. Please ask your provider to place a screening mammogram consult if you are over 40 and have not had a mammogram in the past year, or if you are less than 40 but have increased risk factors, or if you have a palpable concern. We offer walk-in exams as well – there’s no good excuse not to take care of your breast health!

Naval Hospital Bremerton Command Career Counselor Program review a shining success

By Mass Communication Specialist 1st Class (SW/AW) Gretchen M. Albrecht Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton Command Career Counselor team earned a satisfactory score during the annual Navy Medicine West Career Information Program Review that audited numerous command programs.

The inspection is a yearly mandatory audit conducted on all Command Career Counselor programs in the Navy such as career development boards, career waypoints, sponsorship efforts, command advancement and continuing education. The aim of the inspection is to ensure all program aspects are meeting Navy standards, fully supporting the crew and maintaining operationally readiness at all times.

 “The inspection was an assessment of the Command Career Counselors ability to provide superior career guidance to all Sailors in the command,” said Navy Career Counselor 1st Class John Caron. “The Career Counselor Program is paramount in the success of any command’s primary resource; their people.”

An inspection this large would usually mean a lot of last minute preparation, but the daily work practices put into place throughout the year made last minute preparation less of a factor according to Hospital Corpsman 2nd Class Robert deLange.

“Our shop has been preparing the entire year by doing right by the Sailors.  By conducting proper CDBs [career development boards] and documenting appropriately, by ensuring all members are assigned sponsors and contacted so they are able to come to this command with a point of contact and some knowledge, (and) basically by doing our daily activities the right way by making sure our Sailors were cared for, we were able to do well on the inspection,” said deLange.

The inspection was no small feat either with more 1,600 personnel files on hand and available for inspection.  NHB’s parent command Navy Medicine West was represented by Senior Chief Navy Career Counselor David Light who handled the inspection and came away impressed with the documentation and support for staff Sailors.

“Hospital Corpsman Chief Christine Moore (who at the time of the inspection was the leading chief petty officer for Command Career Counselor office) and her team are very engaged career counselors. Everything was very well prepared and ready for inspection,” said Light.  “The information the office provides about separation, retention and outside employment help Sailors by dispelling myths and gives them the full picture of any decision that they make.  They are running an outstanding program and truly care about their Sailors.”

Not only does a satisfactory score mean Naval Hospital Bremerton Sailors careers are being well looked after by the Career Counseling team, it also means this is the third consecutive year the program is eligible for the Golden Anchor award and retention pennant which is considered a testament to the dedication and team work of the six man shop.

Petty Officer deLange also noted the cohesiveness and well rounded technical skills of each career counselor played an integral role in the success of the program and inspection.

“By being able to be the expert in one specific area and have working knowledge in all areas, our team was able to pass this inspection with flying colors.  This method enabled us to take ownership of our program as well as assist each other with their specific programs. The teamwork and dedication of each member played an invaluable role in service to our Sailors and success of the program,” said deLange.

Conservation, Cost Savings and Command Involvement part of Energy Action Month at Naval Hospital Bremerton
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- The month of October might be designated by the Navy as ‘Energy Acton Month,’ but for Naval Hospital Bremerton staff members, it’s not just a prompting about understanding conservation and protecting the environment.

Following the lead of the National Energy Awareness Month, the Navy’s ‘Energy Action Month’ theme has been looked upon at NHB as a validation of continuing practices already in place that many active duty, civilian, contractor and American Red Cross volunteers make part of their daily routine at work and home.

My thanks to everyone for the conservation efforts thus far - keep up the great work and look for new ways to conserve. Energy and water conservation are critical to our mission success.  Every dollar we save on energy stays within our command and can be used for other things that we need,” said Capt. Christopher Quarles, Naval Hospital Bremerton Commanding Officer, during an ‘Energy Action and Awareness’ recognition ceremony on the quarterdeck on Oct. 23, 2014.

NHB has also established a Command Energy Policy that engages all personnel daily to enhance energy efficiency consciousness. The policy encourages every staff member to take the necessary steps to save energy such as: keeping windows and doors closed, turning lights off when not in use and prohibiting the non-essential use of personal refrigerators and heaters.

All during the month, staff members have been highlighted for their efforts with ‘daily man-on-the-street’ interviews on what they are individually doing to reduce energy usage at home and/or work. Their responses and photos, posted on the command’s official Facebook page that have drawn positive reviews, offer up a host of common sense approaches, such as;

"I do a couple things like shut off lights, use the motion sensors lights at work, open up the blinds at home to bring in natural light and during the colder season I use sweaters instead of using heat to warm up,” shared Kim Arias of NHB’s Laboratory department.

"I always make sure to turn off the lights and computers. We are always in a constant repetitive process of keeping the trash smaller and smaller and always recycling what we can to help conserve energy,” commented Hospital Corpsman Christian Wallace of Naval Hospital Bremerton's Endoscopy department.

Logistics Specialist 1st Class Samuel Kenyenso of Material Management says that "conserving energy is critical and we all have to do our part. What we do on a daily basis is ensure that all lights are off before closing down for the  day, turn off all equipment that is not in use and keep track of the equipment that is kept on for operational use."

 “Some ways we conserve energy here where I work is recycling a lot of paper instead of wasting it. I work in Healthcare Business so we deal with a lot of paperwork. Everybody utilizes those shred bins to recycle paperwork. I think that’s a big help because my last hospital I was at, we didn’t have those shred bins,” said Hospital Corpsman 3rd Class (Fleet Marine Force) Angel Castilleja, Angel of TRICARE Operations.

Family Practice’s Hospital Corpsman Chief Mark Sizemore also practices at home what he preaches at work with a little financial incentive added into the mix. "In order to teach my daughter responsible energy use, I charge her 25 cents every time she leaves the light on at home," Sizemore said, explaining that when they began back in January, on average he would collect two to three dollars 2-3 dollars per month when we started. But over the last several months he has collected less than a dollar a month due to his now-11 year old getting more conscious of flipping the light switch off as she leaves a room. 

And the money collected? “I put the money into the power bill (to) contribute to the household budget if she is going to squander the resources.  If she doesn't leave the light on, she keeps her whole allowance and can save for toys or treats that she want to buy,” Sizemore said.

 Ramon Calantas of NHB’s Environmental Division technician attests that Energy Awareness Month helps to highlight energy successes at NHB such as the reduction of energy consumption and water usage.

“With the installation of four new condensing boilers in our heating plant, we have reduced our natural gas consumption this year by 6 percent, resulting in over $15,000 in annual energy cost savings.  We have installed advanced LED lighting fixtures on the outside of our buildings and are conducting pilot LED lighting studies in our parking lots and elevator lobbies, which save over $3000 annually in electricity costs. We have lighting controls in our restrooms and that turn lights out when the facilities are unoccupied, which save over $1300 in electricity costs annually,” stated Calantas, adding that the command is also planning to completely remodel the heating and ventilation systems and install more water efficient fixtures in our restrooms.

According to Robert E. Mitchell, M.Ed., HEM, Naval Hospital Bremerton Environmental Sustainability Program Manager and Command Energy Manager, some of the command’s energy conservation projects fall under the radar, but still achieve the goals of sound environmental stewardship and practical energy savings, as well as cost savings. Some examples that Mitchell cited include a pending B/17 Lighting Controllers project which will have day-lighting controllers and occupancy sensors installed in NHB’s corridors and waiting areas. 

The command is also installing room darkening roller shades in patient rooms and waiting areas on several upper level floors. 

“Although no energy cost savings have been calculated, these rooms face east and west and are subject to bright sunlight.  The shades will help block the sun's radiant heat into the rooms and should reduce the cooling load,” stated Paula McAvoy, NHB Facilities Management project manager, adding that similar roller shades are also being installed in south facing windows at Branch Health Clinic Puget Sound Naval Shipyard. 

In regards to cost savings, NHB Resource Conservation Manager John Payne noted that along with occupancy sensor installations in offices and exam rooms, the command’s HVAC system replacements and upgrades for NHB’s main facility and adjacent Family Practice wing will have an estimated savings of 12 percent of yearly electrical use and 16 percent of natural gas use for a total of $155,157 cost savings.

“Every staff member is encouraged to take the necessary steps to save energy such as: keeping windows and doors closed, turning lights off when not in use and conserving water where possible,” said Quarles.

Inaugural Patient-Shuttle Service for Madigan – NHB Shuttle is underway

By Naval Hospital Bremerton Public Affairs – When Logistics Specialist Seaman Nicoli Legaspigallego found out he had upcoming medical appointments scheduled at Madigan Army Medical Center, he thought he would have to arrange with his department to get there and back.

Not now.

In conjunction with the enhanced Multiservice Market (eMSM), the Army’s Western Region Medical Command and Navy Medicine’s Jointness priority, the inaugural Patient Shuttle service between Madigan Army Medical Center and Naval Hospital Bremerton (NHB) commenced on October 20, 2014.

Legaspigallego, recently assigned to NHB’s Material Management from USS John C. Stennis (CVN 74) broke his neck in August and has a slate of specialty appointments scheduled at Madigan. Having the Patient Shuttle service available is a timely resource for him as well as others to navigate the commute between military treatment facilities.

"I think it's a good deal for all the people in need of transportation like myself to go down there, especially people that don't have their own vehicle. So it's definitely a good deal for me," said Legaspigallego.

Maj. Gen. Thomas R. Tempel, Jr., U.S. Army Western Region Medical Command and Puget Sound eMSM Commander was on hand at NHB for the start of the Madigan/NHB Shuttle Service.“I’m really impressed with all the work going on to make this happen and provide for our patients both ways,” said Tempel.

The convenient new service is being provided by the Puget Sound Military Health System to offer patients with a specialty care referral an option for transportation between the two military treatment facilities (MTF) at no cost.

Departure times from NHB are at 7 a.m., 10 a.m., 1 p.m. and 4 p.m. and from Madigan at 5:30 a.m., 8:30 a.m., 11:30 a.m. and 2:30 p.m.

The Patient Shuttle pickup and drop off at NHB is located at the main entrance (in front of the quarterdeck), and at Madigan’s Main Medical Mall North entrance. The shuttle is slated to and run Monday thru Friday (except holidays). All shuttle rides are approximately one-hour long. However, shuttles may run late due to traffic and other external factors.

But even if the Patient Shuttle bus is full, everyone who needs transportation service from one military treatment facility to the other will still have the opportunity even if that means another shuttle has to called for immediate backup help.

"We have other means to get every patient who needs to get to a referral. Say there's 20 people waiting for a shuttle that only holds 16. We will triage who has priority and call for another shuttle for the others. We're not turning anyone away," said Lt. Cmdr. Kirt C. Nilsson, of Business Planning officer with Strategy Development eMSM Puget Sound.

Reservations will not be taken for the shuttle.  Patients are requested to be at the designated stop prior to the scheduled departure time. Active duty servicemembers will have priority, and all others will be transported on a space-available basis. The primary mission of the shuttle is to transport patients for medical care that have scheduled appointments. If space is available once all patients are embarked, escorts/guests may also ride.  If an eligible beneficiary has a family member who is an in-patient at Madigan, they may take the shuttle is there is available space.

"I had surgery earlier this year and I'm just going for a re-check. I think it's a great idea! I wish they had this a year ago but I'm happy with it, very happy,” shared Dona Roddey, who welcomed the service.

The shuttle is not wheel chair accessible.  Patients riding the shuttle must be able to move about and embark/disembark the vehicle with minimal assistance.

Washington State law also dictates children less than eight years of age must be secured in some form of child safety system unless the child is 4 feet 9 inches or taller.   Child seats are not available on the shuttle.  If a child will be transported, the parent/guardian must provide a child restraint seat. All children under the age of 18 must be accompanied by a parent. 

Additionally, eligible beneficiaries who are pregnant and receiving Obstetrics and Gynecology care at Madigan and NHB may use the patient shuttle up to the 36 weeks gestation period. However, emergency medical services are not available on the shuttle and a care provider should be consulted for recommendation on any type of travel.

Naval Hospital Bremerton Mammography Keeping Abreast of Cancer Awareness

By Mass Communication Specialist 2nd Class Zulema Sotelo – The human breast; they come in all shapes and sizes.

But when abnormalities develop, Naval Hospital Bremerton’s (NHB) Mammography team is fully qualified and standing by to assist, having recently been determined to be in full compliance with the Mammography Quality Standards Act (MQSA).

The annual inspection of NHB’s mammography program and Breast Health Center was conducted by the U.S. Food and Drug Administration (FDA) in order to verify the quality of their mammography services.  The inspection allowed them to see how NHB - one of over 8,000 facilities inspected in September - compared with other facilities nationwide.

According to Mona Sherlock of the Radiology Department’s mammography program and a seasoned mammography coordinator, the day of the inspection was really no different than any other day on the job.

“I wasn’t really nervous about the inspection since I have been through so many over the 30 plus years that I’ve been doing this,” said Sherlock.

Her previous experience with these types of inspections and her savvy and meticulous organizational methods greatly contributed to NHB’s satisfactory score for the assessment.  Sherlock is considered famous for her ability to attain zero discrepancy results on inspections of programs that she manages.

Sherlock added, “We didn’t require much last minute preparation for the inspection this year because I reorganized the entire program when I took my current position in September of 2012 and I spent a lot of time throughout the year keeping all aspects of our program current.”

Performing quality mammography examinations, providing accurate reports, compiling current and flawlessly organized program records, and maintenance of the mammography equipment in top working condition were essential elements to their success on the inspection, which had the FDA inspector scrutinizing quality assurance records, personnel qualifications, mammography reports, medical audit results and outcome analysis records, in addition to inspecting equipment performance.

Noncompliance with MQSA standards can result in a failing grade on the FDA inspection, which in a worst case scenario can result in the closure of a mammography program.  NHB personnel go to great lengths to infuse quality into every level of their mammography program so that they can continue to proudly provide over 3,000 mammograms annually to their valued patients.

Being able to provide this vital service is what Sherlock is known for and has earned her the affectionate nickname of ‘Mammo Mona.’  She even was recently selected as NHB’s Civilian of the Quarter for her pro-active work ethic and dedicated support of NHB’s mammography program.

“They don’t call me ‘Mammo Mona’ for nothing.  I think that when you love what you do and do what you love, it’s easy to give it your all every day,” exclaimed Sherlock.

Throughout her lengthy career, including a period of time when she was a member
of a mobile mammography team that traveled throughout rural areas of the U.S., Mona has kept her mission simple and that’s to take care of women and inform the public about breast cancer.

Compiled statistics show that screening mammography reduces breast cancer mortality by 25-30 percent for women ages 50-70 and by 18 percent for women ages 40-50.  Early detection also provides women with better options for a life saving cure and breast-conserving therapy.

Sherlock attributes the quality of service provided at NHB to the close patient interaction that is more often a fundamental characteristic of military treatment facilities compared to many civilian facilities.

“I do appreciate the time that we are able to give to our patients in the Naval Hospital.  The all mighty dollar drives the civilian world and patients are often shuffled in and out like a meat market.  I don’t believe in meat market mammography.  I never did,” said Sherlock, “You want to be able to spend time with your patients to address their concerns and their fears, and to make sure that you’re doing what’s right for them.”

Since October is Breast Cancer Awareness month she also advises women to take control of their breast care, to follow the American Cancer Society guidelines, and to take advantage of the services that NHB has to offer.

“Women have to be proactive about their breast care,” said Sherlock.

NHB’s current
Breast Health Center opened in Nov. 2010 and is equipped with the latest digital mammography equipment to perform breast cancer screening and diagnosis.  NHB’s fully digital system features leading edge 21st century technology and represents an upgrade from the days of film processing and more recently the use of imaging cassettes.  The modern direct digital system allows for real-time efficiency and enhanced medical imagery.  As soon as the image is taken it can be transmitted to the digital archive and be reviewed by the radiologist.  No film or cassettes to handle as in previous years.

The benefits of digital mammography are many.  The breast is composed of soft tissue mainly consisting of glandular and fatty elements.  When breast tissue is x-rayed, an image is created that looks something like a smoky haze, often making it difficult to see small calcifications, masses and other subtle signs of breast cancer.

With digital mammography, the radiologist reviews electronic images of the breast using special high-resolution monitors.  Sherlock and her team of radiologists can magnify objects to zoom in for close ups of specific areas of interest, adjust brightness, increase or decrease contrast and invert the black and white values while reviewing the images in order to thoroughly evaluate and focus on areas of concern.  Being able to manipulate images is one of the major benefits of digital technology because it makes it easier to find breast cancers.  Another convenience of digital mammography over film-based systems is that it can greatly reduce the need for image retakes due to over or under exposure.  This can save additional time and reduce exposure to x-rays.

Because they are electronic, digital mammograms can be transmitted quickly across hospital networks when necessary in order to expedite the care of the patient.  Digital images can also be reliably stored and easily copied without any loss of resolution or quality eliminating dependence on only one set of “original” films.

“We follow the American Cancer Society guidelines for early breast cancer detection.  The American Cancer Society continues to recommend monthly breast self-examinations and periodic clinical breast examinations for women starting in their 20s and annual mammograms starting at age 40.  The risk of developing breast cancer increases as we get older and we should be doing everything that we can to catch it as early as possible,” Sherlock stated.

For more information about the FDA Mammography Assessment and the Mammography Quality Standards Act, visit http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/default.htm

For more information on Breast Cancer Awareness, visit the American Cancer Society website www.cancer.org

For more news from Naval Hospital Bremerton, visit www.navy.mil/local/nhb/

“Quick Tips by a Dermatologist”

By Lt. Cmdr. Josephine Nguyen, MD, FAAD Department Head of Dermatology, Naval Hospital Bremerton – From far reaches of the sea to extreme locales ashore, Sailors and Marines are constantly exposed to the elements on their varied jobs. From the sun and wind to salt-spray and sand, such conditions impact everyone and can cause unknown damage to anyone’s skin.

Dermatologists like Lt. Cmdr. Josephine Nguyen specialize in how to take care of the skin, and deal with issues such as acne, skin cancer, rashes, and dry skin. 

“The skin, the largest and fastest growing organ of the body, is important because it keeps you warm when it is cold outside, cools you down when you get hot, and keeps bacteria and viruses from entering the body, as long as there are no cuts or open wounds,” said Nguyen.

Nguyen attests that the best part of her job is getting to know her patients as well as their families, and teaching them how to better take care of their skin.

“Skin is the most visible organ of the body, and any problem with the skin greatly impacts a patient's quality of life.  Any treatment I provide has the potential to significantly enhance someone's quality of life and hopefully positively influence their outlook on life,” explained Nguyen.

Skin care is a responsibility not just for those on deployment. It’s also applicable to every family member.

According to Nguyen, by adhering to the Surgeon General’s three top priorities of Navy Medicine, Readiness, Value and Jointness, in her role as the sole Navy dermatologist in the Pacific Northwest, her goal in the next year is to increase the leverage of telehealth to expand dermatologist capabilities throughout the Puget Sound area.

“Telemedicine has already been heavily used by military dermatologists as well as academic dermatologists. I hope to use my experience in this area to provide increased responsiveness to our constituents which will increase the value and readiness of Navy Medicine,” stated Nguyen said, sharing several of her “Quick Tips”

    What is the best way to prevent early aging of your skin? Avoid sunburns and wear sunscreen 365 days a year.  This prevents sun damage that could result in wrinkling, age spots and potentially skin cancer

    What sunscreen should you get? Get a broad spectrum sunscreen (protects against UVA and UVB) that has an SPF 30 or higher, and is water resistant.

    Pull that petroleum jelly out of your drawer! This common product is great!  It is inexpensive and can be used in multiple ways for skin care including: moisturizing cracked hands, feet, lips and peeling nails; helping kids’ scrapes heal quicker; diaper ointment

    If I get acne, is it better to wash your face as often as possible? NO! Washing your face too often can dry your skin and lead to irritation.  Wash your face in the morning and at night, and after sweating heavily.  Perspiration can be irritating to the skin and worsen acne. Wash your face with a gentle non-abrasive cleanser, pat dry, and then apply a facial cream.

    Why does my skin get dry in the winter? Long, hot showers can be drying to the skin.  To limit drying of your skin, limit the amount of exposure to hot water.  Apply a moisturizer to damp skin as soon as you get out of the shower to lock in the moisture. 

    What about those nice smelling moisturizers that cost extra money? Beware!  A more expensive skin care product is not necessarily more effective. The fragrances in some brands may actually cause skin irritation. If you have sensitive skin, it is best to use a bland, fragrance free emollient.

    How do I decrease my risk of getting an infection at a nail salon? Consider bringing your own manicure/pedicure tools.  Also, shave your legs after getting a manicure, not before. Or wait 24 hours after shaving before getting a manicure.  A nick in your skin can predispose you to getting an infection.

For Susan Yake, RD CD CDE CLT and Clinical Dietitian with the Nutrition Department Code at Naval Hospital Bremerton, having October designated as Women’s Health Month provides a great opportunity to remind everyone, not just one gender, on Healthy Eating and Nutrition.

What we eat are the building blocks of our body.  We would not think of using inferior products to construct our home.  Our body is where we live at all times no matter what our duty station or part of the world we live. Nutrition is a major key to feeling better and functioning better. Nutrition affects the function of the body allowing us to lead an active life and have more energy.  We need protein to build and repair the body, carbohydrate to fuel it, fat for energy and transport of nutrients, and vitamins and minerals to help the body function normally.  Too much or too little of these nutrients can cause disease,” said Yake.

Eating fruits and vegetables can affect gene expression in a positive way such as reducing blood pressure, preventing cancer, and fortifying the body to prevent illness.  The Dietary Approaches to Stop Hypertension (DASH) diet can lower blood pressure equal to a medication to control hypertension.  Phytonutrients in plants that contribute to color and flavor in the produce we eat are known to prevent cancer, especially if eaten in a variety of colors.  The orange colored fruits and vegetables such as carrots, pumpkins, and winter squash contain carotenoids. They are great for the skin, help you see well in the dark, and slow the aging of the eye so you can have good vision longer as you get older. Even garlic has a mild antibiotic effect that might be just strong enough to protect you from a cold or flu.

Yake attests that when someone changes over from lousy eating habits to a health-eating routine, they gain numerous physical and physiological benefits.

“With a more nutrient dense diet minus excess solid fats and added sugars, healthy eating provides a consistent energy level allowing the person to be more productive with their time.  They feel better and the body functions better.  Nutrition is the foundation for functional medicine; a practice of medicine started by Dr. Jeffrey S. Bland designed to conquer the causes of chronic disease.  For those who eat healthy and have an active lifestyle, they can live a longer and healthier life,” Yake said.

For those who think that healthy eating and nutrition is a onerous journey filled with distasteful products, Yake stands ready to refute their ill-placed (not tasted) logic.

“What people are afraid of is that they will not be able to eat their favorite foods again.  We all have food preferences and those are taken into consideration during consultation.  What dietitians excel at is individualizing the person’s meal plan so they can enjoy food.  The reality is that we are eating too much food. Often it is a portion control problem,” stated Yake.

Even if a certain food is calorie dense, the recipe can be modified to lower the calories without sacrificing the flavor.  Yake recently served with the Diabetes Care and Education Dietetic Practice Group of the Academy of Nutrition and Dietetics, and the board worked with celebrity chefs to modify recipes to be healthy for patients diagnosed with diabetes. 

As the waistlines of Americans have expanded so has the frequency of obesity and diabetes at about the same pace.  NHB dietitians offer classes and individual counseling to help beneficiaries – Sailors, Marines, their families and retirees - prevent or treat chronic diseases such as diabetes and heart disease. 

And for a tasty treat that keeps on giving, please call 1-800-404-4506 to enroll in NHB’s Intro to Nutrition Class or contact your provider for a consult to see one of the dietitians. For those at other military treatment facilities, please contact their Health and Wellness Departments for more information.

Overseas Screening Process a Streamlined Procedure at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- When a recent Navy wide message on Overseas Screening process was disseminated throughout the fleet, what began as a reminder for some was the culmination of hard work by a select few.

In response to feedback from Sailors, an overseas screening working group was put together in August with representations from throughout the Navy, including Navy Bureau of Medicine and Surgery (BUMED). Naval Hospital Bremerton’s Suitability Screening Supervisor Casey Pruett has been tabbed be part of a collaborative team for the medical screening process.

Under the lead of Dr. Laurie Hobbs, BUMED Special Programs department head, Pruitt and other suitability screeners and coordinators are helping to formulate the Navy Medicine portion of notable revisions made to the Overseas Screening process. The process was implemented with a Navy Administrative message immediately on Sept. 2.

“Laurie reached out to ensure that the new NAVADMIN not only covered the detailing aspect of the screening process, but also the screening portion of it. She contacted me and another coordinator to bounce ideas off of and allow us to review the draft and recommend changes from the perspective of the coordinator.  Anytime you're making policy, it's good to have someone that has the knowledge and experience at the execution level of that policy. Although I reviewed and made recommendations, some of which were made and some that weren't, Laurie ultimately made the decisions and wrote the medical part of the policy,” said Pruett, a retired hospital corpsman chief with 24 years of active duty experience.

The bottom line of the new process is that a Sailor’s orders will not be released until the Overseas Screening process has been satisfactorily completed. The Bureau of Naval Personnel (BUPERS) will issue a Letter of Intent (LOI) to all personnel anticipating overseas (or remote orders), which will then give military treatment facilities (MTFs) like NHB the authority and/or signal to commence the screenings.  NHB is averaging approximately 50 to 60 screenings a month.

Pruett attests that the completion of the screening has historically at times been delayed due to the upswing of operational tempo and the mission of each command. 

“The OPNAV 1300.4D instruction has always dictated that a suitability screen had to be completed within 30 days of receipt of orders and for years, the orders have reinforced that.  This NAVADMIN enforces that policy now by holding all parties accountable,” said Pruett, adding that Sailors have always been able to start their screen with a ‘Letter of Intent,’ but such a document wasn’t usually included in the process. 

“When a Sailor gets orders,” continued Pruett, “and they're found unsuitable during the screening process, it's more difficult to cancel the orders and reissue a new set.  By issuing the letter before the orders, it's less laborious for BUPERS and allows the Sailor to start the screen sooner instead of waiting for the (actual) orders.”

According to Hobbs, the LOI adds approximately 90 days to the process, which ultimately assists the Sailor, family, command and Navy Personnel Command (PERS) should the screening identify potential reasons someone is not suitable for the projected assignment, (and) reduces the stress and anxiety of last minute change in orders for the Sailor while giving PERS time to identify an appropriate backfill rather than gapping the command’s position and ensuring the mission can be met.

Pruett attests that the major changes that have been implemented are not only the letter of intent being issued before actual orders, but just as important, Sailors will now lose their orders and be issued ‘needs of the Navy’ orders without further negotiation if the screen isn't completed within 30 days for active duty and 60 days for family members. However, there is a process for obtaining a waiver for issues that arise that are beyond control of the Sailor or command.  The requests for waivers are submitted by the transferring command and granted by BUPERS on a case by case basis.

“The changes benefit the Sailor by allowing them to start their screen sooner which gives them more time to plan for household goods shipment, find housing, and other similar arrangements,” Pruett said, citing that the entire screening process is complex with a lot of moving parts. 

The most common problems that Pruett deals with that delay a screen include issues such as a Sailor's family gets treated by a civilian primary care manager or there’s been difficulty obtaining the medical records for screening purposes; and during the screening process.

The other frequent concern is that some Sailors prolong in finally starting the entire screen process.  If a chronic medical condition is found in the record, by instruction, the MTF is required to send an inquiry to the receiving MTF. 

“Only the receiving MTF can make the suitability determination.  Replies to those inquiries are sometimes delayed if the screening medical officer at the receiving MTF needs to consult with a specialist before the decision is made,” explained Pruett.

As is often the case, there is method to the administrative/bureaucratic madness and that is to ensure a Sailor and his/her family will be taken cared of when they report to their new duty station overseas.

“The screening process is designed to achieve several goals.  First and foremost is to ensure the member and/or their family are able to get the care they require at their overseas duty station.  Secondly, if we fail to correctly complete the screen and the family is early returned, the cost to the government is tens of thousands of dollars.  When the goals of the system aren't met it's dangerous to the family and becomes a bad experience for the Sailor and their family. What is gratifying for us is that we make sure the family's Permanent Change of Station (PCS) overseas is a satisfying experience and we've protected the Navy from unneeded expenditures from an early return,” stated Pruett.

Early returns are recommended when any MTF is not able to provide care. 

The requisite legwork, required assistance and reliable guidance is handled by an able pair of Hospitalman from NHB’s Directorate of Administration.

“Hospitalman Blake Howe, HN Vanalfon Felipe, and HN Paul Roberts work very hard to keep up with the flow of screens, EFM packages and physicals. They do an excellent job of staying organized.  They're really the guys who make these programs successful here,” Pruett stated, sharing that he does not anticipate the new message to impact NHB’s Overseas Screening process.

“Our personal process is designed to complete screens without affecting access to care. Our turnaround for a screen is pretty quick in the absence of an inquiry,” stated Pruett.

NHB Staff take lead in DEFY with local military family dependents
By Mass Communication 2nd Class Zulema Sotelo, Naval Hospital Bremerton Public Affairs – Sailors stationed at Naval Hospital Bremerton are helping young military dependents make good decisions by coordinating the Navy's Drug Education For Youth (DEFY) program that commenced on Sept. 27, 2014.

 DEFY is a free program for military families that helps to strengthen youth by providing them with the knowledge, insight and life skills they need to avoid involvement in drugs, gangs, and other crimes.

The program also gives the young students – primarily age nine to 12 - the opportunity to take their mind of the stress of deployment, anxiety of change of stations, and handling of peer pressure or family problems that can affect their decision-making at that young age.

 According to Hospital Corpsman 2nd Class Mark Litz, from Lincoln, Calif., DEFY is “A yearlong program that talks to the kids on their self esteem as well as teaches them about responsible decision making.”

This two-phase program allows service members to mentor the youth throughout the year.

Phase 1 teaches skills like etiquette, general social skills, team building, and good communication while also putting an emphasis on building a healthy lifestyle that involves activities like running, swiming, and team sports.

Phase 2 provides education on conflict resolution, gang resistance, internet safety, and bullying.

For a Sailor volunteering like Litz, teaching future generations has a purpose and isn’t just another evaluation point.

“For me, this isn’t another check in the block. I think that programs like this should be continued and participated in because there are so many kids out there that really need help and guidance due to lack of leadership from parents, lack of money, and many other things,” said Litz, “As a father, I wish my kids were old enough to participate but I hope that it’s still in effect when they get older.”

Even though their last gathering was mainly about keeping a healthy lifestyle Litz mentioned future plans for the group and the importance of mentoring at an early stage of their mentees lives.

“In November we plan on taking the kids to the discovery center up at Bainbridge Island and then in December we’re joining up with the CSADD group here at the hospital to do some community service,” said Litz, “I think it’s great we teach the younger generations now because they’re going to be the ones who relieve all of us in the future.”

For more news from Naval Hospital Bremerton, visit www.navy.mil/local/nhb/.

Inaugural Women’s Development Leadership Circle held at Naval Hospital Bremerton

By Mass Communication Specialist 2nd Class Zulema Sotelo – The power of personal conviction and the might of mentorship were themes strongly addressed at Naval Hospital Bremerton on Sept. 25 in the kick off the Women’s Development Leadership Circle (WDLC).  

Sheryl Sandberg, Chief Operating Officer of Facebook, once wrote, “Women need to shift from thinking, ‘I’m not ready to do that’ to thinking ‘I want to do that and I’ll learn by doing it.’” This kind of thinking is what inspired Lt. Cmdr. Josephine Nguyen, Navy Action Officer at Naval Hospital Bremerton (NHB), to plan and implement the WDLC.

The WDLC brought together Sailors and civilians of both genders to discuss women’s issues in the workplace like communicating with confidence, power and influence, and the importance of mentorship. It is a four part pilot program that empowers women to pursue leadership roles.

According to Nguyen, “I saw the need to put this event together after feedback from my peers and others when they expressed their concerns about a lack of leadership development in previous places I had worked at.”

The forum featured a video lecture from Shelley Correll, a Professor of Sociology at Stanford University, that talked about the problems women face when it comes to advancing in their careers and the way society has been trained to think about the genders.

Nguyen saw the opportunity to help women establish a network and form mentorships that could improve the quality of life for themselves, their coworkers and their families during her time as the Health Professions Scholarship Program (HPSP) board president. As the president, she traveled throughout the country to talk to students about the opportunities available within Navy Medicine.

“When speaking with young women I noticed their lack of confidence and believing in themselves and it’s something that continues to motivate me to want to be a role model for them,” said Nguyen. “That job taught me how to mentor the younger generation, as well as my colleagues, on how to be better leaders.”

During the forum one of the greatest emphases was put on mentorship and what the program provides women to want to pursue their goals.

“The biggest thing is equipping them with knowledge about how to encourage other men and women to be aware that understanding is power. And in order for you to lead other people you have to be aware of things like gender bias to prevent it from interfering you from becoming a better leader,” said Nguyen.

By applying what is taught at the forum attendees can teach and possibly change the way that men and women lead future generations.

Nguyen added, “My desire is to make that opportunity available to them and to level the playing field for all.”

 For more news from Naval Hospital Bremerton, visit www.navy.mil/local/nhb/

Inaugural Madigan – NHB Shuttle commences Monday, October 20

Compiled by Naval Hospital Bremerton Public Affairs -- There will be a Patient Shuttle service between Madigan Army Medical Center and Naval Hospital Bremerton (NHB) starting on October 20, 2014.

The convenient new service is being provided by the Puget Sound Military Health System to offer patients with a specialty care referral an option for transportation between the two military treatment facilities (MTF) at no cost.

The Patient Shuttle pickup/drop off at NHB is located at the main entrance (quarterdeck), at Madigan’s Main Medical Mall North entrance and will run Monday thru Friday (except holidays). All shuttle rides are approximately one-hour long. However, shuttles may run late due to traffic and other external factors.

Shuttle Departure times:

Depart Madigan         Depart NHB

5:30 a.m.                     7 a.m.

8:30 a.m.                     10 a.m.

11:30 a.m.                   1 p.m.

2:30 p.m.                     4 p.m.

Reservations will not be taken for the shuttle.  Patients are requested to be at the designated stop prior to the scheduled departure time. Active duty servicemembers will have priority, and all others will be transported on a space-available basis. The primary mission of the shuttle is to transport patients for medical care that have scheduled appointments. If space is available once all patients are embarked, escorts/guests may also ride.  If an eligible beneficiary has a family member who is an in-patient at Madigan, they may take the shuttle is there is available space.

The shuttle is not wheel chair accessible.  Patients riding the shuttle must be able to move about and embark/disembark the vehicle with minimal assistance.

Washington State law also dictates children less than eight years of age must be secured in some form of child safety system unless the child is 4 feet 9 inches or taller.   Child seats are not available on the shuttle.  If a child will be transported, the parent/guardian must provide a child restraint seat. All children under the age of 18 must be accompanied by a parent. 

Additionally, eligible beneficiaries who are pregnant and receiving Obstetrics and Gynecology care at MadiganNHB may use the patient shuttle up to the 36 weeks gestation period. However, emergency medical services are not available on the shuttle and a care provider should be consulted for recommendation on any type of travel.

 NEW TRICARE REFILL WEBPAGE NEEDED

Due to increasing information security requirements NHB is no longer able to host their own web page link for patients to access and enter their pharmacy refill request via the Internet. The prescription refill link on the NHB Internet page will now take patients to TRICARE Online https://www.tricareonline.com/

This process is currently being standardized across Navy MTFs but does require additional steps on the part of the patient.

Patients still have the option to phone in their refill request via the automated telephone line at 360-475-4217

Once at the TRICARE Online web site patients must log in with their personal user id and password: https://www.tricareonline.com/

Once logged in, patients can request refills by selecting "Rx refill" in the lower corner of the home page.

The patient will be directed to a web page that is similar to the one that was hosted by NHB. On this page, patients will need to ensure their primary MTF is correct. If it is incorrect, they can select the appropriate MTF to send their refill request to.

The remainder of the web page is filled out in similar fashion to that of the web page previously hosted by NHB; asking for sponsor's last four and the numeric portion of the prescription numbers to be refilled.

Have Medical Questions? Call the TRICARE Nurse Advice Line.

BREMERTON, Wash. -- Sometimes it is difficult to know if and when to seek medical help for acute health problems, so having professional help at a moment’s notice is invaluable.  

The Military Health System’s (MHS) new Nurse Advice Line (NAL) for TRICARE beneficiaries does just that.  Beginning on May 30, 2014, TRICARE beneficiaries receiving care at Naval Hospital Bremerton can call the NAL toll-free - 1-800-TRICARE (874-2273); Option 1 – 24 hours a day, seven days a week.

The NAL is a team of registered nurses who are available to answer a variety of urgent healthcare questions. They can help you decide whether self-care is the best option, or if it is better to see a healthcare provider. There will always be a live-person on the line to address beneficiary concerns.

The NAL offers a variety of solutions for all TRICARE beneficiaries.  

For pediatric issues, the NAL will route the beneficiary to a pediatric nurse. If follow-up is necessary or requested, the NAL will call the beneficiary back to check the child’s status a few hours later.  

The NAL will make same-day appointments with the beneficiary’s primary care manager (PCM) for TRICARE Prime beneficiaries who are enrolled to Military Treatment Facilities (MTFs).

If a same day appointment is not available, the NAL will re-direct the beneficiary to the closest urgent care center, and advise the PCM that an urgent care referral is needed so the patient does not have to worry about paying any point of service co-pays. All other TRICARE beneficiaries who are not enrolled to a MTF will receive professional health advice about their urgent health concern and when to seek urgent care.

When calling the NAL, a customer service representative will verify the beneficiary’s eligibility through the Defense Enrollment and Eligibility Reporting System (DEERS). Beneficiaries with an acute health care concern or question will be connected with a registered nurse that will ask the beneficiary a series of very standard questions to determine the next steps and allow the NAL nurse to provide the best advice possible. 

Beneficiaries can still call their PCM or clinic, but the NAL is another option for beneficiaries to access the care they need and want in a timely fashion. To access the NAL, once it launches, dial 1-800-TRICARE (874-2273); Option 1. 

  Remembering Those Who Came Before at Naval Hospital Bremerton
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- From the Boxer Rebellion in China at the turn of the 20th century to the jungles of Vietnam in 1968, 22 Navy hospital corpsmen have been recipients of the Medal of Honor for their unrelenting perseverance, steadfast courage and unwavering devotion to duty in the face of extreme personal danger.

Leading up to the Hospital Corps 116th birthday on June 17, Naval Hospital Bremerton (NHB) is remembering those 22 corpsmen, many who gave their lives saving others on the field of battle. During every morning colors on regular work days, NHB’s Color Guard will formally carry a set of dog tags as they raise the flag to symbolize the sacrifice of the Medal of Honor recipient. The dog tags are then solemnly placed on a framed citation for all to view.

The 22 carried out their assigned duties, and then some, from the carnage of the Western Front in France during the First World War, to the bloody island hopping campaign in the Pacific Theater of World War Two, and from the frozen war zones in the Korean War to jungle fighting in the Vietnam War, as well as several conflicts in isolated locales that many people might not have ever heard about.

“The Corpsmen Ball Committee selected to do these mini ceremonies for 22 days as a way to dedicate a day to the remembrance of each corpsman that has gone before us and through back breaking work made the corpsmen rate was it is today. Sometimes people need a reminder that they are stronger then they think and are able to overcome any obstacle. The intentions of this 22 day evolution is to instill pride in our junior Sailors and remind our senior Sailors that we serve in one of the most decorated corps in the Navy and should be proud everyday for that opportunity,” explained Hospital Corpsman 2nd Class (Fleet Marine Force) Mark Litz.

Fittingly, the first hospital corpsman and Navy medical representative to ever receive the nation’s highest military honor was quietly and reverently acknowledged. Hospital Apprentice (retired as a Chief Pharmacist) Robert H. Stanley distinguished himself several times under enemy fire volunteering to carry messages between the American and British legations during the Boxer Rebellion at Beijing, China in June, 1900. He was 19 years old at the time.

“I applaud our Corpsmen Ball Committee for their efforts to remind us all on the supreme sacrifice from the 22 Medal of Honor corpsmen. Many, if not all, gave their lives to save others,” commented Capt. Christopher Quarles, Naval Hospital Bremerton Commanding Officer.

Next recipient recognized was Hospital Apprentice First Class William Zuiderveld, who was assigned to the battleship USS Florida in the U.S. intervention in Vera Cruz, Mexico in 1914. During the seizure of that city, he displayed “extraordinary heroism” while performing his professional duty. Zuiderveld braved incoming gunfire by rushing to help a seriously wounded shipmate who was shot in the head. He stemmed the bleeding and carried the injured Sailor back out of the direct line of fire.

“I think doing this is such a great idea. You can see the differences in the write-ups from last century to the more recent ones. I’m looking forward every day to the ‘next chapter,” said Laurie Gonzalez of NHB Information Management Department.

At NHB on every Friday morning, as many staff members as possible due to clinical and departmental responsibilities assemble on the quarterdeck for morning colors, which is then followed by the traditional pledge of allegiance and any award ceremony added to the schedule.

For May 23, Hospital Apprentice Fred H. McGuire was recognized.

 On September 24, 1911, McGuire was part of a shore party from the gunboat USS Pampanga ordered to capture a force of Moros warriors on Basilan, located off Mindanao in the southern stretches of the Philippine archipelago. As the scout party approached their objective – the village of Mundang - the Moros sprung an effective surprise attack. McGuire responded to the call for help and emptied his rifle at the enemy, and when his ammunition was depleted, he used his rifle as a club in fierce close-quarter combat. Despite being wounded in the battle, he immediately helped his dying leader and other wounded crewmembers until (additional) help arrived. For his action on this occasion, he was awarded the Medal of Honor.

Handling the honor of carrying the dog tags as part of the Color Guard team and then placing them on the framed citation was Hospitalman Austin Robbins.

 “This is really a great way to remember all of these corpsmen who gave their all. They are all part of the historical legacy of our rate. Remembering each one individually shows us what it takes to get it done when faced with overwhelming odds. As a history buff, I have taken the time to read all the citations on display on the third floor, I know I have the training and I just hope I also have what it takes if ever faced with being in such a situation,” commented Robbins, a Colville, Wash. native who brought previous experience to NHB as a volunteer on a command flag detail where he served on ceremonial guard at Joint Base Anacostia-Bolling (Washington, DC).

  According to Hospital Corpsman 1st Class Alexander Henry Bransdorf, the leading petty officer Peri-operative services, the initial idea went from abstract notion to practical application in the Hospital Corps ball committee meetings with HM1 Vincent Kucera and Litz helping with the overall coordination.

 “Besides the obvious honoring of those who are the epitome of the valor of the Hospital Corps, it is a great way to show the proud lineage that today’s hospital corpsman encompass, whether that is on a gray hull out to sea or in the deserts of Afghanistan and Iraq or back taking care of the fleet at one of the shore based installations,” explained Bransdorf, of Lake Stevens, Wash., citing that recognizing the 22 recipients also gets the other enlisted rates stationed at NHB involved and aware of the tradition and history of corpsmen.

 “These men paved the way and set the standard for hospital corpsman to operate.  Should every HM strive to be a Medal of Honor recipient?  No, but when you read these citations and get a sense of “wow,” any corpsman, whether an HR fresh to the fleet or the most senior HMCM, should strive to be the best possible. These men were the forerunners in the HM rate and really set the bar,” stated Bransdorf.  

 Bransdorf, with approximately 12 years in the Navy, attests that by honoring those who have come before, there is a definite sense of pride felt being a part of the corpsmen lineage and what the rating has accomplished in time of peace and in time of war.

“It is important to honor the legacy for many reasons, but the most important is that these men went far above the standard call of duty.  These men earned the nation’s highest military award and they deserved to be recognized, perhaps more than just once a year during the Hospital Corps ball timeframes.  A legacy cannot be continued if the past falls by the wayside,” said Bransdorf.

If there is a collective component of NHB that perhaps daily understands what it means to have paid the ultimate sacrifice and be recognized with the nation’s highest military honor, it would be Branch Health Clinic Everett, with Medal of Honor recipient Hospital Corpsman 2nd Class David R. Ray as the namesake of their clinic.

Ray was awarded the Congressional Medal of Honor (posthumously) for his actions during the Vietnam War at Phu Loc 6 near An Hoa in Quang Nam Province, Republic of Vietnam, on March 19, 1969. BHC Everett, commissioned in 2002, is located within the David R. Ray Health Center.

When Cmdr. Doug Stephens was BHC Everett’s officer in charge, he guided the clinic staff into expanding their efforts in remembering Ray, which has included heartfelt comments from Ray’s family, as well as shared sentiment from another hospital corpsman who served alongside Ray during the Vietnam War.

“What we did was actually spoke to some Marines that served with David R. Ray and a corpsman who was in Da Nang when his body was flown in after getting killed.   We also spoke with and communicated with his sister and nephew on a regular basis to let them know what we were doing to honor her brother and Uncle. We (also) initiated a 5K run where all proceeds ($648) went to the Intrepid Fallen Heroes Fund,” shared Stephens, noting that the clinic initiated a corpsman cup event to compete on basic medical skills and the winner earned the "HM2 David R. Ray Top Doc Competition."

The competition is another way for BHC Everett staff to keep the memory alive of Ray, who would have turned 69 on Feb 14, by what he accomplished as a corpsman and by his sacrifice on the field of battle.

The top doc competition involved professional and practical testing such as what Ray learned in honing his corpsman skills over 40 years ago. The goal of the competition wasn’t to replicate that fateful day on a blood-soaked patch of ground in Vietnam, but to bring a hands-on sense of urgency and realism in a training environment.

“Not a bad start for the first time. Our enlisted staff did a very good job and overall we got some great training done. I think HM2 Ray would have been pleased,” said Hospital Corpsman Master Chief Michael Garritson, BHC Everett Senior Enlisted Leader.

“At my change of charge ceremony with Lt. Cmdr. Willie Carter, the last page of the ceremony program has a handwritten note from David R. Ray to his family.  Sadly, two weeks later, he was killed,” said Stephens.

BHC Everett reads the citation of Ray every year on his Feb. 14 birthday:
"For conspicuous gallantry and intrepidity at the risk of his life above and beyond the call of duty while serving as a HM2 with Battery D, 2d Battalion, at Phu Loc 6, near An Hoa. During the early morning hours, an estimated battalion-sized enemy force launched a determined assault against the battery's position, and succeeded in effecting a penetration of the barbed-wire perimeter. The initial burst of enemy fire caused numerous casualties among the Marines who had immediately manned their howitzers during the rocket and mortar attack. Undaunted by the intense hostile fire, HM2 Ray moved from parapet to parapet, rendering emergency medical treatment to the wounded. Although seriously wounded himself while administering first aid to a Marine casualty, he refused medical aid and continued his lifesaving efforts. While he was bandaging and attempting to comfort another wounded marine, HM2 Ray was forced to battle two enemy soldiers who attacked his position, personally killing one and wounding the other. Rapidly losing his strength as a result of his severe wounds, he nonetheless managed to move through the hail of enemy fire to other casualties. Once again, he was faced with the intense fire of oncoming enemy troops and, despite the grave personal danger and insurmountable odds, succeeded in treating the wounded and holding off the enemy until he ran out of ammunition, at which time he sustained fatal wounds. HM2 Ray's final act of heroism was to protect the patient he was treating. He threw himself upon the wounded Marine, thus saving the man's life when an enemy grenade exploded nearby. By his determined and persevering actions, courageous spirit, and selfless devotion to the welfare of his marine comrades, HM2 Ray served to inspire the men of Battery D to heroic efforts in defeating the enemy. His conduct throughout was in keeping with the finest traditions of the U.S. Naval Service."

Along with the hospital corpsmen who have received the Medal of Honor, NHB also prominently displays those who have received the Navy Cross, including four posthumously, and 29 from the Vietnam War, 65 from World War Two and 57 from World War One. Unbeknownst to many, one of the Navy Cross recipients from the Vietnam War, Warren Work, is a recently retired NHB staff member and has a road on the command, ‘Work Way,’ named after him.

Like those recognized with the Medal of Honor, Navy Cross recipients at NHB are visibly identified as a part of the historical fabric of not only the hospital corpsmen rate, but also Naval Hospital Bremerton, Navy Medicine and the U.S. Navy. And for this special time leading up to the Corpsmen Ball, 22 of them are being remembered above and beyond the norm. Which is exactly what those corpsmen did in the line of duty.

From Speed Mentoring to the Aloha Moani 5K Run, Navy Nurse Corps 106th Birthday a week long remembrance at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- The Navy Nurse Corps 106th Birthday is being recognized at Naval Hospital Bremerton with a slate of week-long events that culminates with a memorial run in remembrance for one of their own before their actual birth date of May 13.

The schedule commenced in earnest on May 6 with the Nurse Corps Professional Development Committee’s ‘Speed Mentoring’ event that gave prospective officer and enlisted Sailors interested in a specific field of nursing the chance to gain information and insight from  experienced subject matter experts and mentors. 

The event was tailored for all those interested to spend a few minutes with Nurse Corps experts and gain knowledge on career interests as well as give the nurses a chance to explain their varied roles.

Lt. j.g. Zackary Byrne of the Multi-Service Ward took on the role as coordinator for Speed Mentoring because he felt it would be important for junior Nurse Corps officers and enlisted to have such a venue to provide easy access to information about advanced careers in nursing.

“Nursing is a vast and diverse field. It can be overwhelming at times when planning your career. A program like Speed Mentoring will give sailors a concentrated source of information about the many avenues nursing has to offer,” said Byrne.

Byrne’s goal with the Speed Mentoring event was to gather senior and experienced nurses from a wide range of advanced roles and have them present in an informal and relaxed atmosphere where attending servicemembers could ask questions and gain knowledge on becoming a Navy Nurse Corps officer. There was over a dozen specific nursing fields experts on hand including nurse practitioner, clinical nurse specialist, operational nursing, emergency nursing, peri-operative nursing and critical care nursing.

“There are so many different ways to achieve advanced careers in nursing, I wanted the senior nurses to be able to share their own stories and experiences and offer advice to up and coming sailors,” explained Byrne.

For Hospital Corpsman 3rd Class Tara MacDonald, NHB’s Branch Health Clinic Bangor Information Assurance Officer and Immunizations assistant leading petty officer, although already selected for the medical commissioning program and set to attend the Medical Enlisted Commissioning Program for Nursing, there is still the need to choose a specific nursing field.

“I’m still deciding on a specialty and the opportunity to stop by here and talk to the experts is very helpful,” MacDonald said.

Byrne also attests that speed mentoring is beneficial for any interested servicemember.

“There are formal programs in place, like career development boards, but I wanted a program where interested sailors can informally sit, chat, and network with nurses experienced in their advanced roles.  By providing a relaxed atmosphere, people can get advice on career and school choices, listen to stories about what worked well - or what didn't work - and ultimately accomplish the Speed Mentoring program's final goal of finding a mentor.  The program can be used to "break the ice" and hopefully open use that professional connection as guidance when making difficult career choices,” Byrne said, sharing that as a former civilian junior nurse before joining the Navy in 2011, he didn’t have any formal mentoring program available and had to wade through overwhelming information on advanced nursing careers.  He found the entire process time consuming and even somewhat intimidating at times. 

 The annual NHB Nurse Corps 5K run has been designated the Aloha Moani Memorial 5K run on May 10. The run is dedicated in memory of Lt. Rebekah Moani Daniel, NHB staff member lost in March due to a rare complication of childbirth. The event is expected to have over 200 runners along with Daniel’s family in attendance from California and Hawai’i. The event is open to the public and taking place at the neighboring Naval Housing Jackson Park.

“We consider this memorial run to really be the highlight of our entire week. It will be emotional for us all,’ said Capt. Iris Boehnke, Director for Nursing Services.

There are approximately 165 active duty and civilian nurses assigned to NHB along with six American Red Cross nurse volunteers, out of the Navy’s active and reserve Nurse Corps components that total more than 4,000 members.

Navy Nurse Corps members will also be active in the extended community throughout the week. The nurses will visit the Washington Veterans Home in Retsil and Lt. Rachel Allnutt will be honored as one of three Junior Officers of the Year by the Kitsap Chapter Military Officers Association of America as part of the community’s annual Armed Forces Festival.

NHB nurses continue their pivotal roles in providing quality health care not just at home but also abroad. Nurse Corps staff members are preparing to participate in Pacific Partnership 2014 humanitarian assistance mission, as well as supporting Operation Enduring Freedom down range in Afghanistan.

The Navy Nurse Corps birthday also coincidently happens to be during National Nurses Week that is annually recognized and celebrated May 6 to May 12, the birthday of Florence Nightingale (1820-1910), the founder of modern nursing.

It was on May 13, 1908, that then-President Theodore Roosevelt signed the Naval Appropriations Bill that authorized the establishment of the Nurse Corps as a unique staff corps of the Navy.

As was the case 106 years ago, NHB’s Nurse Corps continues to provide care and support through direct patient care at the bedside or as a provider, in an administrative role, and even as a mentor and as a grieving staff member for those in need and for those in remembrance.

Naval Hospital Bremerton recognized with 2013 DoD Quality and Patient Safety Award

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton’s resourceful efforts in improving patient safety were recognized May 2 in the 2013 DoD Quality and Patient Safety Awards by the Office of the Assistant Secretary of Defense (for) Health Affairs.

NHB’s submission “Breaking the Cycle of Unnecessary Repeat Cesarean Sections Utilizing an Innovative Patient Centered Approach to Counseling” was selected as one of the two recipients who received Honorable Mention in the 2013 Quality and Patient Safety Awards.

“On behalf of the DoD Patient Safety program, I’d like to acknowledge your outstanding contribution to the 2013 DoD Quality and Patient Safety Awards. Your patient safety initiative has advanced safer patient care and helped create a culture of safety. By doing so, your facility has shown immense dedication to your community of patients and care givers,” wrote Army Maj. Gen. Richard W. Thomas, Director of Healthcare Operation, in a letter to Capt. Christopher Quarles, NHB commanding officer.

The facility submission was set in motion by Cmdr. Susan Toyama, NHB Quality Management department head, who explained that the initiative was developed in 2010 through the command’s Perinatal Advisory Board, lead by Dr. Christopher Tatro, staff physician in OB/GYN clinic.

“It was done in an effort to increase quality and patient safety by implementing a standardized approach to delivery planning in all pregnant patients with a prior cesarean delivery.  Both repeat c/sections and trial of labor after cesarean (TOLAC) are associated with specific risks. But patients with a Successful TOLAC leading to a Vaginal Birth after Cesarean (VBAC) do confer less morbidity in the short and long term.  It is critical then that patients in this category are counseled well and selected carefully,” said Toyama.

Toyama noted that the normal practice at many hospitals is to talk about the plan during individual appointment times as the pregnancy progresses, which can be a ‘hit and miss’ scenario in regards to sharing information and insight from provider to the patient.

“So some patients will receive good counseling, and others are left with questions but never have opportunity to ask.  Some who proceed with a TOLACs are not necessarily the best candidates,” Toyama said.

The solution? A 60 minute monthly group appointment class - held in the OB clinic/classroom setting - was developed at NHB.  Standardized counseling material is presented allowing for questions and answers from patients and their families.  The same provider taught the class each time which made the sessions very consistent in information sharing.

“The group setting and long appointment time seemed to empower patients to taken an active role in their care and allow those patients time to review options and make informed decisions.  Most who are not good candidates to start with will "opt" themselves out after hearing all the information,” Toyama stated.Toyama attests that the success rate of those who attend the class and attempt a TOLAC has been 96-100 percent, and The VBAC rate has increased and c/section rate has decreased at NHB, well above Navy, Department of Defense and national benchmark rate levels.

“Even though Dr. Tatro developed and taught the classes up until this past year, it took a team effort to make it happen.  Family Practice and OB providers had to send their patients to the class and the crew in the clinic had to set up and check patients in for the class.  If patients had questions after the class staff had to be available. Everyone involved made it happen,” said Toyama.

The submitted abstract of the initiative has been posted on the DoD Patient Safety Learning Center - http://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Quality-And-Safety-of-Healthcare/Patient-Safety/Patient-Safety-Products-And-Services/Patient-Safety-Learning-Center - to share with other patient safety champions in the military health system.

Naval Hospital Bremerton Sailors Reminisce on Kitty Hawk Visit

Mass Communications Specialist 1st Class James Evans Coyle-Naval Hospital Bremerton Public Affairs  -- A touring group of 30 chiefs and first class petty officers from Naval Hospital Bremerton (NHB) took a trip back through naval history on the de-commissioned aircraft carrier Kitty Hawk (CV 63) on Apr. 24.

The visit was in conjunction with their ongoing ‘Chief Petty Officer’s 365’ or CPO 365 and coordinated with the assistance from Naval Sea System Command Naval Inactive Ship Maintenance Facility office.

Kitty Hawk, commissioned April 29, 1961 and de-commissioned May 12, 2009, currently moored alongside other de-commissioned aircraft carriers Ranger (CV 61), Independence (CV 62) and Constellation (CV 64) at Naval Base Kitsap provided a unique setting for one group assigned to give historical facts and information about the ship. 

According to Chief Hospital Corpsman Jason Slaton, NHB CPO 365 Director, the CPO 365 program has been a constant flow of solid training at NHB since the program was conceived by former Master Chief Petty Officer of the Navy Rick West. 

“We take every opportunity to make each other better. The Chief’s Mess here at NHB has been on point with the CPO 365 program and the first class petty officer's here at the hospital have embraced the training,” said Slaton.

The first class petty officers at NHB were split up into four different teams or ‘boat teams’ and given specific assignments ranging from ship history presentation(s) to general military knowledge to the history of the Chief Petty Officer.

Boat team four, assigned to do their naval brief about Kitty Hawk, made the most of the nearby proximity to the ship. They provided extensive information about Kitty Hawk such as the second "k" on Kitty Hawk’s nameplate is upside down. The letter was skewed in the 1960s when dry dock welders transferred the small steel letter plates from the fantail to below the flight deck.

Kitty Hawk was once called the, ‘floating White House’ when President John F. Kennedy spent the night aboard the ship near southern California on June 7, 1963. The ship was also featured prominently in the 1980 motion picture, “The Final Countdown.”

Several other facts included:

---The average number of meals served while underway per day (approximately 22,000).

---The number of people who were stationed during her time in active service (approximately 100,000).

--- Kitty Hawk did six tours in Vietnam between 1963 and 1976 and was the first aircraft carrier ever to be awarded a Presidential Unit Citation. The award, the unit equivalent of the Navy Cross, was presented by President Lyndon B. Johnson on Dec. 20, 1968, to the ship and Carrier Air Wing 11.

---Kitty Hawk, before being de-commissioned was the second-oldest active ship in the Navy. USS Constitution or “Old Ironsides” currently has the distinction of being the oldest active Navy ship.

Among the spaces toured on Kitty Hawk were the flight deck, bridge, medical and chief’s mess.

The Kitty Hawk flight deck is smaller than the Nimitz class carriers, with the former measuring at 1,069 feet long compared to the 1,092 feet of the nuclear aircraft carrier. Through Kitty Hawk’s span in active duty the ship had 407,507 arrested carrier landings and 448,235 catapult launches.

Upon touring the the bridge, located seven decks up on the island structure above the flight deck, the visiting NHB Sailors were shown the unique feature of an ignition key. The key didn’t actually start the ship’s “ignition,” but it did make it possible to unlock the rudders in case the ship ever lost steering power from the bridge.

The Kitty Hawk medical department still has the basic set up of an operation room remaining including space for sick call, examination rooms and more than 20 spaces that were once assigned as a mass casualty area.

The chief’s mess aboard Kitty Hawk features private meeting rooms as well as a wide open dining area. Still remaining on the deck of the mess is the Kitty Hawk CPO logo with Mt. Fuji prominently engraved as a testament to Yokosuka, Japan, where the ship was once home ported.

One returning Kitty Hawk sailor was NHB Director of Medical Services, Leading Petty Officer Hospital Corpsman 1st Class Eduardo Navarro who was stationed aboard Kitty Hawk in 1998 as a fireman. Navarro said he’s still grateful for the leadership and guidance he received from the chiefs who served with him while aboard Kitty Hawk.

“It was nice to come back to the ship and walk around through all the different areas. I was so young back then and it was important I had people looking out for me. All the chiefs aboard Kitty Hawk had a goal to help the junior personnel out to become better at their jobs and advance up through the ranks to one day hopefully make it into the Chief’s Mess. That tradition continues on with the Chief’s Mess at NHB,” said Navarro.

Another Kitty Hawk veteran stationed at NHB is Bachelor Enlisted Quarters Leading Chief Petty Officer is Chief Culinary Specialist Denis Mamaril.

“It was 2004 when I left Kitty Hawk. Now, it’s 2014 and ten years later I’m back aboard. The trip has brought back great memories of the camaraderie we all had. We did a lot of hard work to accomplish the mission. It really hit me as if I was right back in time ten years ago as the ship is still in pretty good shape even after a few years of being de-commissioned,” said Mamaril. 

Kitty Hawk is listed as a reserve carrier until 2015. There are not yet funded plans to bring the ship back to North Carolina and have the ship operate as a museum similar to New York’s Intrepid (CV 11) or San Diego’s Midway (CV 41).

Naval Hospital Bremerton Participates in STEM Event

Mass Communications Specialist 1st Class James Evans Coyle-Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton (NHB) Sailors were at the Kitsap Mall in Silverdale on Apr. 26 to participate in the 2nd Annual West Sound STEM Showcase.

Science, technology, engineering and math (STEM) booths were positioned throughout the mall and gave more than 2,000 visitors to the event the opportunity to increase their overall awareness of STEM.  

“The ultimate goal of STEM education is to encourage students to take an interest in STEM subjects at an early age and people are very excited to be able to have the opportunity to get the word out in such a huge setting,” said West Sound STEM Coordinator Corinne Beach. 

According to Senior Chief Hospital Corpsman Arne A. Marin, Diversity Council coordinator and event co-facilitator, the mall atmosphere also provided unique information to shoppers who weren’t aware of the STEM showcase.

“We had visitors leave here with more knowledge about the importance of STEM. They really got a quality hands-on experience with all we had to offer. Their agenda today may have just involved getting some new shoes or a spring dress but they left having really learned something about STEM,” said Marin.

Some of the NHB STEM displays showcased various bio-medical technology equipment, along with simulated cardiovascular, respiratory, and laceration first aid procedures and protocols.

Hospitalman 3rd Class Douglas Pettit of NHB Family Medicine said he liked the enthusiasm from the community and looks forward to providing young people with a look inside Navy medicine.

“The younger generation, who may not have a clue of what their futures may hold, were able to see another look into what’s possible out there for them today with our STEM displays. There were more than a few people who got involved and really became engaged and interested in what we had to say,” said Pettit. 

Along with NHB, there were approximately 65 other booths set up with contributing resources from the Washington State Science Fair, Kitsap County Sherriff’s Office, Olympic College and Puget Sound Naval Shipyard.

Visiting science teacher Rene Walker of Missoula, Mont., shared that her school’s involvement with STEM is constantly expanding and being able to see the STEM Showcase was encouraging that the country and world has embraced STEM.

All students benefit from the STEM program because it teaches independent innovation and allows students to explore greater depths of all of the subjects by utilizing the skills learned. These skills are going to be required in order for today’s students to be tomorrow’s global leaders. All jobs are requiring workers to have a greater ability to think critically, work as a member of a team and independently, and close the performance gap between our American students and those being produced in other countries,” said Walker.

Marin attests that many hours of planning went into showcasing Naval Hospital Bremerton and the medical community, with the intent to get young students interested in medicine and medical/Dental careers. 

“We had over 2,500 students and their families attend. Our booth was very popular with non-stop demos and hands-on training for the students provided by your corpsmen,” Marin said. 

NHB volunteers were Hospital Corpsman Chief Nathan Hagman, Hospital Corpsman 1st Class Ashley Flanagan, HM1 Eduardo Navarro, HM1 Julian Rodriguez, HM1 Kevin Taft, MC1 James Coyle, Hospital Corpsman 2nd Class Jeremiah Hays, HM2 Matthew Heimann, HM2 Samuel James, HM2 Ricler Magsayo, HM2 Thomas Whittum, Hospital Corpsman 3rd Class Benert Cabreralopez, HM3 Steh Jenkins, HM3 Jordan Witten, Hospitalman Meghan Beitzel, HN Jacob Bruhn, HN Katelyn Hotaling, HN Peter Munoz, HN Douglas Pettit, HN Justin Ray, HN Jonathan Robiera, Hospitalman Apprentice Joshua Buchholz, HA Aryton Bryant, HA Isaiah Prado, HA Daniel Poisson and HA Philip Raffler,

NHB's mentorship involvement with the STEM program is patterned after the Naval STEM Strategic Roadmap that focuses on five priority areas: inspire the next generation of scientists and engineers; engage students and build their STEM confidence and skills through hands-on learning activities that incorporate relevant Navy content; educate students to be well prepared for employment in STEM careers that support the Navy and Marine Corps; employ, retain and develop Naval STEM professionals; and collaborate on STEM efforts across the Department of the Navy, federal government and with best practice organizations.

Naval Hospital Bremerton to provide medical care for eligible VA beneficiaries 

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton (NHB) and Veterans Affairs Puget Sound Health Care System (VAPSHCS) signed a Sharing Agreement April 24, 2014, linking both organizations in providing specific types of medical care to current Veterans Affairs eligible beneficiaries.

Capt. Christopher Quarles, NHB Commanding Officer was joined by Michael J. Murphy, Director of VA Puget Sound Health Care System to affix their official signatures on the document.

“We’re very excited to provide services to eligible veterans in Kitsap County. This is a great way to help those who have gone before us get the medical care they deserve and need. We’re looking forward to this,” said Quarles.

As the mission and operational tempo permits, NHB will provide urgent/emergent and inpatient medical services to the 3,829 current VA eligible beneficiaries enrolled to the Bremerton Community Based Outpatient Clinic (CBOC) in the VAPSHCS. Appointment will be made on a space available basis subject to capability and capacity and are expected to commence in June, 2014.

Also in attendance at the Signing Agreement were Nicholas Jay Carr, Constituent Services Representative, Veterans, Active-Duty, Higher Education, Grays Harbor County Office of US Representative Derek Kilmer, Wash. District 06, and Alexandra M. Fastle Kitsap and Olympic Peninsula Director for U.S. Senator Patty Murray.

“It's our obligation to ensure that veterans have access to quality care in their communities,” said U.S. Rep. Derek Kilmer, D-Gig Harbor. “It's why I have advocated for increased partnerships between the VA and Naval Hospital Bremerton to better serve our local veterans. Today's announcement is great news for the region and means that local veterans will see the burden of traveling long distances to visit their doctors reduced. It also maintains access to comprehensive care right here in Bremerton. Finally, this shows that when government agencies work together, we can move the ball forward on providing the kind of health care all veterans deserve.”

“On behalf of Sen. Murray, thank you for doing this. This is great for our veterans,” added Fastle.

NHB’s Emergency Department and Urgent Care Center Services for authorized VA beneficiaries will include diagnostic tests and professional services. Emergency Medicine Services at Naval Hospital Bremerton are currently scheduled to transition to Urgent Care Services by Sept. 2014. When that transition occurs, NHB will no longer be able to provide Emergency Medicine Services to any beneficiaries. However, Urgent Care Services will be available for VA beneficiaries in accordance with the agreement.

Inpatient services provided by NHB will include but are not limited to; cardiology, endoscopy, ENT, gastroenterology, gynecology, neurology, ophthalmology, pulmonology, general surgery, orthopedics, and urology.

Laboratory and Pathology services will include anatomical pathology, chemistry, hematology and microbiology to support urgent/emergent and inpatient medical services.

Radiology services will include Nuclear Medicine CT, MRI, US, X-ray and angiography to support urgent/emergent and inpatient medical services.

Blood Product services for inpatients and outpatients will be calculated using direct materials, direct labor and direct production costs.

NHB will also provide in patient pharmacy support. Upon discharge from NHB, the VA beneficiary will be provided an initial discharge prescription of up to a 10-day supply of medication. The support will be commensurate with the NHB standard of care to Department of Defense discharge patients at NHB. If the patient requires refills, the patient will follow-up with his/her Bremerton CBOC Primary Care Manager.

Additionally, veterans who are treated in the NHB Emergency Department/Urgent Care Center after hours or on the weekends may receive a written outpatient prescription but it will not be filled by NHB. Any outpatient prescription(s) services for VAPSHCS beneficiaries will be provided at the Bremerton CBOC or closest VA pharmacy to their home with his/her VA Primary Care Provider.

Naval Hospital Bremerton highlights Energy Conservation Policy for Earth Day 2014

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- In conjunction with the Navy's 2014 theme for Earth Day, “Global Reach -- Local Action,” Naval Hospital Bremerton showcased the new Commanding Officer Energy Conservation Policy with a recognition ceremony on April 23, 2014.

“Naval Hospital Bremerton is actively adopting new technologies in an effort to improve our energy efficiency.  We have a lot of new energy-saving initiatives and with them we are not only saving money and lowering costs, but we are improving our own environment at our command and in our community,” said Capt. Christopher Quarles, Naval Hospital Bremerton commanding officer.

Among recent completed projects are quarterdeck lighting controls, occupancy sensors in the main hospital and Family Practice wing restrooms, and steam plant boiler upgrades from 80 percent to 94 percent efficient condensing boilers. 

According to Robert Mitchell, NHB Environmental Sustainability Program Manager

Command Energy Manager, the boiler upgrades came on line in Sept. 2012 and represent a significant energy savings project, which has already yielded annual natural gas fuel savings of greater than six percent for Fiscal Year 2014 and Fiscal Year 2013. 

Mitchell attests that the command will achieve even more savings in the future by integrating the improved boilers with a planned project to completely redesign the ventilation, heating and cooling systems for the main hospital building. 

Other planned projects include occupancy sensors for exam rooms, offices, and Family Practice waiting lobby lighting controls and recessed interior LED lighting for elevator lobbies.

“We have accomplished a number of NHB Energy Improvements so far. They might seem minor, but together they add up to a lot,” said Mitchell, echoing the notion that the bottom line of all the command’s energy-saving initiatives is saving costs as well as honoring the commitment to environment stewardship.

The Commanding Officer’s Energy Conservation Policy is a hospital-wide endorsement drafted by the command’s Green Team, an all-volunteer committee of enlisted, officer and civilian staff members brought together by common environmental care and concern. The policy was then finalized and approved by NHB leadership and Environmental Management.

The policy attests that conservation of energy and water is a continuing top priority for NHB and will be a significant factor in all decisions, procedures, and practices.  Each and every staff member, regardless of position, rank, or function, plays a significant role in this effort.  Some of the specific expectations of the Energy Conservation Policy include: equipment will be turned off at the end of the day or when not needed; lights will be turned off when rooms are empty; doors and windows will be kept closed in air conditioned buildings; energy savings devices will not be removed or tampered with; computer system settings  - such as monitors shutoff and sleep mode - will maximize energy savings to the extent practical; personal refrigerators and cooking devices will not be allowed. Shared appliances in lounges and coffee mess areas will be limited to the minimum needed; personal space heaters will not be allowed, unless specifically authorized by the Safety Manager; any identified energy wasting deficiencies (such as dripping faucets or unnecessary lighting) will be promptly reported via a work request; all material purchases will be in accordance with published green purchasing policies; and energy conservation will be one of the criteria used to prioritize facility renovation and repair projects.

Additionally, each directorate has been asked to provide at least one member to the Green Team committee, whose responsibility will include soliciting suggestions and input from their respective work-areas of responsibility.

One such Green Team member is Hospitalman Hannah Pickett from Branch Health Clinic Bangor who was on hand at the ceremony and has actively engaged in environmental stewardship during her six months assigned to NHB.

“This is my first duty station and being able to help with our energy effort and environmental awareness is just something that comes natural. We’re doing what we can to lessen our carbon and chemical impact and got a lot of recycling efforts underway,” explained Pickett, an Oregon native from the Willamette Valley.

Puget Sound Energy and Kitsap County Solid Waste were also on hand to provide educational materials, along with a display from Stryker showing the waste reduction from using their reprocessing program.

“Our Environmental guys and the Green Team members really did a lot of hard work for this event. They also do a lot behind the scenes to continue to make as environmental friendly,” said Mike Pearson, NHB Safety Manager.

Earth Day was first celebrated April, 1970, as a grassroots movement to raise public awareness on the perils of pollution, the fragile natural ecosystems, and the need to encourage as many people as possible to make positive changes for the environment and for energy use in their communities that help protect the planet. 

 American Red Cross Volunteers recognized at NHB

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- The American Red Cross volunteers at Naval Hospital Bremerton (NHB) were thanked for their many contributions as vital members of the command with a recognition ceremony on April 22, 2014.

“We are very appreciative of the support our Red Cross volunteers bring. They are a vital part of our Naval Hospital Bremerton family,” said Captain Christopher Quarles, NHB Commanding Officer. “They bring tradition, heritage and incredible skills. They are all very special and such an important part of our team.”

NHB currently has over 50 American Red Cross volunteers who donate approximately 1,000 hours a month. In March, 32 volunteers donated 928 hours of valuable time, expertise, and effort in numerous clinics, departments and offices. 

“It’s not just hours they bring and add to us. It’s indispensible time. Since July 2012, we have had our American Red Cross volunteers donate almost 20,000 hours to us and for our patients. Thank you all for what you do,” stated Quarles, noting that volunteers bring support to almost every level of support in the hospital from greeting beneficiaries, manning the information desk, serving as providers and nurses and helping with technical support.

The volunteers contribute time as doctors, nurses, outpatient and inpatient record assistants, patient advisors, and have handled duties in such areas as Health Promotion, Dermatology, Mental Health, Pediatric, Orthopedic, OB/GYN, Labor/Delivery, Ophthalmology, Urology, Dental, Ambulatory Procedure, Pharmacy, Laboratory, Quality Management, Professional Affairs, Patient Services, Physical Therapy, Fitness Center, Staff Education and Training, Emergency Room, Family Medicine, Internal Medicine, Family Centered Care, and Referral Management.

“We have a great group of volunteers that do a lot of us and especially our patients. It’s nice that they are being appreciated with this ceremony because I very much appreciate them as does our regional American Red Cross office. I can’t say enough about our volunteers,” exclaimed Ms. Joyce Berry, NHB American Red Cross chairperson, noting that many volunteers go above and beyond to provide needed hours which she took the time to individually recognize with several awards.

Mr. Richard Litscher was selected as the NHB American Red Cross Volunteer of the Year 2013.

Litscher has volunteered since January, 2001 at NHB and has given over 4,800 hours primarily working at the Hospital Information Desk providing guidance and directions to beneficiaries and visitors and assisting the Pharmacy by delivering various medications to departments. He has also worked numerous extra shifts, extended his shift-time due to volunteer shortages and helped to mentor new volunteers.

“I gave mom and dad 20 years, gave the Navy 20 years, gave 20 years as a federal service employee and I might as well go for giving another 20 as a Red Cross volunteer,” said Litscher, a retired nuclear technician master chief who began his volunteer career over 13 years when he decided to join his mother who was then volunteering at NHB. He routinely works his shift on Tuesday morning at the Hospital Information Desk and has also been filling in on Monday in the same capacity when his mother passed away a few years ago.

Ms. Myke Farbarik, a volunteer since May 1999, was also recognized as the NHB American Red Cross Volunteer for the  Quarter. She has volunteered approximately 4,600 hours to NHB manning the Hospital Information Desk, assisting the Pharmacy and helping in the Ambulatory Procedure Unit. She is known for extended her shift or work other shifts if needed and her reputation for excellence, flexibility and reliability have earned her the recognition for the quarter.

NHB Pastoral Care Chaplain Shawn Redmon noted during his invocation that the ceremony was a ‘day dedicated to the selfless efforts’ of the American Red Cross Volunteers.

 Charlie Young, a 30-year Marine Corp veteran, is one such American Red Cross volunteer who efforts epitomize the chaplain’s comments. Young’s volunteer efforts for the past five years at NHB are a direct result of wanting to support the hospital.

“Naval Hospital Bremerton has been great to us and this is my way in giving something back. Plus, my wife strongly hinted at it,” Young said, adding that if he can give as many years as he gave the Corps, everyone and everything should be in great shape.

Naval Hospital Bremerton Nuclear Medicine unveils new state of the art equipment

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton’s Nuclear Medicine Clinic officially reopened with a ribbon-cutting ceremony on April 17 unveiling state-of-the-art medical imaging technology.

The clinic has been completely upgraded with a combination single photon emission computed tomography (SPECT) and computed tomography (CT) unit that not only replaces the clinic’s gamma camera but adds an independent fully diagnostic CT scanner to the hospital’s medical imaging armamentarium. 

 “This new piece of equipment will completely enhance patient-centered care,” said Lt. Cmdr. Jessie Puryear, NHB Radiation/Laser Safety Officer, Radiation Health Officer and Radiology Division Officer.

The new hybrid SPECT/CT scanner combines nuclear medicine and radiology imaging technologies on a single scanner.  The resulting multipurpose scanner can perform traditional nuclear medicine examinations previously performed by the clinic’s gamma camera in addition to performing sophisticated CT examinations previously only obtainable in the Radiology Department.  This new capability provides an alternate pathway for NHB patients to receive vital CT services, effectively doubling the hospital’s capacity, and establishing a secondary CT scanner for use when the primary CT scanner is out of commission. 

Equally beneficial is the ability to digitally superimpose nuclear medicine and CT images to allow precise anatomic localization of disease processes.  The net result is a rapid and accurate diagnosis of the patient’s ailment followed by a tailored treatment plan and expedited return to wellness.

According to Nuclear Medicine technologist Hospital Corpsman 1st Class John Ulanday, the addition of the new SPECT/CT unit makes the NHB clinic unique in the Puget Sound area.

“This is completely state-of-the-art. This new unit gives us the opportunity to use improved software and hardware and provide a much more in-depth and specific diagnosis in order to help our patients,” said Ulanday.

For those not familiar with Nuclear Medicine, Ulanday explained that the clinic is part of NHB’s Radiology Department and performs diagnostic imaging along with therapy procedures for inpatients and outpatients.

“We have distinct types of patients with unique needs referred to our clinic. Active duty personnel frequently require bone scans to evaluate injuries resulting from the wear and tear associated with deployments or life onboard a ship or submarine. Older patients, including our retiree population, often require myocardial perfusion imaging (MPI), which is a procedure that shows how well the blood flows through their heart muscle,” said Ulanday.

“As a nuclear medicine technologist, my job is to operate and maintain our equipment that is used to localize and trace the movement of radioactive isotopes throughout a patient's body. We also assist in preparing and administering radioactive isotope treatments designed to detect and treat disease,” said Ulanday, an Omaha, Neb. native.

The new SPECT/CT unit and modifications to the configuration of the clinic required the dedication, drive and determination of a number of NHB staff members from various directorates and departments.  Although existing staff will require special cross training under the direction of NHB’s lead Nuclear Medicine technologist, Hospital Corpsman 1st Class Vincent Kucera, and lead CT technologist, Scott McGibbon, no new employees are needed to operate the sophisticated piece of equipment.

“I thank everyone who helped make this happen. This reopening is a culmination of countless hours of effort on behalf of many,” shared Cmdr. Mark M. Morton, Radiologist and Radiology Department Head, citing Gary Crist of NHB’s Facilities Management, Cmdr. David Hardy, Director of Clinical Support Services, Lt. Cmdr. Afshin Afarin, CT Imaging Section Head, McGibbon, Puryear, Kucera and the rest of the nuclear medicine technologists for their involvement for making the project – three years in the making – come to fruition.

“This is a major accomplishment due to a lot of work that went into this project,” said Capt. Christopher Quarles, NHB Commanding Officer.

 Hospital Corpsman 3rd Class Garrett Masters, Nuclear Medicine technologist, attests that the improvements in the clinic have already drawn rave reviews from patients.

“We had one patient say he was mesmerized by the new equipment and how much more open and organized we look. Another patient said we had completely transformed our clinic into something beautiful and she was fascinated by the change,” said Masters, a Toledo, Wash. native, adding that as a technologist, being able to offer a modality with both the SPECT and CT imagery means they can pinpoint to the nearest millimeter any medical concern ranging from a stress fracture to a tumor.

NHB averages approximately three patients per day in the Nuclear Medicine Clinic. The new SPECT/CT unit will be used to provide images of organs and areas of the body not obtainable with a standard X-ray unit. Nuclear Medicine is particularly effective in locating abnormal tissue growths, such as tumors. After a SPECT/CT scan is completed on a patient, a radiologist then reviews the images to diagnose and guide the treatment of the injury and/or disease process.

 “The SPECT/CT unit can combine two different types of images into one and this combination aids physicians in making treatment decisions.  We can use it as a gamma camera, as a standalone CT, or combine the two. The unit it replaced was just a gamma camera that did not have the capability to use CT to enhance the image for localization or to be used as a standalone CT,” added Puryear, also noting that the previous unit was several years beyond its life span and was due for replacement. Additionally, with the rapid pace of technology advancements the new unit has a quicker acquisition time which reduces the amount of time a patient has to lay still on the table.

Along with providing a picture of an organ’s structure, Nuclear Medicine imaging can also show how well a particular organ is functioning. Or not. If an organ is diseased or not functioning normally, it will appear different relative to a healthy organ. Nuclear Medicine is especially valuable in detecting and diagnosing a problem or disease in the early stages.

“Nuclear Medicine provides physiological or functional information whereas CT and X-ray evaluate anatomical structures. Nuclear medicine can detect subtle abnormalities like stress fractures, that an x-ray can’t show because the images produced by this SPECT/CT are more sensitive and more specific,” explained Ulanday.

“Both nuclear medicine technologists and radiology technologists will be trained to operate the new SPECT/CT scanner. The key difference is that the nuclear medicine technologists will be trained to use both the gamma camera and CT capabilities of the unit but the radiology technologists will only receive training on the CT aspects,” Puryear said.

According to Puryear, one of the added benefits of the new Siemens Symbia T16 unit is that it is currently the only SPECT/CT scanner on the market that can also be used as a fully diagnostic standalone CT. This gives NHB a redundant CT scanner for patient care when the primary CT scanner is not available due to maintenance or repair.

“No longer will we have to send patients out in town when the Radiology Department’s primary CT is not operational.  We can simply transport them to the Nuclear Medicine clinic and perform the study,” stated Puryear.

Naval Hospital Bremerton E-Prescribing Initiative benefits Providers and Patients

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- The old yarn about trying to decipher a doctor’s scribbled shorthand note for a prescription is coming to an end with a new electronic prescription initiative implemented at Naval Hospital Bremerton (NHB).

NHB is the first military treatment facility in the Department of Defense (DoD) to use the electronic prescription initiative, or e-prescribing. This capability allows civilian prescribers to electronically forward their prescription request(s) on behalf of their patient to NHB’s Pharmacy to fill instead of utilizing a handwritten paper script.

After NHB Pharmacy leadership briefed over a dozen medical business managers back in January 2014 on the initiative, the command went live for e-prescribing on March 14, 2014. The first e-prescription (eRX) was received March 20 at 9:55 a.m. Currently over 50 local civilian prescribers are participating in sending their patient’s prescription electronically to the NHB pharmacy.

“This capability allows civilian providers to securely send their prescription and associated instructions electronically to Naval Hospital Bremerton for any of our NHB beneficiaries. We’re the first site to roll out the function but eventually all Department of Defense military treatment facilities will have access to this capability,” said Lt. Cmdr. Eric Parsons, NHB Pharmacy Department head.

According to Parsons, the electronic prescription initiative is part of a Congressional mandate that centers on ‘meaningful use’ of the Electronic Healthcare Record (EHR) system.

“This initiative helps civilian healthcare providers meet that standard by using the EHR for what’s it’s designed to do which is eliminate paperwork and electronically connect a provider with a pharmacy such as ours,” said Parsons, citing that if all hardcopy prescriptions were to be sent electronically, based on the past 365 days, that would be 47,375 prescriptions annually.

“We were so happy to find out that NHB was doing this. We love it. This is much more convenient for patients and much more cost efficient for providers,” said Ms Laurie Kehler, Clinic supervisor at Harrison Medical Center, Bremerton, Wash.

Prior to implementation of the e-prescribing capability, if a beneficiary went to see a doctor outside of NHB and as part of the overall treatment had to pick up medication(s), the provider would have to hand write the prescription for the patient to fill at the NHB Pharmacy.

“Receiving the prescription electronically helps to clarify the dosage, quantity, and actual medication, increasing patient safety. It also prevents the potential for losing a written prescription,” stated Parsons, adding that once a script has been sent to NHB’s Pharmacy, it can ‘sit’ for up to a year before being filled once the patient actually shows up to request the medication.

Parsons also attests that once the initial electronic prescription has been sent, received and filled by NHB, future refills remaining on the prescription can then be simply phoned in by the beneficiary and picked up at the drive-through option if so desired.

“Ideally we want all hard-copy requests for any prescription to go electronic,” Parsons said, noting that local doctor offices are excited to use the service due to it being much simpler, safer and more streamlined.

However, the system is currently no set up to handle any controlled substances such as Percocet or Vicodin. All controlled substances must be hand written prescription as in the current process.

Parsons attests that this is not only a secure method for transferring prescription data which means better accuracy, increased patient safety and less prescriptions lost or misplaced, but as the pharmacy staff get used to processing the eRXs, the familiarity will translate into more timely processing of the prescription than the old method of transcribing a written script.

Cmdr. David Hardy, NHB Clinical Support Services director, was on the TriService design and implementation team that determined NHB would be the perfect location to test the initiative.

“NHB is the ideal site to be the inaugural site due to our outstanding staff's can-do attitude and their willingness to contribute to a successful effort.  We are not only testing the software for issues, we are also forging the way the new software is operationalized and integrated into our daily workflow,” explained Hardy, adding that lessons learned here will be rolled throughout the DoD healthcare enterprise. 

The design team has developed implementation and user guides with NHB staff contributing significantly to refinement of those documents, such as Parsons developing a comprehensive set of training slides which he will begin teaching to all of DoD Pharmacy in June.

The design team has been comprised of the DoD PITAC (Pharmacy Information Technology Advisory Council) that consists of pharmacy information technology subject matter experts from Navy, Army, Air Force and Defense Health Agency, the Composite Health Care System (CHCS) Program Office, and Leidos (the contractor that maintains CHCS).

 The electronic prescribing address for NHB’s e-pharmacy is

DoD Bremerton ePhcy,
1 Boone RD Code 08RAZD,
Bremerton WA, 98312,
Phone: 360-475-4425,
Fax: 360-475-4786


SAAM, SAPR and SAFE are more than just acronyms

Contributed by NHB Public Affairs and Lt. Ken Padgett, NHB Sexual Assault Prevention and Response (SAPR) Program coordinatorOur hope is that the acronyms SAAM, SAPR and SAFE are not just disregarded abbreviations of military jargon, but that each immediately bring an understanding that Sexual Assault is a crime. That is our goal for recognizing April as Sexual Assault Awareness Month (SAAM) because the Department of the Navy does not tolerate sexual assault.

Nationally, SAAM is a monthly commitment to raise awareness and promote the prevention of sexual violence through use of special events and public education.

This year's theme is "Live Our Values: Step Up to Stop Sexual Assault" with the stated goal to "Live Our Values" every day, all year long. "Step up" is a direct reference to intervene when appropriate, report crimes, and support victims to help stop sexual assault and sexual harassment.

NHB’s Sexual Assault Prevention and Response (SAPR) and
Sexual Assault Forensic Examinations (SAFE) are comprehensive programs staffed by dedicated personnel that reinforce a culture of prevention, response, and accountability for the safety, dignity, and well-being of Sailors and Marines.

The acronyms have been active this month at NHB. Victim Care Protocols were tested with a SAPR and SAFE drill on April 10. The drill was a vital part of NHB’s on-going support of SAAM to ensure Victim Care Protocols get handled in a standard, coordinated response whenever needed to meet the healthcare needs of sexual assault victims.

Being able to conduct SAFE exams is a vital service to provide here at NHB. In case of a sexual assault at another command, victims can come here to receive medical care and receive an exam if they wish. Holding such a drill helps better prepare our departments in the hospital in case they encounter a Sexual Assault while here at work. This also provides an opportunity for the command victim advocates to reach silent victims and tell them that they don't have to go through this alone and there is help out there.

NHB Victim Advocates made sure that as many staff members and beneficiaries as possible understand that April is SAAM. At our weekly SAAM informational table by the Terrace Dining Facility, Hospital Corpsman Second Class Nathan Cole of  Orthopedic Clinic and Hospitalman Taylor Ellison of General Surgery manned the static display during peak hours. They queried, quizzed and shared with passersby on sexual assault facts, figures and uncomfortable realities.

Our victim advocates are absolutely dedicated in their position.  They are all essential in what they bring to help someone in need. They bring a perspective to what they do because the unfortunate truth is some have been victims themselves.

They are not there to judge. They are there to help and provide support for someone through the entire process. They receive comprehensive training to immediately provide front-line, deck-plate prevention, response, and accountability for the safety, dignity, and well-being of Sailors and Marines.

We know there are those who are scared. Victim advocates are there to take care of someone who just gone through a horrible experience not just medically, but also emotionally. Our job is not to penalize or harm a career, but to get that person the care they need and deserve.

It's also our job to utilize SAAM as an opportunity to tell every Sailor that sexual assault ends with you. Be a bystander, help others, listen, and spread the word about sexual assault and let the world know how it affects every single one of us. So many victims are out there, and they're silent. We need to end the silence. We are all warriors in the battle against preventing sexual assault.

On a regular basis, NHB ensures that sexual assault education is provided to every Sailor. There is a informational photo board on the first floor displaying the command’s victim advocates, so staff as well as beneficiaries are aware of who they can turn to for questions or help. Additionally DoD Safe Helpline posters are affixed throughout NHB so everyone knows where to turn for professional assistance.

Our acronyms provide a balance of focused education, comprehensive response, compassionate advocacy, and just adjudication that promotes professionalism, respect, and trust, while preserving Navy mission readiness. And that’s not jargon to be ignored.

Victim Care Protocols tested during Sexual Assault Forensic Examinations drill

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton Victim Care Protocols were tested with a Sexual Assault Prevention and Response (SAPR) and Sexual Assault Forensic Examinations (SAFE) drill on April 10.

It’s a drill that everyone who responds to hopes that they never have to do. Candice, the alleged victim, shivering and scared, assisted by a friend, showed up with a black eye, swollen jaw, bruised neck, no shoes, torn and disheveled clothing at NHB’s Emergency Department. In a shaken voice, she explained to the clerk she had been sexually assaulted.

“As soon as anyone comes in and says “I’ve been assaulted,’ that’s all that is needed to start the SAFE process,” said Lt. Cmdr. Lacy Gee, Main Operating Room Division Officer, SAFE examiner and official observer of the drill.

The Sexual Assault Forensic Examinations are part of the command’s response ability in conjunction with the Navy’s Sexual Assault Prevention and Response (SAPR) Program to prevent and eliminate sexual assault.

For this drill, Candice shared that she was out for a mid-morning jog when ‘out of nowhere’ a guy came and dragged her off the road. She tried in vain to get away and was beaten before being assaulted.

Candice was quickly triaged and with a victim advocate and SAFE examiner paged, was then seen by an ER nurse on duty. As an active duty servicemember, she was explained how the Navy restricted and unrestricted reporting policy encourages victims to seek the medical support that is available to them without fear of reprisal or stigma.

Lt. Stephany J. Daniell was the responding ER nurse who also happens to be on the SAFE examiner team. She explained who a victim advocate is and what they do, and what will take place once the SAFE examiner comes in.

“Lt. Daniell was really very thorough in her role as the ER nurse. She was very impressive,” commented Hospital Corpsman First Class Laura Blanco, Director of Surgical Services leading petty officer and victim advocate who played the role of the victim’s friend.

When victim advocate Hospitalman Britany Gil arrived, she immediately established a relationship with Candice.

“I’m going to take care of you,” Gil said, further explaining what she does as a victim advocate is to completely
help by listening, guiding and consoling a sexual assault victim through the entire uncomfortable process.

The SAFE examiner role was filled by Lt. Sarah Huley, who further explained the step-by-step process she would handle if this was a real case, from conducting a physical examination to obtaining digital imagery for official documentation.

Both the victim advocate and examiner also stressed the time element involved in such a scenario.

“A patient needs to know that this can be a lengthy process. It is not easy, especially from the emotional standpoint of the patient,” said Gil.

“To any patient being seen at three o’clock in the morning, five minutes can seem like five hours,” added Gee, who commended Gil and Huley for providing professional care and personal concern to their patient.

NHB’s SAPR and SAFE are comprehensive programs staffed by dedicated personnel that reinforce a culture of prevention, response, and accountability for the safety, dignity, and well-being of Sailors and Marines. The Department of the Navy does not tolerate sexual assault.

“We hope we never have to use this type of training that we did today during this drill, if we do, we will be prepared to provide the necessary medical and emotional help to any victim. SAFE is important because we care for our own and will provide follow-up services and consults if needed,” said Cmdr. Susan Toyama, NHB Sexual Assault Forensic Examiner Training Facilitator and Quality Management Department Head.

According to Toyama, NHB has two drills slated for this month to recognize Sexual Assault Prevention month.  The drills are arranged using a team approach with the SAPR/VA and SAFE.  

“The drills take the staff from when our mock patient enters the ER or clinical area through the reporting options with the VA to calling in the forensic examiner to providing the patient critical follow-up education and support.  It is a learning experience for all staff involved. Our goal to increase knowledge and awareness to provide quality safe care to our patients,” explained Toyama

 There is a designated Isolation Room in the Emergency Department to conduct SAFE. Although the ER is slated to transition to an Urgent Care Unit by Sept., 2014, the Isolation Room will still be in place, with a backup space also available.

“The Isolation Room in our Emergency Medicine Department area that can be immediately used is ideally suited for the need should it arise,” Toyama said, noting that NHB will provide compassionate, competent medical care that is victim-centered, gender-sensitive and takes into account the reporting preferences of the individual.

“I think the drill went well. Everyone was helpful and took care of our ‘patient’ without any long delays in care. They knew what they needed to do, and notified all the appropriate ancillary services correctly. I'm pretty proud of our ED, they did a great job,” stated Gee.

The Navy’s Bureau of Medicine and Surgery (BUMED) directed military treatment facility like NHB last year to establish a multidisciplinary team to be able to handle any type of sexual assault case with a staff trained and ready to provide timely and appropriate medical care as soon as possible.

Staff members – 14 SAFE trained examiners and nine SAFE trained assistants – have learned correct procedures in evaluating a victim of sexual assault and how to properly go through the extensive course of action with the individual. Such training is required on an annual basis. There are also 15 victim advocates on the staff.

“We now have an elite selected staff fully qualified and certified to conduct a wide-ranging sexual assault forensic exam if needed. The operational staff is in place for the needs of the victims who need our assistance in their evaluation,” said Toyama.

According to Lt. Ken Padgett, NHB Sexual Assault Prevention and Response (SAPR) Program coordinator, the drill is a vital part of NHB’s on-going support of Sexual Assault Awareness Month to ensure Victim Care Protocols are handled in a standard, coordinated response whenever needed to meet the healthcare needs of sexual assault victims.

“Being able to conduct SAFE exams is a vital service to provide here at NHB. In case of a sexual assault at another command, victims can come here to receive medical care and receive an exam if they wish. Holding such a drill helps better prepare our departments in the hospital in case they encounter a Sexual Assault while here at work,” said Padgett, adding that in addition to spreading awareness, SAAM provides an opportunity for the command victim advocates to reach silent victims and to tell them that they don't have to go through this alone and there is help out there.

Padgett, whose job as SAPR Program coordinator is to educate the staff on the current policy, and ensure training and current policy compliance, attests that SAAM is a way to highlight the growing problem of sexual assault. Sailors benefit from SAAM due to overlapping events that inform and educate.

“It's our job to utilize SAAM as an opportunity to tell every Sailor that sexual assault ends with you. Be a bystander, help others, listen, and spread the word about sexual assault and let the world know how it affects every single one of us. So many victims are out there, and they're silent. We need to end the silence. SAAM is just one time of year that we can really focus on sexual assault, but it should be highlighted everyday of our lives. We are all warriors in the battle against preventing sexual assault,” Padgett stated.

NHB is utilizing every Tuesday of this month to pass out awareness (teal) ribbons to wear on the staff ID's allowing staff to show their support in preventing sexual assault. In addition to the ribbons, people are filling out a small questionnaire which can help get the Sailors engaged in thinking about how they actually play a part in preventing sexual assault. There is also a run with ‘Question and Answer’ stops that combines exercise with education, and a follow-up 5K and One Mile Run to also help show support.

On a regular basis, NHB ensures that sexual assault education is provided to every Sailor. There is a informational photo board on the first floor displaying the command’s victim advocates, so staff as well as beneficiaries are aware of who they can turn to in case they have questions or need help. Additionally throughout the entire hospital, DoD Safe Helpline posters are affixed so everyone knows where to turn for increased professional help if needed.

NHB’s SAPR program and SAFE capability provide a balance of focused education, comprehensive response, compassionate advocacy, and just adjudication in order to promote professionalism, respect, and trust, while preserving Navy mission readiness.

Victim Advocates stepping up for Sexual Assault Awareness Month

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – Victim Advocates at Naval Hospital Bremerton are making sure that as many staff members and beneficiaries as possible understand that April is Sexual Assault Awareness Month (SAAM).

At the SAAM informational table by the Terrace Dining Facility on Apr. 8, Hospital Corpsman Second Class Nathan Cole of NHB’s Orthopedic Clinic and Hospitalman Taylor Ellison of NHB’s General Surgery manned the static display during peak lunch time. They queried, quizzed and shared with passersby on sexual assault facts, figures and uncomfortable realities.

 Victim advocates such as Cole and Ellison are specially trained to assist victims in finding their own route to recovery by advising them on such procedures as reporting options and various resources. Ellison is one of 15 NHB victim advocates and brings not only personal insight, but quiet strength to her volunteer duties in helping to listen, guide and console a sexual assault victim.

“I was a sexual assault victim and have empathy as well as sympathy to support someone in need and be there when they need someone to lean on. I take my role as a victim advocate seriously,” Ellison stated.

For Cole, handling the role as a victim advocate is a duty that he has continued since being assigned to U.S. Naval Hospital Rota Spain.

“I had a friend who was sexually assaulted. I wanted to help then and still want to help out my peers and Sailors. I want them to know that we’re here for them as victim advocates. We hope of course that we never have to be, but ‘blue-on-blue’ remains a problem and hopefully by continuing to stress the awareness with campaigns like SAAM, we’re helping to eliminate the crime,” said Cole.

According to Cole, there is a lot of awareness at NHB, but what the month-long campaign really does is help to remind everyone to remain vigilant and not complacent.

“Some have that ‘out-of-sight, out-of-mind’ thinking when it comes to something like this, which is why having us share is important. Plus, it lets others know that we’re here to help in any way if someone has a problem. They don’t have to hold it in. They have someone to turn to,” Cole said.

As HM2 Robert Delange walked by the table he was asked, ‘How can you prevent a sexual assault?’ and ‘Do you know how to report a sexual assault?’

Delange promptly replied that the best way to prevent any assault is by going out with the buddy system and a person can use restricted and unrestricted ways to report an assault.

“I served in Japan for several years where we became well versed with SAAM training,” said Delange.

 Along with the command’s victim advocates taking on a proactive, visible role in the SAAM campaign, NHB has a host of other awareness events slated throughout the month. The Information Management department is including a graphic onto everyone's computer each day, the Marquee at the gate entrance has key-note messages, an awareness remembrance run is planned, along with a scavenger hunt, and there will be two SAPR training exercises.

“Our victim advocates are absolutely dedicated in their position.  They are all essential in what they bring to help someone in need. They bring a perspective to what they do because the unfortunate truth is some have been victims themselves,” explained Lt. Ken Padgett, NHB Sexual Assault Prevention and Response (SAPR) Program coordinator.

Padgett stresses that the victim advocates are not there to judge, they are simply there to help and provide support for someone through the entire process. They receive comprehensive training to immediately provide front-line, deck-plate prevention, response, and accountability for the safety, dignity, and well-being of Sailors and Marines.

“We know there are those who are scared. Victim advocates are there to take care of someone who just gone through a horrible experience not just medically, but also emotionally. Our job is not to penalize or harm a career, but to get that person the care they need and deserve,” Padgett said.

Nationally, SAAM is a monthly commitment to raise awareness and promote the prevention of sexual violence through use of special events and public education. This year's theme is "Live Our Values: Step Up to Stop Sexual Assault" with the stated goal to "Live Our Values" every day, all year long. "Step up" is a direct reference to intervene when appropriate, report crimes, and support victims to help stop sexual assault and sexual harassment.

“It is absolutely inconceivable to me that our shipmates would assault one another — those they entrust their lives to at sea, on the battlefield, or at one of our medical treatment facilities around the globe. It is up to you — our leadership and fellow shipmates — to take a stand and not only hold offenders accountable but take a step further and eliminate sexual assault from our service,” shared Vice Adm. Matthew L. Nathan, U.S. Navy surgeon general and chief, U.S. Navy Bureau of Medicine and Surgery in a message throughout Navy Medicine.

The Navy Sexual Assault Prevention and Response (SAPR) Program mission is to prevent and respond to sexual assault, eliminating it through a balanced of focused education, comprehensive response, compassionate advocacy, and just adjudication in order to promote professionalism, respect, and trust, while preserving Navy mission readiness.

Lt. Rachel Allnutt, NHB Multi-Service Unit Clinical Nurse Educator was hand-selected to be a SAPR Facilitator. She has been instrumental in conducting quarterly training sessions in 2013 for approximately 70 enlisted staff members at NHB focusing on the three components of active bystander intervention: assess for safety; be with others; and care for your shipmate.

“My goal as a SAPR facilitator when conducting the training sessions is to ensure sexual assault awareness is given the utmost attention to our Sailors to ensure that everyone leaves with the knowledge and resources to be an effective bystander,” said Allnutt, adding that the educational awareness training is important for all hands.

Allnutt’s training covers a variety of different areas from work situations, to being on liberty, as well as discussing the judicial and legal background of this crime. The training also provides strategies on how to intervene as a bystander.

“This issue is all around us. We need to have the basic understanding on what sexual assault means, know the resources that are available and how to appropriately report unrestricted or restricted reports. There are strict consequences that are taken and everyone needs to know that this crime is not tolerated. We are a team. We need to respect, trust, and be committed to one another. When a crime like this happens, these attributes fall to the waste side. Sexual assault is a traumatic, frightening, life-altering experience for victims. How does our military continue to strive and to build, when time and energy are used when dealing with these harsh actions? We all are bystanders whether we know it or not. It's what we do that will affect the outcome in stopping sexual assault from happening in our military,” Allnutt stressed.

The official SAPR website states that SAAM provides commands/installations an annual opportunity to highlight Department of Defence and service policies addressing sexual assault prevention and response. DoD policies address sexual assault prevention and seek to establish a climate of confidence in which education and training create an environment in which sexual assault and the attitudes that promote it are not tolerated; victims of sexual assault receive the care and support that they need; and, offenders are held accountable for their actions.

According to the Department of Defense Annual Report on Sexual Assault in the Military for Fiscal Year 2012 to Congress, the military services implemented and continued a variety of training and education programs for service members that featured bystander intervention and other prevention methods. DoD surveys indicate that the vast majority of servicemembers are receiving prevention training, hearing key prevention concepts, and reporting an intention to take active steps to prevent sexual assault.

Although measuring the overall impact of prevention efforts is difficult, the Department uses the Workplace and Gender Relations Survey of Active Duty Members (WGRA) to estimate the prevalence (occurrence) of unwanted sexual contact (USC) involving servicemembers in a given year. In the 2012 WGRA, 6.1 percent of Active Duty women and 1.2 percent of Active Duty men indicated they experienced some kind of USC in the 12 months prior to being surveyed. For women, this represents a statistically significant increase over the 4.4 percent USC rate measured in 2010. The change in the USC rate for men from 2010 to 2012 was not statistically significant.

The term “unwanted sexual contact” (USC) is the survey term for contact sexual crimes between adults prohibited by military law, ranging from rape to abusive sexual contact. USC involves intentional sexual contact that was against a person’s will or occurred when the person did not or could not consent.

“Knowing is half the battle,” said Cole, citing local facts that Naval Base Kitsap compiled statistics from 2006 to 2012, that 16 percent of the victims of sexual assault were male; 53 percent occurred on base; 61 percent were blue on blue; 70 percent had alcohol involved and 79 percent knew the attacker.

In FY12, there were 3,374 reports of sexual assault involving servicemembers. These reports involved one or more servicemembers as either the victim or subject (alleged perpetrator) of an investigation. The 3,374 reports involved a range of crimes prohibited by the Uniform Code of Military Justice (UCMJ), from abusive sexual contact to rape. This represents a 6 percent increase over the 3,192 reports of sexual assault received in FY11.

In FY12, the DoD Safe Helpline, the Department’s confidential 24/7 hotline resource for sexual assault victims, received more than 49,000 unique visitors to its website and more than 4,600 individuals received specialized care through its online chat, telephone helpline, and texting referral services.

For those interested in becoming a Victim Advocate can contact the Sexual Assault Response Coordinator, at Command Navy Region Northwest Fleet and Family Service Centers at (360) 396-SAPR (7277), or NHB’s Lt. Padgett at 360-475-4572. More information is also available online at http://www.navylifepnw.com/site/346/SAPR.aspx

Naval Hospital Bremerton Celebrates Women’s History Month

Mass Communications Specialist 1st Class James Evans Coyle-Naval Hospital Bremerton Public Affairs  -- Naval Hospital Bremerton's (NHB) Diversity Events Committee showcased Women's History Month March 21 with the featured theme of ‘Celebrating Women of Character, Courage, and Commitment’ and honored the extraordinary and often unrecognized determination and tenacity of women.

The women who spoke at the event were, Lt. Cmdr. Louis Nellums, NHB Staff Education and Training Department Head, recently retired Aviation Maintenance Administrationman Master Chief Angela M. Mattison-Lindbom and Hospital Corpsman 1st Class Laura Blanco, NHB Senior Sailor of the Year. Also speaking at the event was Yvette Guerrero, NHB Resources Management-Third Party Collections. 

“It inspires me endlessly to be here and be a part of NHB and see all the wonderful and amazing things all the women who work here at this hospital do every day,” said Guerrero.

According to Senior Chief Hospital Corpsman Arne A. Marin, NHB Diversity Council coordinator and event facilitator, the women who shared their personal insight represented different individuals who are in distinct stages of development in their respective careers and understand the importance of who they are and what they do.

“The women selected as speakers for Women’s History Month represented a wide spectrum of diversity that’s indicative of all the women working at NHB. Officer and enlisted as well as a huge work force of civilian workers,” said Marin.

Mattison-Lindbom encouraged women in the audience to go further in their education and continue to be a positive role model to all women in the community and in the United States Navy and look to the future with eyes wide open to all the possibilities available.

"Make sure you’re always looking around for the next greatest thing out there and take advantage of all the opportunities you have, "said Mattison-Lindbom.

There are currently more than 54,000 active duty women and more than 10,000 female reservists comprising 17.1 percent of the Navy. Additionally, there are approximately 35 active and reserve female flag officers and 59 female command master chiefs.

On March 1, President Barack Obama gave his official proclamation for Women’s History Month, 2014.

“As we honor the many women who have shaped our history, let us also celebrate those who make progress in our time. Let us remember that when women succeed, America succeeds. And from Wall Street to Main Street, in the White House and on Capitol Hill -- let us put our Nation on the path to success,” said Obama. 

Women have served in and with the Navy since the American Revolution and became an official part of the Navy with the establishment of the Navy Nurse Corps in 1908. As a result of the Women's Armed Services Integration Act on June 12, 1948, women gained permanent status in the armed services. In 1978, women were assigned to selected non-combatant ships for the first time. In 1994, women began serving in combatants and piloting combat aircraft following the repeal of the Combat Exclusion Law. In April 2010, the Navy changed its policy allowing women to serve on submarines.

The beginnings of "Women's History Month" can be traced back to 1911 when "International Woman's Day" was commemorated. In 1978, the Sonoma County School District in California celebrated "Woman's History Week" and three years later in 1981 with growing support and enthusiasm was passed by Congress proclaiming a Women's History Week. Then, in 1987, the National Women's History Project petitioned Congress to expand the celebration to the entire month of March.

Navy Medicine West Visits Naval Hospital Bremerton

Mass Communications Specialist 1st Class James Evans Coyle-Naval Hospital Bremerton Public Affairs -- Rear Adm. Bruce L. Gillingham, Commander Navy Medicine West arrived at Naval Hospital Bremerton (NHB) on March 25. Gillingham met with NHB command staff, took a tour of the facility and later met with NHB active duty and civilian staff in the hospital’s Ross Auditorium.

Gillingham’s started his talk by giving thanks for all the efforts of everyone who works at NHB and for continuing on with the hospital’s 118 year tradition of providing exceptional health care to active and retired service members and their families and for always caring about accomplishing the mission.

Before taking a series of questions from the audience Gillingham encouraged everyone, regardless of rank or position, to always speak up if they see something potentially wrong in any given situation. Gillingham gave an example of while in flight with wounded service members who were exposed to cold elements. A hospitalman gave the suggestion to place the wounded into the extra body bags on board thus keeping the patients warm and saving their lives.

“It was because of that young person’s quick thinking and resourcefulness that the system of the ‘hot pocket’ is so widely used today. The extra warmth and insulation for those patients made the difference. You too can always be a factor and your opinion and ideas matter so please don’t ever be afraid to speak up,” said Gillingham.   

Gillingham referenced the ethos of Vice Adm. Matthew L. Nathan, Navy Surgeon General and encouraged good communication as well as an aware vision of collaboration that will ensure success in the hospital’s everyday operations. Gillingham also spoke of some possible changes to the hospital in the future and gave an example of a lesson he learned from a high school track coach.

“The coach always used to tell us to “run through the tape” meaning to finish strong and give it everything you have. I hope all of you will take up what my old coach taught me. If you’re faced with any changes in the way or routine you do things, just keep on charging,” said Gillingham.

Also visiting NHB was Navy Medicine West Command Master Chief, CMDCM (SW/EXW/FMF) Hosea Smith, Jr. Smith also answered questions and mentioned the opportunities for Hospital Corpsman “C” schools, better and more extensive training at Hospital Corpsman “A” school and forward deployed Individual Augmentee billets in the near future.

Gillingham ended the session by giving additional thanks and reassuring everyone’s place as the top hospital facility in the area.

“We are depending on Naval Hospital Bremerton to be here for a very long time so keep up the outstanding excellence in all the things you do every day,” said Gillingham.

Certified Nurses recognized at Naval Hospital Bremerton
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – The professional dedication and enhanced patient-centered care capability of Certified Nurses was recognized with a day of their own on March 19 at Naval Hospital Bremerton (NHB).

 “Certified Nurses Day is a national day to honor and recognize the important achievements of Certified Nurses. Achieving certification validates pride in your chosen specialty. Certification exams require dedication to mastering your clinical skills and the willingness to subject yourself to third party review of your knowledge. Earning and maintaining certification is not a requirement, yet several of our colleagues here at NHB have taken that extra step to show their commitment to our profession,” said Lt. Cmdr. Patricia D. Butler, Perinatal Clinical Nurse Specialist.

According to Cmdr. Johannes Bailey, Assistant Director of Nursing Services, there are 79 nurses at NHB out of 170 who have achieved their certification in 28 specific nursing fields.

“What is a certified nurse? A certified nurse is one who shows an uncommon level of professionalism and dedication. There is demonstrated excellence here and NHB leads the way!” said Bailey.

The average is 20 percent on a staff at a hospital in the U.S. being certified, and NHB more than doubles that percentage at 51 percent, including 10 new certified nurses in 2013, and already two for this (calendar) year.

“Earning certification validates professional expertise and provides tangible recognition of the nurses' commitment to their specialty. Deciding whether or not to achieve certification is a personal choice, but for those that have taken the extra step, it is certainly a matter of pride and should be celebrated,” said Butler.

Registered Nurse Carolyn Kellogg of Case Management was recognized as holding the longest certification from 1978, which Lt. Cmdr. Carmelo Ayala, attests is a testament to her commitment as a nurse.

“Carolyn is great. To not only have the certification, but to maintain it and recertify it when needed is such an achievement,” said Ayala, Internal Medicine division officer.

Cmdr. David Thomas, Deputy Director for Medical Services, was noted for holding the most certification with four at NHB – along with Cmdr. Thecly Scott, Director for Surgical Services - and shared that his increased knowledge base intentionally overlaps so he is able to provide increased support when called upon either stateside or on deployment.

“We have very high quality, dedicated people here who are certified and the environment encourages everyone to be insightful and as knowledgeable as they can be in their chosen field. We all raise our level of education and understanding which of course is such a benefit to our patients,” Thomas said, noting that military medicine has some knowledge sets that make it unique from civilian counterparts, such as those that pertain to deployments and serving on ship and submarine.

Thomas cited that achieving his multiple credentials showed that there was a commonality of core curriculum of his specialties and he used the overlapping knowledge that initiated with being certified in Emergency Room Nursing to help him get certified for Medical Surgical Nursing which helped him get certified for Ambulatory Nurse which helped with Professional Legal Nurse Consultant.

“The tests are very challenging and a good reflection of what we should know. The outline for each certified nurse field focuses on what is most important, along with leadership, professionalism and process management. Much of the themes we went over on safety and quality management were also similar,” said Thomas, adding that a definite highlight of being certified is working with others who are also  (certified) and being able to help those who are studying towards their own certification(s).

Certified Nurses Day was chosen to be annually recognized on March 19 as a way to honor the legacy of Margretta "Gretta" Madden Styles, Doctor of Education, Registered Nurse and Fellowship of American Academy Nursing (1903-2005). March 19 is Styles’ birthday, and she became known as the ‘Mother of Nurse Credentialing’ and a visionary scholar who made an international impact on the nursing profession.

“Styles designed the first comprehensive study of nurse credentialing, spending more than two decades advancing nursing practice and professional regulation,” Butler noted. 

The specific nursing field certifications held by staff members at NHB are in Adult Clinical Nurse Specialist, Adult Registered Nurse Practitioner, Ambulatory Perianesthesia Nurse, Case Management, Critical Care Nurse, Electronic Fetal Monitoring, Emergency Room Nursing, Family Nurse Practitioner, Gastroenterology Nurse, Infection Control and Epidemiology, Inpatient Obstetrics, Lactation Consultant, Lactation Educator, Legal Nurse Consultant, Maternal Newborn Nursing, Medical-Surgical Nurse, Neonatal Intensive Care Nurse, Nurse Midwife, Occupational Health Nurse Specialist, Operating Room Nurse, Pediatric Emergency Nurse, Pediatric Nurse Practitioner, Post Anesthesia Care Nursing, Professional in Healthcare Quality, Professional in Utilization Review, Registered Nurse Anesthetists, Women’s Health Nurse Practitioner and Wound Ostomy Continence Nurse. 

“I currently hold two certifications: Inpatient Obstetrics and Electronic Fetal Monitoring. As a labor and delivery nurse, I felt that these were the most appropriate certifications to earn in order to demonstrate my commitment to the perinatal specialty,” said Butler.

Registered Dietitian Nutritionist Day an on-going theme at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – There was no cake but there was compassion on the 7th annual Registered Dietitian Nutritionist Day of March 12 as Naval Hospital Bremerton (NHB) registered dietitians continued to improve their patient’s health with timely intervention.

Registered dietitian Susan Yake ran into a beneficiary she has known and helped for the past 15 years and immediately extended the offer to come in and discuss his current nutritional status. He readily agreed.

“I saw Jim and told him to come on in,” said Yake.

“Susan has taught me well. I have discovered new things continually about my nutrition and eating such as going over what foods can be an irritant,” said Jim Wylder, retired Navy commander.

There are four registered dietitians assigned to NHB. Along with Yake, there are Cmdr. Kim Zuzelski, Nutrition Management head and Jennifer Meeks at NHB, and Cheryl Decker at Naval Branch Health Clinic Everett. Registered Dietitian Nutritionist Day is a national event put on by the Academy of Nutrition and Dietetics to bring awareness that dietitians such as the NHB four are committed to improving the health of their patients and community.

According to Yake, NHB’s dietitians help patients learn about their nutrition to improve their overall health.  If a patient has a health concern such as diabetes, heart disease, insufficient kidney function, gastro-intestinal problems, overweight or obesity, a dietitian can provide guidance to reduce symptoms and/or reverse the condition.  If the patient has a food allergy, intolerance, or sensitivity, a dietitian can teach the patient how to avoid the triggering foods and learn what is safe for them to eat. Even when someone is preparing for surgery, the dietitian can provide support with a nutrition care plan to speed healing and reduce the risk of infection.  Dietitians can also identify nutrient deficiencies and recommend supplements and meal plans to correct a condition. 

“Our service can be life changing. Balanced nutrition provides the key nutrients for proper function resulting in increased energy and stamina,” Yake said, noting that dietitians help patients with disease prevention and treatment, and even with medically-related cost savings.

Dietitians work to prevent disease as well as treat it.  Studies show that lifestyle changes can prevent disease. 

“An example is that diet and exercise prevents diabetes 58 percent of the time, even better than the 38 percent decrease seen from some diabetes medication,” said Yake, with over 30 years of experience, 27 spent at NHB.

Dietitians save medical costs by reducing the need for medication, emergency room visits, doctor appointments, and hospitalizations.  A dietitian who is a diabetes educator can help a patient control their blood glucose levels through diet and make recommendations to the physician for medication adjustments to achieve good control of their glucose. 

“Better control means reduced risk of complications.  For every dollar spend on dietitian services, three to five dollars is saved in medical costs,” stated Yake.

One hurdle that NHB’s Nutritional Management staff routinely handles is dealing with the perception of the word ‘diet.’ People tend to associate that word with needing to lose weight, fast, or starve. Yake quickly points out that the true meaning is more than that. Dietitians still use the words ‘diet’ as well as ‘meal plan,’ but today there is more of a focus on the word ‘nutrition.’ This is also reflected in the fact that the name of the dietitian has changed from registered dietitian to registered dietitian nutritionist.  The name of their organization has also changed from the American Dietetic Association to the Academy of Nutrition and Dietetics.

“There is much more to ‘diet’ than losing weight though weight loss is important for health with the obesity rate at 27.2 percent along with another 35.5 percent of Americans overweight. Limiting the focus to weight alone misses the point of how powerful nutrition really is to our bodies and health. What we eat has far more effect on our health than was once thought,” said Yake, citing that increased awareness and enhanced knowledge are also powerful nutrition tools she enjoys sharing.

“Because some portions of food have been “supersized” many of us are eating too large of portions,” continued Yake. “Learning what is normal for health is one of the hurdles. Another hurdle is learning what is balanced.  Listening to the media and reading popular diet books can be confusing.  Patients want to know how much carbohydrate, fat, and protein to eat, and what are they doing right and what do they need to improve.  Dietitians can individualize diet recommendations based on individual health and nutrient needs.”

Yake and the others also provide support to help deal with disorder eating patterns and food addictions.  Dietitians can use specific tools such as cognitive behavioral therapy to assist patients in the healing process.  Often support groups and referrals to mental health providers work well.  Eating involves not just the physical side, but also the mental, emotional, and spiritual side of the person. In the healing process, all aspects of the individual need to be strengthened using the nutrition care plan.

“With all the conflicting information on the internet and in the media, it can be hard to sort out what is fact. Dietitians have the nutrition knowledge base as to what works and have evidenced-based clinical guidelines to follow. This provides our active duty members and eligible beneficiaries with safe, reliable nutrition information,” explained Yake.

Yake states that the most gratifying aspect of her job is being able at times to see the remarkable improvement in her patient's health and wellbeing

“Some patients say that I saved their life. I think medical nutrition therapy saved the quality of their life after they made important changes to their lifestyle and diet,” said Yake, also adding that on the flip side, seeing someone who is not ready to make changes, or who is struggling with disordered eating patterns or food addictions is the most difficult part of her job. 

“They want the benefits of healthy habits without the effort to make the necessary changes.  Overcoming old habits is not easy.  Dietitians can guide and coach them, but cannot do it for them. It is the responsibility of the patient to act on that knowledge and use those tools,” stressed Yake.

There are success stories like Jim Wylder. Yake attests that often times just implementing simple changes can bring results, such as one patient who cut his meat consumption in half and lost fifty pounds in one year.

Yake was worked with chronically ill patients suffering from inflammatory diseases such as fibromyalgia, migraine headaches, irritable bowel disease, eczema, and inflammatory arthritis. After identifying food intolerances and sensitivities, many patients can live normal lives. They can improve the symptoms of their disease or put them in remission. Dietitians support patients with food allergies and sensitivities to reduce symptoms of inflammation such as gastrointestinal problems, migraine headaches, and skin conditions.

“Dietitians can make a big impact on quality of life. For example, chronic pain patients have been able to drop their pain level by 80 percent after identifying food sensitivities contributing to their inflammation,” Yake said.

Even children with attention deficit hyperactivity disorder (ADHD) or autism have functioned better at school and home allowing them to reduce or stop taking medication after guidance from a dietitian on diet modification. 

NHB’s dietitians additionally work with younger children and their parents to help prevent and treat obesity. Compiled data from the Center for Disease Control notes over 17 percent (or 12.5 million) of children are obese with 32 percent being overweight or obese.

Childhood obesity has also become a priority for dietitians. The Academy of Nutrition and Dietetics and the Academy of Nutrition and Dietetics Foundation launched ‘Kids Eat Right Champaign’ in November 2010. This dietitian-driven campaign is dedicated to supporting the efforts of the White House to end the childhood obesity epidemic within a generation. Dietitians nationally have advocated for more nutritious school lunches and healthy school environments. 

“At Navy Hospital Bremerton, the dietitians give expert advice to parents on creating a healthy food environment at home.  Obesity rates have decreased for children ages 2 to 5. We hope this trend extends to older children in the near future,” said Yake.

Active Duty Members can self refer for weight control by checking with the Wellness Center (360-475-4179) to book into a class.  A popular class is the Intro to Nutrition offered on the first and third Friday of every month. The Carbohydrate Counting Class is held once a month and there are also specialty classes taught, such as an Irritable Bowel Class offered every two months by the gastroenterologist along with a dietitian that is designed to restore quality of life. 

“Irritable bowel disease affects 10 to 12 percent of the population and up until five years there wasn’t a good treatment to offer.  Now that has changed and most patients who take the class see improvement in as little as three weeks,” Yake explained.

Yake encourages beneficiaries to ask for a referral from their provider for appointments and call TRICARE Regional Appointment Center (1-800-404-4506) to make their appointments.

You Can Prevent Colorectal Cancer; Get Screened

Submitted by Lt. Cmdr. Steven J. Bernick, MD, FACP, Medical Corps, Naval Hospital Bremerton, Division of Gastroenterology head

March is Colorectal Cancer Awareness Month. Among cancers that affect both men and women in the United States, colorectal cancer is the second most deadly.  As there are often no immediate signs or symptoms, if left undetected colorectal cancer can spread throughout the body before a diagnosis is made, leaving little hope for cure.  An estimated 150,000 Americans will develop this disease over the next year, and nearly 50,000 will die. Unfortunately, according to the Centers for Disease Control and Prevention, over sixty percent of these deaths could be prevented if everyone 50 years of age or older had regular colorectal cancer screening. Put another way, colonoscopies save lives.

Current guidelines from the American College of Gastroenterology suggest a colonoscopy as the preferred strategy for colorectal cancer screening starting at age 50 in average-risk patients. Subsequent surveillance colonoscopies are then completed at an interval determined by the first exam.  This is often every 10 years, but may be more frequent if precancerous growths, known as polyps, are noted.

As the Gastroenterologist at Naval Hospital Bremerton, I simply cannot emphasize enough the value of colorectal cancer screening.   According to the American Cancer Society (ACS), rates of colorectal cancer have been declining in the United States since the mid-1980. Multiple studies have demonstrated that this decline is due to the increased detection of precancerous polyps.  While not all polyps will result in colorectal cancer if left in place, removal of precancerous polyps is the most fool-proof method of stopping colorectal cancer in its tracks.

Unfortunately, almost half of Americans age 50 and older are still not getting screened.  People in this age group are at the highest risk for developing colorectal cancer.  Other risk factors include a family history of the disease, a prior history of colon cancer or precancerous polyps, certain genetic syndromes, and certain diseases such as inflammatory bowel disease. Additionally, several lifestyle-related factors such as smoking, obesity, a diet high in red meat, physical inactivity, and heavy alcohol use have also been identified.  If you are age 50 or older or have any of these risk factors, colorectal cancer screening should be discussed with your healthcare provider.

It is important to note that, irrespective of age, the following symptoms may indicate the need for earlier evaluation, which may include colonoscopy:

-Rectal bleeding or pain

-Narrowing of stools

-New onset of unexplained pain or cramping in the lower abdomen

-Unexplained anemia, weight loss, or change in a regular bowel pattern

Colorectal cancer screening is a covered benefit to those enrolled in Tricare. Why then, one might ask, aren’t more people getting screened with colonoscopy?  The answer to that question is likely complex. However, the one factor that I will address is not: individuals may simply be hesitant to undergo the procedure and the bowel preparation that accompanies it.  Concerns regarding discomfort during and after the exam, procedural complications, and embarrassment are easy to understand.  In addition, the need for a bowel-cleansing clear liquid diet and laxative ingestion may provide additional mental roadblocks.  Although these concerns are appropriate, with the current instrumentation and anesthesia, colonoscopy is relatively painless and safe.  In addition, modern bowel preparations have a lower volume of fluid, and are split over a two-day period, making the bowel cleansing process easier to tolerate. 

Should a patient elect to do so, colorectal cancer screening can also be completed through annual stool testing.  Although this method is an option, the protective benefit is lost if testing is not completed annually and in accordance with the manufacturer’s instructions. If a stool test is positive, a colonoscopy is then performed to investigate further.  Thus, many patients elect to utilize a colonoscopy as their initial screening method, as this allows both the detection and removal of polyps in one setting.  This is one of the reasons why colonoscopy is considered the “Gold Standard” of screening tests.

Remember, colon cancer is preventable. It is up to you, however, to take the steps to prevent it.  Reduce modifiable risk factors by getting more exercise, eating more fruits and vegetables, pursing tobacco cessation, and reducing alcohol intake if indicated. In addition, ask your healthcare provider about a colon cancer screening test.  Get the test. Get the polyp. Get the cure. Then ask your loved ones and friends to do it.  You will be glad you did.

Patient Safety Awareness Week recognized at Naval Hospital Bremerton
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – There was rough shoals and choppy waters to traverse as patients, staff, and visitors at Naval Hospital Bremerton (NHB) took part in Patient Safety Awareness Week March 3 to 8, 2014.

The theme this year was ‘Navigate Your Health in Safety’ highlighted by an elaborate nautical display on NHB’s Quarterdeck, featuring 2014 National Patient Safety Goals (NPSG) exhibited in a decidedly colorful navigational format.

“The foundation of patient safety can be found in the Hippocratic Oath - first do no harm.  In our modern world, we have 21st century diagnostic machines, advanced medications and treatments and the ability to treat and cure a wide range of diseases.  With all that complexity, there are risks. The principles of developing a culture of a patient safety helps us manage complex treatments by putting our patients first.  Patient safety helps us build safeguards that ensure that we are safely delivering the highest quality care,” said Captain Christopher Quarles, NHB Commanding Officer.

 According to Lt. Cmdr. Susan Toyama, Quality Management Department Head, Patient Safety Awareness Week has been in existence since 2002 and is an annual NPSF-led education and awareness campaign for healthcare safety.   The goal is two-fold - to raise public awareness about the work being done to improve safety to patients and to emphasize to patients the importance of being partners in their care by directly involving them as part of the healthcare team. 

 “It is felt that if there is better communication among patients, providers, families and communities it is hopeful that there will be a decrease in health care errors,” stated Toyama, adding that Patient Safety Manager Mayda Schaefer and assistant Mondee Norton must be applauded for the creativeness and thinking that went into the display. 

The theme and reasoning for the theme is set well in advance by the NPSF, actively promoted by Navy Medicine, and left up to each military treatment facility to find a way to display that theme and message.

“With this year’s “Navigate Your Health ... Safely” theme, Ms. Schaefer and Ms. Norton put together the Quarterdeck display to match the theme. Navigating is showed by the boat with the blue stream and the items you see along to river path - snake and  alligator are indicative of safety hazards, and the good catch/speak up for safety is indicated by the Fish,” explained Toyama.
 
National Patient Safety Week provided a perfect opportunity to get command leadership, staff members and patients to interact, focus and address key salient points in a new manner.

“What is gratifying about National Patient Safety Week is talking to the patients and staff who stop to read and look at the display.  That's what it's all about is educating and raising awareness. The display helps to draw in patients and staff members, who are also healthcare consumers, so they will read, think and learn.” Toyama said, citing that along with Patient Safety Week is also the Patient Safety Recognition Program now in full motion, where staff members are receiving accolades for speaking up, documenting near misses and taking part as being delegates for Patient Safety.

Some of the rough shoals and choppy water hazards that staff members and beneficiaries need to handle include ‘Falls,’ which are a common cause of injury, both within and outside of a health care setting. It is estimated that more than one-third of adults over 65 fall each year.

Injuries that result from falls can include fractures, bleeding and sometimes even death. Patients may be at increased risk of falls if: they have impaired memory; they have muscle weakness; they are older than 60; they use a cane or walker; and they are on certain medication.

“Falls are taken very seriously at NHB and many steps are taken to reduce the chance of falling,” stated Toyama

Diagnostic errors are another patient safety awareness hazard to negotiate. A diagnostic error is a diagnosis that has been either “wrong, missed, or unintentionally delayed.” A (no fault) error may happen when there are masked or unusual symptoms of a disease, or when a patient has not fully cooperated in care. A diagnostic error may also result from system-related problems, such as equipment failure or flaws in communication. A wrong diagnosis may also happen when the clinician relies too much on common symptoms, without looking further into what may be causing them.

Patient Safety is also about awareness of wrong site surgery, which is when an operation is done on a wrong part of the body or even on the wrong person. It can also refer a wrong surgery being performed. Wrong-site surgery is rare and preventable, but it can still happen. There is Universal Protocol with important prevention steps such as conducting a preprocedure verification process; marking the procedure site; and conducting a time-out before the procedure is performed, all steps for preventing wrong site, wrong procedure and wrong person surgery as part of the National Patient Safety Goals.

There are medication errors that happen when a patient receives the wrong medication, or when they receive the right medication but in the wrong dose or manner. Unfortunately, medication errors are extremely common. Medication errors harm an estimated 1.5 million Americans each year, resulting in upward of $3.5 billion in extra medical costs. Improving the safety of using medications is continually stressed at NHB and is a current National Patient Safety goal.

Another Patient Safety goal is awareness of a health care-acquired infection (HAI), which is an infection that a person can get while being treated for a medical condition. This can occur in the hospital or even in the home. An infection is considered to be health care-acquired when it occurs after treatment begins. In the United States, one out of 20 hospitalized patients contracted an HAI. The three most common HAI types are: 1) catheter-related bloodstream infections; 2) hospital-acquired pneumonia; and 3) surgical site infections;

The requirements for handling such goals as previously listed are decided upon from a “pool” of recommendations as part of patient Safety Awareness Week. Each year, the previous goals are evaluated by a panel of widely recognized patient safety experts, called the Sentinel Event Advisory Group. New recommendations are made and the goals are updated or change. The one new goal added for 2014 is ‘Reduce the harm associated with clinical alarm systems.”

Other goals are; improving the accuracy of patient identification; improving the effectiveness of communication among caregivers; improving the safety of using medications and; identifying safety risks inherent in its patient population.

“Although we don’t necessarily talk about patient safety every day, it is what we do every day. The quarterdeck exhibit arranged by our Quality Management staff really reminds us that our patient safety is an ongoing continued process that all of us must continually navigate for their safe health care,” Quarles said.

But such an event wouldn’t be complete without handy tips from Infection Control. According to Tom Shirk, Infection Control Division coordinator, household bacteria hotspots that most people take for granted yet can make someone very sick are fridge handles; toothbrush holder; countertops; sponges; cutting boards; and television remotes.

Even carrying out a simply task like going to the grocery store over lunch has potential risks to patient safety. Shopping carts have an average of 860,000 germs per square inch. Shirk highly recommends to use one of the disinfectant wipes provided at many grocery stores as well as hand sanitizer.

This proves that patient safety awareness not only takes place at the command and home, but can also be applicable in someplace in between, such as in an innocuous marketplace.

Naval Hospital Bremerton promotes March National Nutrition Month theme of “Enjoy the Taste of Eating Right

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton’s Nutrition Management team is out to educate, convince and remind everyone that the theme “Enjoy the Taste of Eating Right” for March as National Nutrition Month® 2014 is not just a temporary proposal.

It’s a permanent motto for staff members and beneficiaries to live by.

According to Cmdr. Kim Zuzelski, NHB Nutrition Management head, a person’s eating habits are more than just 'eating this and not eating that;’ it’s more about knowing what foods offer the best nutritional choices and what foods a person to enjoy in moderation.

“It seems cliché to say that eating well is a lifestyle, but that is the message we want to convey.  It is certainly more than a black list of foods to avoid, as I'm a firm believer that all foods can fit into a healthy diet.  Once people are educated about nutrition, they are equipped to make informed decisions about what, how much, and how often they eat.  We aim to identify barriers to healthy eating, which may be a basic lack of knowledge, but may also be present due to social or psychological issues that need to be addressed before someone can truly be successful in reaching their goals,” said Zuzelski.

The Academy of Nutrition and Dietetics National Nutrition Month® 2014 "Enjoy the Taste of Eating Right" theme is based upon consumer research that taste trumps nutrition as the main reason why one food is purchased over another. While social, emotional and health factors also play a role, the foods people enjoy are likely the ones they eat the most.

The "Enjoy the Taste of Eating Right" premise focuses on how to combine taste and nutrition to create healthy meals that follow Dietary Guideline such as consuming more of certain foods and nutrients like fruits, vegetables, whole grains, fat-free and low-fat dairy products, as well as consuming fewer foods with sodium (salt), saturated fats, trans fats, cholesterol, added sugar and refined grains.

Zuzelski noticed that eating right is really less about dieting and more about behavioral modification.

“While some people think eating less is the solution to weight management, they may find that they can actually eat more if they make different choices.  Being mindful of habits and the eating environment can also influence healthy eating,” said Zuzelski, who along with the rest of the registered dietitians on the command’s Nutrition Management team - Susan Yake and Jennifer Meeks at NHB and Cheryl Decker at Naval Branch Health Clinic Everett – are doing their part to share their knowledge and experience on choosing healthy, and in some cases a healthier balance, of foods instead of 'fast-food' fare. 

“There are more healthy food choices available at fast-food places than there have been in the past. However many people aren't ordering the healthy options when they go to those places.  Many people still skip meals and then have a tendency to choose less healthy items and overeat at the next meal.  Prior planning goes a long way.  There are numerous healthy options that travel well, and we know that the majority of people who are successful at weight loss and maintaining that loss do not skip breakfast.  Taking a few extra minutes on a weekend or the night before at home to pre-portion snacks or meals can save a lot of money and drastically improve the quality of one's diet,” exclaimed Zuzelski.

Zuzelski also attests that a variety of foods is encouraged because there isn't any one food that offers all the needed nutrients.  Fruits and vegetables have a combination of vitamins and nutrients that cannot be replicated in a supplement and the various colors all confer different health benefits and have different roles in promoting a healthy immune and circulatory system. 

The advantages of healthful eating - A variety of fruits, vegetables, grains, protein and dairy products - go well beyond simply losing unneeded pounds.

“Although many consider weight management as a primary benefit to healthful eating, benefits also include healthy skin and hair, reduced risk of chronic diseases such as diabetes, certain cancers, and cardiovascular disease,” stated Zuzelski, adding that for someone to eat healthy,  it depends on their current dietary habits and how willing they are to make some changes. 

“Some find that they actually have a preference for healthier foods, but their lack of planning puts them in a situation where there aren't a lot of healthy choices in their immediate surroundings. Planning can make a big difference in availability of healthy foods.  Others have eaten convenience foods for years, and it's a difficult transition to add foods that they haven't traditionally had in their homes,” said Zuzelski.  

The Nutrition Management team also runs into common hurdles that a number of patients have when it comes to modifying their eating habits.

“People will often ask for a menu or list of what they should eat, rather than investing the time to educate themselves.  Although it may save time initially, it's not helpful in the long run as that menu is very limiting, becomes very boring, and doesn't teach any life skills on how to choose food.  We have to eat until the day we die, so I think it's well worth the investment to have a good understanding of how to do it in a healthful way that is still enjoyable.  We are still fascinated by marketing of various diets and supplements to lose weight fast.  I've never argued that people can lose weight fast on a myriad of methods found on the internet, however, losing weight fast also means losing additional lean mass and water weight that is quickly regained,” Zuzelski explained, noting that maintaining lean mass (muscle) while losing a higher proportion of excess weight as fat allows someone to eat more calories each day without gaining weight. 

NHB offers several avenues to educate beneficiaries on nutrition.  The Nutrition Clinic holds classes on basic nutrition, prenatal nutrition, irritable bowel syndrome, and carbohydrate counting for those with pre-diabetes or diabetes.  Additionally, the registered dietitians are available to teach classes to individual units or work centers upon request and also see patients on an individual basis to work with them on meeting individual goals.  Although a consult is typically required from the primary care manager for the Nutrition Clinic, active duty personnel do not require a consult to be seen for weight management and can book directly through the TRICARE regional appointment center (1-800-404-4506). 

NHB’s Health Promotion and Wellness department also supports Nutrition Management efforts and offers a Healthy Shopping commissary tour, as well as a class on diabetes prevention.  

“In the past, some people really underestimated the profound impact that nutrition has on health and quality of life. They have learned that nutrition is important for more than weight control.  There are many people who are at a healthy weight, but deficient in various nutrients and have a diet that increases health risks or exacerbates other health conditions,” Zuzelski said. 

Zuzelski has had several patients who struggled with weight loss despite a good effort to eat healthier.  One patient had diabetes while she was pregnant and had a strong family history of obesity and diabetes.  Zuzelski worked with her to follow a meal plan similar to someone with diabetes and discussed diabetes prevention through permanent lifestyle changes.  The patient was able to safely lose the weight she needed to pass her weigh in. 

“It was extremely rewarding to see her reach her goal and now have the knowledge she needs to maintain her loss.  I had another patient a couple years ago who had chronic kidney failure and was feeling tired much of the time.  She also complained of how food tasted and that she had tingling in her fingers at times.  After meeting with her, we identified deficiencies of vitamin D, B12, zinc, and iron.  Once treated, her symptoms resolved, she was able to start exercising again, and her quality of life drastically improved,” said Zuzelski.

The incentive for some is preparing for the semi-annual Physical Readiness Test. For others, it’s a lifestyle transformation of continuing on a New Year’s Resolution, one meal at a time. Zuzelski and her expert team are there to provide as much assistance as necessary.

“I love providing people the education and tools to make healthy choices that they didn't have before we met.  Helping people understand that they have a lot of control over their health outcomes through the choices they make on a daily basis is very rewarding,” Zuzelski said.

 TRICARE For Life Pharmacy Pilot Starts March 2014

From Naval Hospital Bremerton Public Affairs -- TRICARE For Life (TFL) beneficiaries will be required after March 14, 2014 to use a military pharmacy or TRICARE Pharmacy Home Delivery to fill prescriptions for select maintenance medications used on a regular basis for chronic health conditions such as high cholesterol and blood pressure.

This pilot program is a provision of the 2013 National Defense Authorization Act.

On February 18, 2014 TFL beneficiaries taking an affected medication started receiving letters notifying them of the pilot. After the pilot starts, they may have up to two 30-day refills of their prescriptions covered at a retail pharmacy and will receive a reminder each time before they are responsible for 100 percent of the cost at retail. Affected beneficiaries may have their prescriptions filled at their local Military Treatment Facility (MTF) pharmacy or may call the TRICARE pharmacy contractor, Express Scripts, at 1-877-882-3335 to switch to home delivery or ask questions about obtaining their medications. TRICARE Pharmacy home delivery is safe, convenient and easy to use, offering beneficiaries up to a 90-day supply of their brand name medication for $13.

Some individuals are exempt from this pilot program, including people with another prescription drug plan, or people living outside the United States. People living in a nursing home may contact Express Scripts to request a waiver.

“For patients who live near a MTF, the MTF pharmacies are the best alternative for the patient and the taxpayer. Naval Hospital Bremerton has a robust formulary of medications available for our beneficiaries. Home Delivery is also an excellent choice for TRICARE beneficiaries to get their maintenance medications, especially for those who live farther away from a military pharmacy. Both of these choices are less expensive than the TRICARE Retail network, and Home Delivery offers the convenience of having maintenance medications delivered directly to your home. If you decide to try the Naval Hospital Bremerton or Branch Health Clinic Everett pharmacy, you can call ahead (360-475-4425) to make sure your medications are available and so we can provide timely, concise and accurate assistance,” said Cmdr. David Hardy, NHB Director of Clinical Support Services.

NHB’s formulary listing is also available online at http://www.med.navy.mil/sites/nhbrem/patients/Pages/pharmacy.aspx.

Patient costs vary based on where a beneficiary gets their prescription filled and the type of drug: generic, brand name or non-formulary. Beneficiaries can save on cost by asking their doctor to write them a prescription for a generic version of their medication.

A summary of the overall costs of prescriptions filled using your TRICARE benefit is included below:

Military Pharmacy

Get up to a 90-day supply of most prescription drugs.

·       $0 copayment

·       Not all drugs are available; call the military pharmacy first to check

Home Delivery

Get up to a 90-day supply of most prescription drugs.

·       Generic: $0

·       Brand name: $13

·       Non-formulary: $43 (unless you get medical necessity)

Retail Network Pharmacy

Get up to a 30-day supply of most prescription drugs.

·       Generic: $5

·       Brand name: $17

·       Non-formulary: $44 (unless you get medical necessity)

Note: For a 90-day supply, a beneficiary will pay the cost for each 30-day supply; for example, a 90-day supply of a generic drug will cost $15.

Note: Beneficiaries affected by the TRICARE For Life Pilot will pay 100 percent of the cash price for affected medications, after receiving two 30-day fills.

Non-Network Pharmacy

A beneficiary will pay more to get their prescription filled at a non-network pharmacy (including host nation pharmacies), and they very well might need to pay up front and then file a claim for reimbursement.

For the most recent information about the pilot or to sign up for e-alerts with the latest updates, go to www.tricare.mil/tflpilot.

Satellite Dental Annex will close March 28 at NBK Bangor IMF

By Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton’s Branch Health Clinic Bangor will be closing the satellite Dental Annex at Naval Base Kitsap Bangor Intermediate Maintenance Facility (IMF) on March 28, 2014.

The closure is expected to impact a handful of patients primarily from IMF and several smaller commands such as from Fleet Industrial Supply Center detachment and Submarine Development Squadron 5.

According to Lt. Cmdr. Marjorie A. Wytzka, BHC Bangor officer in charge, those patients who used the annex will be seen at the Bangor Dental Department after the closure.

“The annex is closing to allow quicker on-site consultations for patients with specialists and for providers to speak with specialists about patient's care,” said Wytzka, also noting that the closure will end up saving patients multiple trips, as well as reduce costs by consolidating patient care. 

Cmdr. Daniel Brown, Dental Director for Naval Hospital Bremerton which includes BHC Bangor, BHC Everett and Puget Sound Naval Shipyard, stated that this change will “increase access to multi-specialty care within one location, thereby saving our sailors time by having a “one shop stop” for all your dental needs.  This change will help ensure that we have the highest level of dental readiness for our operational forces.”

Additionally, the current Dental Annex staff will transition to BHC Bangor Dental Department and will continue with similar assigned functions in accordance with their position description and contract requirements.

For services at BHC Bangor, appointments can be made by calling: 360-315-4287. Sick call hours are available between from 7 a.m. until 9 a.m. and scheduled care during regular hours 7 a.m. until 3:30 p.m., Monday through Friday.  Our top priority is to ensure that any sailor getting underway has all their urgent dental needs completed.

Top priority is given at BHC Bangor Dental Department for any emergency treatment needed to relieve pain, control infection, or repair trauma for any patient and is available 24 hours a day. There are also specialty care providers available for prosthodontic, endodontic, and periodontal needs.

From Arizona to Afghanistan – Naval Hospital Bremerton Corpsman a vital part of Trauma Unit

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Handling devastating injuries is part of the norm at NATO Role 3 Multinational Medical Unit (MMU) at Kandahar Air Field (KAF), one of the busiest trauma centers in the world.

Arizona native and Hospital Corpsman 3rd Class Kayla Blum, has been doing her share and more since arriving down range in July, 2013, to help care for the wounded as a Trauma Unit procedure corpsman at the MMU.

Blum, on deployment from Naval Hospital Bremerton, is upholding the MMU motto and principle of providing every casualty with “The Best Care Anywhere” resulting in a 98 percent survival rate

“This deployment is why I joined the military in the first place. I wanted to help the service members who were risking everything for our country. That’s what I am able to do while at NATO Role 3 MMU. No matter where I worked before coming here, nothing could have prepared me for the things for the things I saw and did here. Working in the Emergency Room and Pediatrics at NHB was a great experience, but nothing comes close to what I am able to do out here,” said Blum.

The vast majority of Blum’s duties are directly related to trauma care, whether as a procedure corpsman starting an IV line and assisting a surgeon with central lines, chest tubes and arterial lines, or helping as an ambulance driver to transport wounded from the flight line to the hospital. Even when she’s not been tasked with actual driving, Blum has leaped into the back to act as the receiver to assist with monitoring and stabilizing patients until reaching the operating room.

Soon after arriving down range at the busy hospital, Blum was assigned as training petty officer for the Trauma Unit corpsman and immediately put her energies into ensuring that every corpsmen and medic that worked in the trauma bay had the required training.

“When we first arrived, I was asked by the director of medical services to put together new personnel qualification standards for future training. I got the entire group of Trauma Unit corpsmen involved by having each one type out a list of things they did at their position such as being a procedure corpsman or airway corpsman, Then I took bits and pieces of each to make the training that much easier to understand,” explained Blum, who compiled the information in a study folder as well as a power point display with step-by-step instructions that went thoroughly over all the different procedures assisted in by the trauma corpsman (and medics). After compiling, completing and then getting the necessary approval by her chain of command, she immediately began teaching the curriculum.

“I went right to work training the Role 1 Army medics we had working with us at the time. They were trained as ad hoc members in case of a mass casualty situation,” Blum said, noting that there are only so many Trauma Unit teams available, and if there are multiple casualties coming in, there is always the need for extra help.

Blum’s training regimen was completed within the first month, with approximately 30 corpsmen and medics honing their skills. Practical application of the Trauma Unit training was almost immediately put to the test, when word came one day that a number of wounded were inbound to the hospital.

“We experienced our first real mass casualty situation shortly after. Thankfully, everyone was ready to go due to the training provided,” said Blum.

Blum attests that a typical day at the MMU hinged on the weather. If the weather was cold, the patient load was minimal, as they mainly handled routine injuries such as sprains and strains, and bruises and breaks. When the weather warms in Afghanistan, the war also heats up and as such, Blum and the rest of MMU Trauma team’s were busy.

 According to Role 3 records for 2010, there were approximately 800 battlefield casualties treated there during May through September — the traditional fighting season in Afghanistan — with more than half of the cases U.S. or other NATO troops. The rest were Afghan soldiers and civilians too badly hurt to be cared for at nearby Afghan military or civilian hospitals. Compiled statistics also show that almost half of all battlefield injuries treated then were caused by improvised explosive devices (IED).

“The days were busy when we first arrived. We saw anywhere from 10 to 20 patients. Typically those patients had gunshot wounds, and IED related injuries such as shrapnel and amputated limbs. I knew coming out here that even with the drawdown, we would be seeing some serious injuries and that a lot of the patients would be our troops. But that’s why I’m here, to do my part in taking care of these guys. I wouldn’t trade that for anything in the world,” related Blum.

Besides her Trauma Unit team experience, another interesting aspect of her deployment has been working in such a diverse environment with a number of other coalition forces. 

“We work with so many different countries – Slovakians, Belgians, Australians, Lithuanians, the British - the list goes on. I’ve made some great friends out here and not all of them are Americans,” shared Blum, citing that the war zone in southern Afghanistan is a long ways indeed from her days growing up in Prescott where she attended Granite Mountain Middle School and Prescott High School before enlisting in the Navy in 2009.

“If I was to share on everything I have been able to learn out here, this article would take three pages. But one of the most important lessons I learned is to enjoy the little things, because it’s the little things that help get you though the toughest times. I thank God everyday for my Trauma team. They are lifelong friends that will always be there for me and I will always be there for them,” said Blum, also sharing to those following in her deployment footsteps to remember to rely on the simple concept of taking the time to open up and share with others.

“Don’t forget to talk about things. You can see things here that may shock you and affect in one way or another. It is important to remember that talking to a shipmate or a close friend is always an option for dealing with the challenge of working around – and in – battlefield trauma. It really does help,” stressed Blum, who was also recognized for her Trauma Unit team efforts by being selected as the NATO MMU’s “Sailor in the Spotlight” for September and October 2013.

 The Role 3 MMU provides the highest echelon of care at KAF for active duty military, NATO Forces without organic medical support, local nationals - including the local populace, the Afghan National Army and Police, as well as third country nationals and civilian contractors from all over the globe. The U.S. Navy assumed responsibility for the Kandahar Role 3 Hospital operations from Canadian forces in August 2009, and a newer, more modern $60 million facility was opened in May 2010.

The term "Role" describes the tiers in which medical support is organized, with Role 3 describing the capabilities of a theater-level hospital.  A Role 3 military treatment facility includes additional capabilities such as specialist diagnostic resources, specialist surgical and medical capabilities, preventive medicine, food inspection, dentistry, and operational stress management teams.

Role 1 refers to emergency medical care in the field, historically handled by independent duty corpsmen. Role 2 has been traditionally defined as Battalion Aid Station, where the wounded are linked up with a nurse and physician in the chain of evacuation. Landstuhl is the
largest American hospital outside the United States and an example of a Role 4 facility. Role 5 sites are rehabilitation facilities such as Naval Medical Center San Diego.

Three Naval Hospital Bremerton Sailors Selected for Medical Commissioning Programs

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – The Navy’s Nurse Corps and Medical Service Corps gained new members courtesy of Naval Hospital Bremerton (NHB) as a trio of enlisted staff members were announced being selected for medical commissioning programs on Feb. 21, 2014.

“Our three Sailors here have demonstrated sustained superior performance. This is a very competitive process. We are very proud they can further their education, get a commission and continue on to bigger and better things as part of Navy Medicine,” said Capt. Christopher Quarles, NHB Commanding Officer.

Hospital Corpsman Chief (Surface Warfare/Fleet Marine Force) Shawn Kenney, Director of Medical Services Leading Chief Petty Officer, will be attending the Interservice Physician Assistance Program, and Hospital Corpsman 2nd Class Taylor Lee Smith, assistant leading petty officer for NHB’s Oral Surgery Clinic, and Hospital Corpsman 3rd Class Tara MacDonald, NHB’s Branch Health Clinic Bangor Information Assurance Officer and Immunizations assistant leading petty officer, will both enroll in the Medical Enlisted Commissioning Program (MECP) for Nursing.

“We had the three apply and they all were selected. Obviously batting a thousand is great, but what really made this program a success is not just that the Sailors are outstanding, but that the command was outstanding to help them achieve their goals,” said Cmdr. David Thomas, NHB Medical Services deputy director and a prime architect of the command’s annual Medical Commissioning Programs Symposium.

Thomas attests that having the backing of the command, especially from the Chief’s Mess, to help mentor and tutor the Sailors throughout the process is a valuable resource that can’t be understated.

“The Sailors we assisted are all top-notch and they are going to become top-notch officers,” stated Thomas.

“Becoming a physician assistant has been a goal of mine for years,” said Kenney. With over 19 years in the Navy, the Victorville, Calif. native, will detach from NHB in the summer for 16 months at the Interservice Physician Assistance Program at Ft. Sam Houston on Joint Base San Antonio, Texas, followed by another 14 months of clinical rotations at Naval Medical Center San Diego.

Kenney notes that two of the most important aspects of being selected are centered on being a top-notch professional and a willing student in higher education.

“As Skipper said, a person has to demonstrate ‘sustained superior performance’ in their duties. A person also needs to have the necessary academic backing – a grade point average of 3.5 or higher – in science-based courses to back up the package they submit,” Kenney said, who has served as an independent duty corpsman and Fleet Marine Force from ship to shore to down range as an Individual Augmentee. He has accumulated medical experience serving on the frigate USS Taylor (FFG 50), at Branch Health Clinic Bangor, and Forward Operating Base Inkerman in Helmand Province, Afghanistan.

“With my IDC and FMF background, I know what to do when someone is in front of me and needs hands-on medical assistance. By becoming a PA, I will further enhance by background knowledge in being able to provide more in-depth medical care. I got a ways to go, but I’m on the way,” Kenney said, also noting that even though the qualifications are stringent for any medical commissioning program, if he can do it, so can others.

“I’m proof that anyone can do it. A person has to be patient, thorough and stick with it. I also had two people - Cmdr. Thomas and HMC Gil Garcia – help in tracking my progress, setting up boards, organizing the package and much more. Both of them were a huge help. I can’t say enough how valuable they were to me, as was the entire command,” said Kenney. 

For Hospital Corpsman 2nd Class Taylor Lee Smith, from Knoxville, Iowa, his path to pursue a medical commission in the Navy Nurse Corps was driven by his commitment to aid others in need. 

 “I have a passion for helping people. I look up to Navy Nurses and this also is one of the way to continue to help others after I retire,” explained Smith, who knew he wanted to follow the medical commission path when he was stationed at Captain James A. Lovell Federal Health Care Center, Great Lakes, Ill, in 2012.

Smith, with approximately five and half years in the Navy, advises others not to simply talk the talk if they’re not actually walking the walk.

“Don’t just say you are going to do it. Start the process and do it! I said for six months that I was going to and never did. Then Lt. Lanae Hickman guided me along the way for the most part and gave me all the instructions and the direction that I needed to get going and to not stop until I was selected,” related Smith, adding that the most difficult aspect was accomplishing the required personal statement for the package.

“I think the personal statement was the hardest. You only get 250 words to explain why you want (to become a Navy Nurse Corps officer) and I started off with pages of reasons. It took months to perfect it. The wait was also stressful,” Smith said, sharing that the entire process was gratifying by knowing he had taken a huge step forward in his career by undertaking the process and being accepted. Like Kenney, the process was one he could not have done without tutoring and mentoring along the way, from Lt. Hickman at Great Lakes to Cmdr. Thomas, Lt. Cmdr. Carmelo Ayala, and Lt. Sheila Phillips at NHB.

MacDonald has been stationed at BHC Bangor for most of her approximately three years in the Navy. Soon after checking onboard, she began the process of applying to become a Navy nurse.

“I’m going into nursing, possibly Nurse Practitioner. I began looking into MECP about three months after I checked onboard Bangor. I immediately contacted Cmdr. Fran Slonski at NHB (then Quality Management department head) and she got me started on my package,” MacDonald shared, adding that she applied initially in 2013 and was selected as an alternate and then reapplied for 2014.

“I started the process by looking up the instruction and finding out exactly what I needed to do. There was a lot of paperwork involved along with contacting nursing programs and fulfilling their requirements as well. Cmdr. Slonski and Lt. Cmdr. Katie May (BHC Bangor Nurse) helped me with the package,” said MacDonald, from Westmoreland, Tenn.

MacDonald says that the best advice she can share with others preparing to apply to MECP, or any future goal, is to work hard and always strive to do the best in handling responsibilities.

“Every little thing counted towards this package, from physical readiness test scores and evaluations to science classes I took years ago,” MacDonald noted, adding that the most difficult part of putting her package together was trying to find a nursing school that would allow an early acceptance for the next fall semester. Fortunately, she already had an AAS (Associate of Applied Science) degree in Pre-Nursing which proved to be very helpful in that regard.

MacDonald commented that she has been working towards her BSN since high school, but due to financial issues and having to support herself through college, there were some detours. Yet she has persisted.

“The most rewarding thing about being selected for this program is knowing that all the hard work I’ve done has paid off. I’m finally getting the chance to go back to school and start my career as a nurse! I received so much advice from so many people, but I have to say that without Cmdr. Slonski and Lt. Cmdr. May, I would not have been able to submit the best package that I could put together in time for the cut-off date. Also, my chain of command, and Hospital Corpsman Senior Chief Joseph Haner specifically, supported my future aspirations to join the Nurse Corps from the very beginning,” MacDonald exclaimed.

There are others getting ready to follow the trio of Kenney, Smith and MacDonald. At the 2nd annual NHB Medical Commissioning Programs Symposium recently held Jan. 29, 2014, the ranks of those in attendance swelled to listen to the extensive information provided on the Navy’s many officer commissioning opportunities in medical health science fields.

Subject matter experts all provided extensive information on the Seaman to Admiral (STA-21) program, Medical Enlisted Commissioning Program (MECP) for Nursing, as well as opportunities and information on other scholarship programs including medical school commissioning pathway(s) via scholarship from the Uniformed Services University for the Health Sciences (USUHS), the Health Professionals Scholarship Program (HPSP), and the Medical Services Corps Inservice Procurement Program (MSC-IPP) with an emphasis on physician’s assistant and health care administration track, and dental school commissioning pathway.

The Medical Enlisted Commissioning Program (MECP) that Smith and MacDonald have been accepted gives enlisted Sailors in the Navy an opportunity to earn an entry level degree in nursing and be appointed as a Navy Nurse Corps officer. To be considered for the program a Sailor must meet the minimum requirements and submit an application package to Naval Medical Education and Training Command.

The minimum requirements for the Medical Enlisted Commissioning Program (MECP) are:

U.S. Citizenship (No Waivers);

Opened to all rates and rank;

Applicant must be commissioned prior/before reaching their 42nd birthday (No Waivers);

No high school transcripts are required;

At least 19 years of age;

A minimum of 30 semester hours (or 45 quarter hours) of undergraduate courses accepted for transfer towards a bachelor's degree in nursing (BSN) by the institution(s) for which you are applying. Courses such as English, Psychology, Biology, Chemistry, Physiology, etc. are desirable;

Cumulative GPA of at least 2.5 on a 4.0 scale;

SAT or ACT test taken within the past 3 years from application due date;

Must complete all requirements for a BSN within 36 months or less;

No history of felony conviction or any record of drug abuse. A driving under the influence (DUI/DWI) violation is disqualifying if within four years of the application deadline, or convicted of any misdemeanors (except minor traffic violations) within three years of the application deadline;

Have no record of courts-martial convictions or civilian felony convictions;

Security Clearance, contact your Security Management Office. JPAS (
Joint Personnel Adjudication System) security investigation printout is acceptable;

Favorable endorsement from commanding officer;

Once accepted in the program a candidate will have to extend as an enlisted Sailor to cover the period of training and must serve a minimum of 10 years as an officer to be eligible for retirement pay.

Kenney will enter the United States Military’s Interservice Physician Assistant Program that is designed to train service members both active duty and reserve, from all branches of the U.S. military, to become Physician’s Assistants.

The program offers approximately 150 candidates per year the opportunity to enter the comprehensive program with candidates are drawn from the Navy, Coast Guard, Air Force, Army, U.S. Army Reserve, National Guard and the U.S. Public Health service.

Basic qualifications for IPAP include:

Must be Active Army, Reserve, National Guard (officer, warrant officer, enlisted) ROTC cadet, Air Force, Navy, Marine Corp or Public Health Service (prior occupational specialty is not a determining factor in eligibility)

Must be physically qualified for service retention and be within the height/weight guidelines of Army Regulations

Must meet time in service requirements (three years active federal service by August 30 of the year following application).

Must be U.S. Citizens

Must have a sound understanding and ability to speak and write in English.

In lieu of having a BA degree, applicant must have at minimum 60 hours of transferable credits from an accredited institution of higher learning, 30 of which must have been earned in-residence. Any applicable anatomy, science, physiology courses must have been completed within the past five years or applicant will be subject to having to repeat these courses. These courses must have been completed with assigned letter grades to be considered acceptable for program purposes.

Must meet GPA requirements

Must have completed minimum credit hours in humanities, English, chemistry, anatomy, physiology, algebra (or higher math) and psychology

Once in the program, candidates are expected to maintain a minimum GPA of no lower than a “C” during the didactic (coursework) first phase of training and successfully complete phase 2, the clinical component. Each phase lasts approximately 53 weeks.

Paving the path for Medical Commissioning Programs at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Take it from an undesignated Seaman who is now a Navy Nurse Corps officer; nursing school is not easy.

But if a person is dedicated and determined, they can make the grades to make the grade and follow a career path similar to that of Lt. Cmdr. Carmelo Ayala, who started out part of Deck department on fleet oiler USS Cimarron (AO-177) and is now Naval Hospital Bremerton’s (NHB) Internal Medicine Department division officer.

“There’s no room for procrastinate if you get selected and make it to the college of your choice to study medicine,” said Ayala, who shared his personal experience and professional knowledge becoming a Navy Nurse during NHB’s Medical Commissioning Programs Symposium held Jan. 29, 2014.

The symposium provided extensive information on the Navy’s many officer commissioning opportunities in medical health science fields.

Along with Ayala, other subject matter experts provided presentations on the Seaman to Admiral (STA-21) program, Medical Enlisted Commissioning Program (MECP) for Nursing, as well as opportunities and information on other scholarship programs including medical school commissioning pathway(s) via scholarship from the Uniformed Services University for the Health Sciences (USUHS), the Health Professionals Scholarship Program (HPSP), and the Medical Services Corps Inservice Procurement Program (MSC-IPP) with an emphasis on physician’s assistant and health care administration track, and dental school commissioning pathway.

“The number one question asked in our command career counselor office is on some type of commission program. This symposium provides our Sailors with a perfect opportunity to learn about a number of ways to start the process,” said Naval Hospital Bremerton Command Master Chief Douglas George.

Ayala was subject matter expert for MECP, an in-service procurement path that gives qualified enlisted men and women a chance to earn an entry level degree in nursing and be appointed as an ensign. Part of the checklist for applying for the program is a minimum of 30 semester hours (or 45 quarter hours) of undergraduate courses needed to be accepted for transfer towards a Bachelor of Science of Nursing by the institution a person is applying.

“One of the common characteristics of MECP selectees is that they are academically sound. They have a strong academic track record, especially in science. They took tough courses and made good grades in those subjects. Each of them distinguished themselves by such traits as being leading petty officers, and marked as a early promote on their fitness evaluation (FITREP),” Ayala said, noting that selectees should strive to be ‘well-rounded’ applicants and career-oriented, going through the motions in order to get a degree or commission.

The checklist for MECP calls for having a commanding officer’s endorsement and/or recommendation, along with ACT or SAT scores completed within three years; copies of college transcripts; copies of the least five years of observed evaluations or FITREPs; three interviewer appraisal sheets; and a personal statement.

“The selection board looks for a personal statement that says ‘wow!’ They want to see that a commanding officer and the interviewers were obviously compelled to take the time to hand-write or type comments not routinely seen on other packages such as, ‘I trust this man with my family,’ or ‘candidate Seaman Jones possesses every trait of a naval officer.’”

Other distinguishing features of submission packages shared by Ayala were that they were administratively neat, concise, conservative in preparation – no card stock or heavy weight paper – and the content has to be accurate and easy to follow. There can be no grammatical or punctuation errors and no misspelled words.

“The personal statement has to be clearly articulated. The applicant has to demonstrate their understanding of their future roles as a Navy nurse in addition to becoming a Navy officer,” Ayala said.

Selection boards also look for proven track records of candidates taking on leadership opportunities. They want to see if a person has demonstrated leadership by taking on increased responsibility and challenges.

“If there is a candidate who is applying from a shipboard command but doesn’t have a warfare pin, then that’s going to have me wonder why they don’t. It’s not going to look good for them,” Ayala said.

Ayala stressed that a candidate’s package must leave no doubt that the applicant has a nursing career in mind and that the experts in their chosen program strongly support the applicant.

“We don’t want any package to be a head-scratcher for the board. These are packages that make board members wonder ‘what happened?’ or ‘why is this item missing?’” said Ayala, citing that a submitted package missing personal readiness test (PRT) results and/or a previously failed PRT with no apparent explanation are non-starters. Other examples mentioned were service record discrepancies left uncorrected for several years or no warfare designation when the opportunity existed to earn one.

Lt. Sheila Phillips of NHB’s Ambulatory Procedure division and Post Anesthesia Care Unit and a Navy Nurse, also shared selection board tips. She stressed to all those interested that if they’re going to apply, then they simply need to put the time and effort into it and make sure they comply with all requirements, from college level classes to Navy fitness evaluations.

“What are board members looking for? They look at everything. They want to see if someone applying has taken college classes that are applicable like anatomy, physiology, microbiology, chemistry. Not fluff classes,” said Phillips, sharing the example that if a person is applying for the Navy Nurse Corps, the board also is looking for acceptance letters from both the college and the Department of Nursing of that same college.

Other such items needed for a submission packet include letters of recommendations, test scores from ACTs or SATs within three years; college course grade point average; Navy FITREPs in chronological order, and even an essay/personal statement explaining why a Sailor wants to become, for example, a Navy Nurse.

“I tell people to speak from their heart. Don’t put down what you think they might want to hear. Be honest. It’s also a good idea to have someone else proofread the essay to ensure there are no errors at all. Same for Navy FITREPs. Make sure they are all accurate and in order, the commissioning board is going to consist of six or seven senior Navy Nurse Corps officers and one line officer. They are looking for their replacement. They want someone who is well rounded and has shown already to have gone above and beyond on their current duty, helping in the community and by advancing their education,” Phillips said.

The emphasis on academic performance, leadership potential, and involvement with collateral duties for every commissioning path chosen was also stressed by Cmdr. David Thomas, NHB Medical Services deputy director and symposium facilitator.

“We want our Sailors who are applying for a commissioning program to show how they’ve been inspired and how they can contribute to the corps,” said Thomas, sharing that for those who are at shore-based commands like NHB, this is the perfect opportunity to enroll in college classes and eliminate as many if not all the science-related courses as they can, especially those that have labs as part of the curriculum.

“Start today. For example, there are 30 credit hours needed to apply for Navy Nurse Corps. Science-related classes with labs are not generally available on a ship or when deployed overseas. Now is the time to get those required classes out of the way. It’s also a good idea to carefully consider adding too many classes to the current hectic work/life balance that we all have. If a person overloads with number of classes at once and then doesn’t get good grades, that’s just not good planning,” Thomas said.

Although most of the enlisted staff members attending the symposium were primarily hospital corpsmen, there were personnel with other rating specialties in attendance such as Yeoman 2nd Class Ashli Defraties of NHB’s Human Resources department.

“My goal is to become a nurse in the Navy. This symposium was very well taught with a lot of great information shared. I especially liked the MECP part because that is the program I’m now interested in applying. I’ve started already at Olympic Community College. I plan on getting as many of the pre-requisites in math and science out of the way as I can, so when I apply I can be ready to go that same day if possible!” exclaimed Defraties, a Texas native.

For Defraties or anyone else seeking information on a particular commissioning programs or getting ready to actually apply for one, Thomas, Ayala, Phillips are available to help with the process. One grade at a time to get the process right.

TRICARE SERVICE CENTER WALK-IN SERVICE CLOSED APRIL 1, 2014

Effective on April 1, 2014, the Defense Health Agency eliminated walk-in services for the TRICARE Service Center at Naval Hospital Bremerton and Branch Health Clinic Everett 

According to DHA, this is part of the reorganization of the military medical system. After a year-long review, military health system leaders concluded that customers would have better access and could be better served with toll-free TRICARE telephone customer service centers or by online services.  To accommodate additional customers, TRICARE’s toll-free customer service call centers will be improved, to include increasing staff and upgraded technology. These upgrades will provide greater access to information through current toll-free call centers and readily available internet resources.  All stateside TRICARE Service Center walk in service will be eliminated, but Overseas TRICARE Service Centers will not be affected.

For more information, please go to:  http://www.tricare.mil/TSC
For TRICARE information, please go to: http://www.tricare.mil/

Contact Information for NHB area:
TRICARE Regional Contractors for enrollment assistance and answers to questions via web site or toll free call center:
West Region
UnitedHealthcare Military & Veterans
1-877-988-WEST (1-877-988-9378)
www.uhcmilitarywest.com

Naval Hospital Bremerton Caring and Concern Helping with the Cold and Flu Season

By Douglas H. Stutz, Naval Hospital Bremerton Public Affairs
BREMERTON, Wash. (NNS) -- The arrival of the New Year has not only brought football playoff fever to the greater Pacific Northwest, it has also heralded the arrival of the cold and flu season.

Naval Hospital Bremerton is geared up to provide influenza vaccinations to those in need at the main hospital Immunization Clinic and at the Branch Health Clinics.

"There have been six deaths caused by influenza reported in the state of Washington this season so far," said Capt. Mark Malakooti, NHB Population Health head. "They have been in middle to older aged persons who have had medical conditions that made them more likely to suffer severe influenza.

"There have also been reports of severe respiratory illness in young and middle-aged adults caused by influenza H1N1. Since this is the strain that caused an unexpected high rate of serious illness in children and young adults during the 2009 pandemic, it is even more important to emphasize that all age groups should be protected by receiving the influenza vaccination, whether young and healthy or older with chronic illness."

Navy Medicine's seasonal influenza vaccine immunization program was held in October 2013 with a weeklong Influenza Vaccination Clinic, specifically designed for Sailors and Marines, mission-essential healthcare personnel, and eligible beneficiaries. Many have already gotten their flu shot and for those who missed that opportunity, they can visit NHB's Immunization Clinic at the main hospital and Branch Health Clinics that are offering both injectable and, for healthy patients between 2 years and 49 years of age, intranasal flu vaccine.

"For those who have not yet been immunized, the influenza vaccine is available at the Immunization Clinic at the hospital and the branch clinics, no appointment required," Malakooti said, adding that the current influenza vaccine includes protection against the H1N1 strain that is the most common flu virus circulating this season.

"While no vaccine is 100 percent effective, the current flu vaccine will greatly decrease the chances of influenza infection, and if someone does still become infected, they are less likely to have severe symptoms," stated Malakooti.

According to Malakooti, anyone can become infected by this H1N1 strain of influenza, but people who are vaccinated are much less likely to become infected, and even less likely to become seriously ill. Due to the six fatalities in the state, H1N1 flu has been in the news of late. State Health Department data shows three confirmed flu deaths as of mid-December, with another two deaths during the first week of January, and one more confirmed Sat., Jan 4, in Grant County.

"Influenza is currently widespread in Washington state, and the numbers continue to increase as we move towards the peak of the flu season. It is definitely still worthwhile to get immunized with the current influenza vaccine," stressed Malakooti.

Malakooti notes that the US Centers for Disease Control and Prevention recommend that everyone, even those as young as six months, should get the influenza vaccine each year. It is especially important for pregnant women and people with chronic diseases like asthma and diabetes, and those that have weakened immune systems.

Additionally, Dr. Dan Frederick, NHB Population Health and Forecasting expert, points out that the value of vaccinating the pregnant population is multiplied because of the cocooning protection to the newborn when mom (and other close household contacts) are vaccinated. Just as it is important for military personnel who live and work in close quarters to receive the vaccine, it is also highly recommended for school-aged children, as they come into close contact with each other and can easily spread the influenza virus.

For those who have already received their immunization, they do not need to receive it again - only children who have never received a flu vaccine because they require a two-shot series the first year they get vaccinated.

For those with flu-like symptoms such fever, sore throat, body aches and pain, etc., Malakooti that they should stay home and rest to recover quicker and prevent spreading the infection. Drink plenty of non-alcoholic/non-caffeinated fluids, cover coughs/sneezes, and wash hands frequently. "And get their immunization," he added.

The H1N1 flu is a relatively new influenza virus, first detected in the U.S. in April 2009, as well as many other countries around the world.

"Our experience in the past with H1N1 flu reinforced the need to protect ourselves," said Tom Shirk, NHB Infection Control coordinator, who also recommends for everyone to continue proper personal hygiene at all times. "It's the little things that add up to the whole, such as hand washing, covering a cough, and staying home if ill. We now know it's important and it's up to us to not only set the example, but ensure our family and friends do the same."

Immunization remains the primary method of reducing seasonal influenza illness and its complications. The seasonal influenza vaccine not only helps protect vaccinated individuals, but also helps protect entire communities by preventing and reducing the spread of the disease.

Influenza is not the common cold. Influenza can be a severe to life-threatening disease and getting an annual influenza vaccine immunization (either the traditional shot in the arm or the newer nasal spray vaccine) protects many people from getting the disease or becoming severely ill.

There are also multiple steps, attests Shirk, that can be done daily to mitigate the potential spread of the flu. "Besides hand washing with soap and water, we encourage everyone to use our alcohol-based hand sanitizers," said Shirk. "They are phenomenally effective in eliminating the transfer of a virus. Anyone entering and leaving, or waiting by the elevators can use them."

Influenza is thought to spread mainly from people touching something with influenza viruses on it and then touching their mouth or nose. One of the challenging aspects of flu is that someone who becomes infected can infect others one day before they have symptoms and up to five days after becoming sick. Influenza usually causes mild to severe illness, and uncommonly can lead to death. Symptoms of influenza include fever, headache, extreme tiredness, dry cough, sore throat, chills, runny or stuffy nose and muscle aches. Stomach symptoms such as nausea, vomiting, and diarrhea also can occur but are more common in children than adults. Traditionally, seasonal flu impacts the elderly and the young.

"I encourage parents to get a thermometer for home-use if they don't have one already. If a family member is running a fever of 100.4 or greater has a cough and/or sore throat then it is very possible that they have influenza," noted Shirk. "If anyone is concerned that their symptoms are not consistent with a mild case of the flu, they should contact their medical provider and/or seek medical attention. For those with mild symptoms recovering at home with over the counter medications for symptom relief is usually all that is needed."

According to the CDC, every year in the United States, more than 200,000 people are hospitalized from influenza complications and about 36,000 people die from influenza-related causes.

General information of seasonal influenza can be found at http://www.cdc.gov/flu/.

What can people do to protect themselves against the flu virus? Naval Hospital Bremerton follows CDC recommendations to:
* Avoid close contact with people who are sick, when you are sick, keep your distance from others to protect them from also getting sick.
* If possible, stay home from work, school and errands when you are sick. You will help prevent others from catching your illness.
* Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
* Washing your hands often will help protect you from germs.
* Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his/her eyes, nose or mouth.

Different Influenza Types
Seasonal flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available.

Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person.

Avian Flu is caused by influenza viruses that occur naturally among wild birds. Low pathogenic avian flu is common in birds and causes few problems. Highly pathogenic

H5N1 is deadline to domestic fowl, can be transmitted from birds to humans, and is deadly to humans. There is virtually no human immunity and human vaccine availability is very limited.

Bird Flu is commonly used to refer to avian flu. Bird flu viruses infect birds, including chickens, other poultry and wild birds such as ducks.

Patient-Centered Care Remains the Focus During Naval Hospital Bremerton Transition

By Douglas H. Stutz, Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- Naval Hospital Bremerton's (NHB) legacy of providing patient-centered care, concern and compassion will continue as the command reshapes and realigns resources to better serve the beneficiary population.

NHB will focus on offering timely outpatient services with increased inpatient and ambulatory surgery to support the enrolled population. The bottom line is that NHB will maximize resources to maintain mission readiness, provide value and continue quality patient-centered health care to all patients.

"We are not closing our hospital nor are we discontinuing services," said Capt. Christopher Quarles, Naval Hospital Bremerton commanding officer.

Perhaps the most noticeable transitional change for NHB will be the conversion of the Emergency Department to an Urgent Care Center (UCC) by September 2014.

NHB's Emergency Department has traditionally treated a low volume (less than three percent) of actual sight, limb or life-threatening medical emergencies. An UCC provides the ability to deal with a wide spectrum of medical ailments from a mild case of poison ivy to handling broken bones, stitching up cuts, and caring for minor burns or bruises. The NHB UCC will be available to beneficiaries 24 hours a day, seven days a week, with acute care needs handled on a case-by-case basis.

In emergency cases, patients will be transferred via ambulance to the local Emergency Room at a community hospital such as Harrison Medical Center.

"The best course of action that any of our patients should do is first start off with seeing their regular health care provider and Medical Home Port team. Providing patient and family-centric care is what they do," stated Quarles, noting that NHB's Medical Home Port teams deliver basic care for common ailments and illnesses, minor injuries and routine health exams, as well as help every patient manage their health care.

According to Quarles, every patient should use their Medical Home Port team to schedule appointments for such medical needs as common illnesses as flu and fever; minor injuries such as sprains and strains; and regular physicals, prescription refills, vaccinations and screenings.

"But when it's after hours or on the weekend, and someone's regular health care provider isn't available, our Urgent Care Clinic is here to handle our patient's needs," Quarles said.

There are approximately 59,000 eligible beneficiaries of active duty service members, retirees, and their families in the West Puget Sound, with more than 29,000 enrolled at NHB.

From 2011 to 2013, the Bureau of Medicine and Surgery conducted a study on nine Navy Military Treatment Facilities across the U.S. and evaluated their patient population needs, which showed advances in clinical medicine along with technology, resulted in a migration of care from inpatient to predominately outpatient services and provided an opportunity to shift to ensure there is a correct mix of personnel and service to meet the needs of active duty service members, family members and retirees.

Another notable alteration to NHB includes the closing of the Intensive Care Unit due to low patient usage. Those in need of admission to an ICU will be referred to a local area hospital in June 2014.

Additionally, the command's Family Medicine Graduate Military Education program will be slowly but surely phased out with residents redistributed to other Military Treatment Facilities through 2016.

NHB will continue to offer a broad spectrum of needed and necessary inpatient needs such as Northwest Beginnings Family Birth Center and Obstetrics and Gynecology services, Orthopedics, Main Operating Room, inpatient General Surgical procedures with robust outpatient surgery services; Radiology (mammography, Magnetic Resonance Imaging, X-ray, fluoroscopy, computed tomography, ultrasound, nuclear medicine) Physical Therapy; Ears, Nose and Throat Clinic, Audiologist, Ophthalmology (Lasik), Oral Surgery, Urology, Optometry, Pharmacy, Laboratory, Internal Medicine (gastrointestinal/Endoscopy, Pulmonary/Respiratory Therapy, Cardiology, Neurology), Dermatology; Mental Health (and Substance Abuse Rehabilitation Program), and Pediatrics Department.

Primary care services have transitioned these last several years from the individual patient/provider model to a standardized primary care team model to provide better access, continuity, wellness, and disease management for patients.

By standardizing primary care services and enhancing access and continuity, NHB has improved the partnership between the patient, his/her primary care provider and their primary care team, and where appropriate, the patient's family. This partnership has focused on sustaining and enhancing wellness for patients as well as providing efficient delivery of comprehensive health care services, based on the needs of our patients. This effort aligns with civilian models of enhanced primary care known as Patient-Centered Medical Home (PCMH). In Navy Medicine, PCMH is known as "Medical Home Port."

What is a Medical Home Port Team? NHB has reorganized the primary care clinics into smaller group practices, or "Medical Home Port Teams." These healthcare team will work together to assure every patient's care is provided in a coordinated, comprehensive manner.

This is 'team-based' healthcare: A patient will have an entire team responsible for their healthcare. In addition to a primary care manager (PCM), there will be a registered nurse, and a hospital corpsman and/or medical assistant assigned to the healthcare team. Additional physicians/providers are also part of the team to fill in during absences. This team will partner with every patient to fulfill administrative requests and provide additional medical services.

How does a patient get assigned to a Medical Home Team? If a patient is already enrolled in TRICARE Prime at Naval Hospital Bremerton, there is no need to do anything. Medical Home Port Teams are in place in the Primary Care Clinics at the Naval Hospital and Branch Health Clinics and patients will automatically be assigned.

How can a patient schedule an appointment with their Medical Home Port Team? Patients do not need to do anything different than they have in the past. Contact the TRICARE Regional Appointment Center at 1-800-404-4506 to schedule an appointment.

Additional ways to reach your PCM and team: If any patient has a question that doesn't require an appointment, they may contact the clinic directly to speak with their Medical Home Port Team.

RelayHealth offers health care options - all primary care manager and Medical Home Port teams are available 24 hours a day for non-urgent questions and requests online through the RelayHealth Secure Messaging system.

Any beneficiary can sign up for this service at their next visit or through the website www.relayhealth.com/patients and search for their PCM.

NHB strongly encourages all patients to enroll in RelayHealth, a secure messaging system. RelayHealth allows two-way communication between patients and the Medical Home Port Team to answer questions, refill medications, receive test results and more.

RelayHealth is a web-based doctor-patient service that makes it easy for any patient to communicate with their provider's/doctor's office.

Patients can request appointments, renew prescriptions, ask non-urgent questions, and receive lab results-all from their home computer. This can reduce phone calls, waiting-room time, and the time it takes to travel to their doctor's office. Patients can use www.relayhealth.com/patients to consult with their doctors about non-urgent medical care needs.

RelayHealth provides connectivity that enables all participants in the delivery of healthcare to communicate with each other more efficiently, effectively, and securely.

RelayHealth benefits also include; access to lab and other diagnostic test results; consultations for non-urgent health matters; access to view healthcare account information; and pay bills.

Patients can also use RelayHealth to set up and management of Personal Health Records, which features; consultations with your provider; prescription renewal appointment scheduling; Personal Health Record management and referral requests; and access to Medically Reviewed Information.

For more information, visit http://www.relayhealth.com/patients#sthash.eZWRDT2U.dpuf.

Showing their Playoff Colors at Naval Hospital Bremerton

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- Is it just a coincidence that the Navy's Working Uniform (NWU) has a color-scheme that bears some semblance to the hue and tint of the Seattle Seahawk uniform?

The similarities of color have not gone unnoticed for some Naval Hospital Bremerton staff members, especially during this year's national Football League playoffs with the Seahawks hosting the New Orleans Saints on Sat., Jan 11.

"I have thought about that. Just think, everyone in the Navy is actually wearing Seahawk colors," said Hospital Corpsman 3rd Class Tyler J. Wharton of NHB's Operational Readiness Department, and Shelton, Wash. native.

Wharton is also a member of The 12th Man, the Seahawks loud and proud fan base who routinely strive to build upon their tradition as having the loudest stadium in professional football. Seattle heads into the playoffs with the best record in the NFC at 13 wins with only three losses, having earned a first round bye and home field advantage through the playoffs. They have only dropped one game at home in the past two seasons. Many attribute part of that success to the solid and boisterous fan support.

"The 12th Man brings good, loud, luck. Cheering for your team is part of the game. I was at the Tampa Bay game when we were down by 21 and came back for the win. That was huge and I know The 12th Man had a part in the win," Wharton stated, alluding to the impact their noise has at home games by causing opposing teams to have communication gaffes such as momentum-stalling false start penalties.

Just as the NWU's blue and touch of gray color scheme is indicative of the Navy's nautical and ship heritage, the Seattle Seahawk uniform colors were designed with Seattle's reputation of being in sync with surrounding Pacific Northwest ecosystems. The designated colors represent the waters of Puget Sound and the prevalence of surrounding greenery, specifically evergreen trees that are throughout the city and entire region.

"Well of course the NWUs have Seahawk colors. I had some recommendations that were implemented in their design before I retired. If they had green in them, I'd have gone out and got a pair," quipped Casey Pruett, of NHB's Suitability Screening and Exceptional Family Member Program and Seahawk fan who routinely wore a Seahawk shirt on 'sports-shirt Thursday' during the regular season.

The Seahawk uniforms also have a touch of white for the snow-covered Cascades mountain range that rings the city, a grey color that signifies the overcast cloudy days during football season - there's a reason why there's so much green; it rains - and there's even a splashier shade of green.

"All the NWU really needs is just that little bit of extra bright green and we'd really be good to go," Wharton said.

Melissa Rochefort, referral coordinator with NHB's Utilization Management has been a Seahawk fan for years and attests that the last three years have been especially fun for her and her husband Phil to follow the team.

"Doing as well as they have of course has a lot to do with it and going to the games is a lot of fun," Rochefort said. "There's so much energy there."

And the game itself?

"It'll be a much closer game from the first time they met (a 34-7 Seahawks romp on Dec 2), but Seattle will win. I don't think the Saints can match up with the Seahawks physically," Pruett said, predicting a Seahawk 24-10 win.

"Seahawks by at least seven this time against New Orleans," added Wharton.

"I'm almost hesitant to make a prediction. I think we'll be on the edge of our seats and it will be a close game with the Seahawks prevailing," said Rochefort.

Yet there are those who have not jumped upon the local team bandwagon and are not taken by The 12th Man rallies at the state capital in Olympia or local gatherings by Kitsap area chamber of commerces.

"That guy Russell Wilson is the real deal. His level of maturity is impressive and he's genuine. But I'm an (Oakland) Raider fan and not one who thinks when you transfer from one place to another you automatically shift your allegiance," shared Hospital Corpsman Chief Macorcel Gozum, Leading Chief Petty Officer for Patient Administration and Decedent Affairs.

"And I think they're going to knock off New Orleans," Gozum shared.

First Baby of 2014 Welcomed at Naval Hospital Bremerton

By Mass Communications Specialist 1st Class James Evans Coyle Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- After 29 hours of labor the first baby of 2014 was delivered at 5:17 a.m. on New Year's Day at Naval Hospital Bremerton's Northwest Beginnings Family Birth Center.

The birth of the 6-pound, 14.4-ounce, 20 inches long, not yet named baby girl to Sonar Technician Submarine 1st Class Eric Cornelius' wife and is the couple's first child.

"We're expecting great things from her. Not only was she the first baby born here at the hospital, but she was also born with her water bag intact and we are all very, very happy," said Cornelius' wife.

The Cornelius baby is exceptional for not only being the first baby born at NHB for 2014 but for also being "born in the caul" - born with an intact amniotic sac. According to the University of Rochester Medical Clinic's OB/GYN Encyclopedic Medical statistics a baby who is born this way occurs in less than one out of every 1,000 births.

To be "born in the caul" means a child is born with the amniotic sac or membranes still intact around a newborn's body. The sac consists of two adherent membranes (chorion and amnion) of fetal origin which separate the amniotic fluid and fetus from the maternal uterine wall. When a baby is born in the caul, the sac balloons out at delivery, covering the baby's face and body as he or she emerges from the mother.

According to medieval legend, the appearance of a caul on a newborn baby was seen as a sign of good luck. It was considered an omen that the child was destined for greatness. Gathering the caul onto paper was considered an important tradition of childbirth. The midwife would rub a sheet of paper across the baby's head and face, pressing the material of the caul onto the paper. The caul would then be presented to the mother, to be kept as an heirloom. Other medieval European traditions linked being born with the caul to the ability to defend fertility and to harvest against the forces of evil.

For being the first born in 2014 at NHB, the Cornelius family received a gift basket that included baby toys, diapers, blankets, books other items commemorating the special event from the command's Oakleaf Club association.

The Oakleaf Club is comprised of Medical, Dental and Medical Service Corps officers' spouses and is active in promoting community awareness and supporting staff members and beneficiaries at the hospital through charitable projects.

Cornelius who is stationed at Trident Training Facility, Naval Base Kitsap Bangor, Wash., said he was looking forward to the future with his expanding family.

"I don't really know what to say other than I'm so incredibly proud of my wife and new baby. She's so wonderful with the way she was born into the world and being the hospital's first baby of 2014. We're all very excited and proud," Cornelius said.

Eye Opening Efforts by Naval Hospital Bremerton Optical Support Unit
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- They are a team that is out of sight for most yet impact the vision of many.

There are over 26,000 reasons in the past fiscal year alone why Naval Hospital Bremerton’s Optical Support Unit has made their efforts an eye-opening continuous accomplishment.

 “Our Optical Fabrication Shop fabricated 26,565 pairs of glasses for the most recent fiscal year.  That would be second highest production total in the Navy, quite a feat and an important contribution to readiness for all the commands in the area.  Bravo Zulu to our Optical Support Unit staff of Hospital Corpsman 1st Class Gil Umayam, Machinist’s Mate 2nd Class Steven Collier, Hospitalman 3rd Class Brandon Minyard, Hospitalman Kendra Heikkila, Hospitalman Clifton Lee,” said Capt. Christopher Quarles, Naval Hospital Bremerton Commanding Officer recently sharing with the entire staff on the workload achievements of the shop.

The Optical Support Unit (OSU) that handles the duties of the Optical Fabrication Shop fabricates single vision glasses for all eligible active duty and retired service members.  Additionally, the OSU team can provide certain tints to lenses to provide UV protection when worn outdoors.

 “We can’t overstate the importance associated with having the best eyesight possible as well as having the best eye protection to prevent eye injuries. That’s what we provide here on a daily basis,” said Hospital Corpsman 1st Class Gil Umayam, leading petty officer and lab manager.

According to Lt. Mike Buyske, Optometry and Optical Fabrication department head, NHB has one of 16 fabrication labs in the Navy not counting Naval Ophthalmic Support & Training Activity. They produced the second highest total of glasses over the last fiscal year, primarily due to the OSU Sailors, who are highly regarded by Buyske as the "workhorse" of NHB’s Optometry clinic. 

 “The corpsmen fabricate about 150- to 200 pairs of glasses per day in our lab.  Not only do they provide glasses for patients seen at NHB, but also those at our Bangor and Everett branch clinics, and many military clinics across the Pacific Northwest, including Whidbey Island, Joint Base McCord, Fairchild Air Force Base, Joint Base Elmendorf-Richardson, and Ft Lewis, to name a few,” explained Buyske, citing that the OSU team strives to have a 24-hour turnover on all orders received electronically from other bases, as well as same-day service for our patients seen at NHB. 

“Actually, the Army is our main customer. About 70 percent of our product goes to them,” said Hospital Corpsman 3rd Class Brandon Minyard, a Ft. Worth, Texas native and assistant leading petty officer.

“Often, the sheer volume of orders received precludes the same-day service, but those orders are always completed within 24-48 hours to ensure timely delivery of all spectacles to our patients,” added Buyske. 

The service(s) provided even goes beyond the line of sight. The more glasses the OSU fabricates, the more Sailors, Soldiers, Airmen, and Marines become operationally ready from a vision standard.  The work being done in the OSU directly impacts this readiness for commands across the military spectrum. 

“Additionally, it is a service that we are more than happy to provide our retired service members to maintain their optimum vision and, in most cases, help keep them from paying the high premium associated with bifocal and multifocal lenses out in the community,” explains Buyske. 

Buyske notes that optical labs were implemented at naval facilities to reduce the daily workload of the Naval Ophthalmic Support and Training Activity (NOSTRA), which is the Navy's main fabrication lab in Yorktown, Va.

“Utilizing a local lab also reduced the wait time for patients to receive their glasses by eliminating the need to ship out and receive orders.  There are still occasions where orders might to be forwarded to NOSTRA based on the amount of prescription or the type of glasses made, but most service members are able to receive their glasses in a matter of days vice weeks.,” Buyske said. 

NHB’s OSU can take care of all eligible active duty members and retirees who have prescriptions that can be made with the stock lenses. Bifocal, trifocal and high-order prescriptions are sent to NOSTRA for fabrication. That old joke about Navy-issue eye glasses being called ‘birth-control’ glasses is not applicable these days. There are multiple designs and styles available.

There are currently five corpsmen working full-time in the OSU and the two GS staff members who typically work with patients in the clinic are both familiar with the fabrication process and can assist back in the lab when they are needed. 

Buyske explained that all of the orders they get follow the same fabrication process to ensure the highest quality spectacles for every patient.  The orders are received and processed via the electronic Spectacle Request Transmission System (SRTS), and then individually placed in trays where they are then matched to the appropriate frames and lenses.  The lenses are then cut, shaped and placed into the frames.  Next, the corpsmen verify the prescription of the lenses based on the order and must adhere to very strict established margins of error or the lenses fall out of standards and must be re-fabricated.  After the verification process is complete, the lenses and frames are cleaned, placed in a case and either placed in a bin for shipping to the respective clinic or walked to the front to hand deliver to the patient.

“One of the most frequent compliments we get from our patients is with regards to the quick turnaround on their glasses.  They are very surprised that a free pair of glasses comes back so quickly to them and is a testament to the work being put in by our team in the OSU. We get a lot of ‘Wow, I never got my glasses this quickly at any other command’ and those always feel nice to hear, but don't always get filtered back to the OSU.  Any outside recognition the OSU gets is great because so much of what they do on a daily basis flies under the radar,” Buyske stated.

Both Umayam and Minyard echo Buyske that the best feedback they receive is when someone shares that their eyesight has improved.

“When I hear, ‘I can finally see,’ that makes me feel that we’ve done our job,” said Umayam.

If there is a difficulty beyond their immediate control, it’s the unpredictability of the volume of orders. Some days there might only be 75 orders and some days there will be over 300. 

“Fortunately, the OSU team is great at adapting to whatever the day brings and finding ways to complete all orders on time every time. They are exceptional at handling their responsibilities,” commented Buyske.

Buyske also recommend patients have their eyes examined every 12-24 months unless the doctor recommends otherwise.

“Having your eyes examined regularly ensures you have the most up-to-date prescription for glasses/contacts as well as a thorough ocular health examination,” said Buyske.

Navy Ortho Doc helps bring Medical Care to Afghans in need
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs --
The Tarin Kowt district of Afghanistan is mired in poverty, wracked by warfare, and beset by a host of concerns such as lack of available medical care.

Lt. Cmdr. Leah Brown helped to alleviate some of that medical care shortage by providing direct patient-centered care to the local population during her time recently deployed with Combined Joint Special Operations Task Force – Afghanistan.

Brown, an orthopedic doctor at Naval Hospital Bremerton received the Army Bronze Star for her humanitarian efforts when she assigned to the Role 2 hospital in Tarin Kowt Forward Operating Base, located in southeast Uruzgan province from Oct. 2012 to May 2013.

“I was part of a medical team utilized by special operations and we took on a humanitarian assistance role to visit the local hospital which served the entire province. They had a very large catchment area. It is also one of the poorest regions as well as a very traditional area that really needed dedicated medical support,” said Brown, an Atlanta, Ga. native who attended Benjamin E. Mays High School and the University of Georgia for her undergraduate work before going to Ohio State University and the Cleveland Clinic Foundation for medical school before her 10 years of Navy service.

Brown noted that as part of the Role 2 hospital’s medical team, she and others were invited by the local hospital equivalent of chief medical director to help them care and offer services to the surrounding population. Brown conducted orthopedic surgeries that the local doctors couldn’t handle as well as provided orthopedic care to many local children and men. She made such a positive impact, she even started treating women.

“Being able to treat Afghan women was a very big deal due to their rigid beliefs rooted in old ways. It was a huge turnaround and a big accomplishment,” Brown said, adding that as part of an all-female team, they really made a strong positive impression in providing health and wellness care.

As a result of their efforts, Brown attests that the all-female medical team really helped to win over hearts and minds and facilitate relationships.

“We started to see women on a regular basis at the Role 2. But at the start, we never saw any. Then we started to see young girls, then older women and then mid-adult age women. This symbolized that we had advanced in our relationship and were trusted. We visited the hospital and coordinated getting the patients to the base to the Role 2 facility which was one of the reasons it was such a big deal. It also helped to have an advanced female medical team made up of an orthopedic doctor, anesthesiologist, critical care nurse, hospital corpsman and translator. We pulled from every level of care we had to comprise our team,” said Brown.

The all-female team became high profile in the area, primarily all Navy with three Air Force personnel. They utilized all the resources at their disposal and devoted extra time and effort helping the local populace. Brown and her team shared what they could, donating underutilized supplies such as gauze and a few instruments. All this helped to show that they were willing to assist the locals. Still, they were in the midst of a very volatile region of the country. They were always very careful in going to the hospital to provide medical care. Hospital visits were always carefully coordinated with safety and security being of paramount importance.

The local hospital itself had seen better days. Three decades of war had depleted skilled medical workers, what supplies were to be had, and there was a limited infrastructure, not only in the hospital but throughout the region.

“The hospital staff was limited due to the constant danger and there were simply not a lot of resources. It was also frustrating to see so much poverty and what the prolonged war had done to the country. In conversation with our translators, they would share on how it used to be. It’s sad,” Brown said.

Due to local tradition, the Tarin Kowt hospital was segregated along gender line. There was an entire separate area in the hospital for women, which lacked many of the amenities found on the other side of the hospital.

“It was vastly different. We even provided a lot of health items for women. Their female medical director, really an equivalent to a midwife, was aggressive in pushing the agenda for women’s health care. We did mid-wife training for a group of 14-15 year old girls, who were essentially the only providers available for women there. The main concern for medical attention for women was it was just mainly required during the birthing process,” related Brown.  

Along with being smack in a war zone and trying to deliver medical care to a populace in need, there were constant logistical, location and logical issues to handle and try to comprehend on a daily basis. Those dilemmas were part of the legacy of constant warfare, pain, and suffering for overlapping generations over the past 30 years.

“Dealing with the Afghan people in such a different environment to ours, and trying to understand the psychology of them living in nearly impossible situations was so difficult,” Brown shared, adding that the cultural divide would always lessened when a local hospital provider would contact them to see a specific patient.

“There were many cases I remember such as when we were asked to care for a local child with a femur fracture that had been that way for a week, and the provider added an ‘oh by the way can I send another I’m caring for.’ The other kid, around 10 to 12 years old, had wounds sustained from live ordnance – with a finger already amputated, an upper extremity open wound and a serious tibia fracture. We took care of him and essentially saved his leg,” said Brown.

Local children finding improvised explosive devices and unexploded ordnance were a constant theme. Another local child found ordnance and the resulting blast caused a huge skull defect.

“The child’s father had cared for him but we took him in and immediately provided emergency care. With treatment and therapy the young child went from being bed ridden to using a walker to zooming around our area,” remembered Brown, adding that they then got to send him to the Role 3 multinational medical unit at Kandahar Air Field and then on to Landstuhl Regional Medical Center in Germany for neurological help. “It was case by case consideration, but that’s an example of doing all we can.”

“It was a hard deployment but our entire base embraced what we did at the hospital. Everyone got involved, from helping with a blood transfusion to bearing a litter. There was a definite ‘what can we do to help?’ feeling at the FOB. From the gate to operating table to recovery, a local was never alone. The morale of our forces always got a boost from helping a local who received medical care. It gave us all an improved outlook,” Brown said.

The deployment also had traumatic moments. Special Warfare Operator 1st Class Kevin Ebbert, a hospital corpsman with 18-Delta combat medical training, was killed in action on November 24, 2012 while supporting stability operations in Uruzgan Province.

I was able to work with a great team. We made due with the resources we had. There was no ‘Gucci medicine’ practiced here. We were all a little proud to do a lot without all the extras that are normal at our military treatment facilities. We got used to that.  I wish people knew more on what we did,” stated Brown.

Brown’s efforts did get noticed internally with the Army Bronze Star. Her advice for those following?

“Practice medicine with the total altruistic reason that got you into the field in the first place. You get what you get and you provide what you can, even if it’s just a band-aid or pair of crutches with a smile,” shared Brown.

Note: Role 2 is a Battalion Aid Station providing emergency surgical care, stabilizing hemodynamic status in order to send the patient to the Role 3. It is also where the wounded are linked up with a nurse and physician in the chain of evacuation. A Role 1 refers to emergency medical care in the field, historically handled by independent duty corpsmen. The Role 3 multinational medical unit at Kandahar Air Field has the
highest level of care available in theater, with additional capabilities such as specialist diagnostic resources, specialist surgical and medical capabilities, and preventive medicine. Landstuhl Regional Medical Center, Germany, is the
largest American hospital outside the United States and an example of a Role 4 facility. Role 5 sites are stateside rehabilitation facilities.

Corpsman Courage and Combat Care - Bronze Star with Combat V presented to Naval Hospital Bremerton Hospital Corpsman

By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Running 300 meters, just under the length of a flight deck, is one thing. Legging that distance out across improvised explosive device (IED) laden ground as a target for small arms fire to save the life of a severely wounded soldier is quite another.

That’s exactly what a hospital corpsman on deployment to Afghanistan did on July 19, 2011.

Hospital Corpsman 2nd Class Michael Marchante, currently assigned to Naval Hospital Bremerton, was involved in combat operations searching for enemy locations when a soldier from the Republic of Georgia stepped on an IED in a wadi (dry streambed) in southern Helmand Province. Marchante immediately ran to save the life of the badly wounded platoon commander. He promptly applied tourniquets and pressure dressings to staunch the rapid blood loss while coming under heavy enemy gun fire. With the bullets flying all around, he shielded the casualty with his own body and continued to provide life-saving medical care.

For his actions on that day, Marchante was recognized with the Bronze Star medal with Combat Distinguishing Device at an award ceremony at NHB on Oct. 25.

“It was just something that came naturally. As soon as I heard the blast, my training kicked in and I ran to provide medical care. I was the only corpsman there, and that’s what we do,” said Marchante, understating the surrounding dangers of his involvement.

“What he did doesn’t surprise me at all. He’s a very humble, hard-working and reliable corpsman,” commented Hospital Corpsman Chief Philip Nacionales, Director for Nursing Services Leading Chief Petty Officer.

The day began with Marchante, a Murrieta, Calif. native, part of a mounted Marine patrol from Patrol Base Didgori that linked up with the other coalition forces to participate searching a specific area that was known to provide the enemy with firing positions. After Marchante’s group established a western vantage point in the area in question, they soon came under sustained small arms fire. Meanwhile, elements of the 33rd Georgian Light Infantry Battalion were actively sweeping for reported IEDs in the area. The soldiers were moving back to their vehicles when the scout platoon commander stepped on a pressure-plate IED. The subsequent blast hurled him into the air, amputated his right leg, and peppered his other lower extremities with shrapnel.

Marchante immediately grabbed his medical kit bag and followed his team leader and two Marine explosive ordnance disposal (EOD) technicians as they quickly swept a safe path through the threat of secondary and tertiary IEDs to the wounded soldier. Once Marchante reached the severely wounded Georgian, he immediately came under small arms and heavy machine gun fire.

Witnesses note that the volume of fire was heavy for the first two to three minutes with rounds landing within inches of Marchante as he focused his complete attention on saving the life of the soldier in front of him. Without regard for his own safety, Marchante instinctively used his body to shield the casualty. While initially positioned at the foot of the casualty, he then pivoted, exposing his back to enemy fire while he knelt over the casualty to continue to provide protection as he rendered the needed critical care. As the enemy fire continued, other coalition personnel went prone to avoid it, but Marchante remained in his kneeling position to continue to provide vital emergency care.

He applied tourniquets to both legs and several pressure dressings to stop the heavy blood loss. After the Marines positioned a Mine-Resistant, Ambush Protected (MRAP) vehicle to shield the casualty and Marchante, that ended the incoming gunfire threat. By that time, the bleeding had stopped and Marchante assisted in loading the casualty into the vehicle which was then used to transport to a hastily-setup helicopter landing zone. Marchante continued to provide medical aid in the MRAP and up to the point the casualty was handed off to the crew of the Medical Evacuation helicopter.

Throughout Marchante’s deployment, his medical assistance was officially documented to be directly responsible for preserving the lives of 14 Georgian soldiers. The summary of action on his award for the Bronze Star asserts that ‘his courage under fire, his care for his fellow man, and his proficiency as a corpsman were inspiring to witness. For the impact he made on the 33rd Georgian Light Infantry Battalion and his heroic actions on July 19 in which he prioritized the care of a wounded coalition partner above his own personal safety,’ he was recommended for the Bronze star with Combat Distinguishing Device.

“The Marines I deployed with, Army medics and other corpsman in Afghanistan and elsewhere…this is what we do. I didn’t think I did anything special, except my job. When I transferred from Camp Pendleton to here, I was told about being put in for an award, but I didn’t think much about it. It’s very humbling and overwhelming. I wear this medal for all the corpsmen,” Marchante said, at the time attached to Supporting Arms Liaison Team Delta, 1st Air Naval Gunfire Liaison Company, Headquarters Group (Forward), 11 Marine Expeditionary Force (Forward) from May 15, 2011 to Dec. 4, 2011, with the mission to provide support to a few isolated patrol bases manned by soldiers of the Republic of Georgia.

“Marchante displayed courage in the face of the enemy while under fire, and his actions undoubtedly saved the life of the scout platoon commander that day,” stated U.S. Marine Corps Capt. S.A. Stewart, team leader, who witnesses the actions.

Staff Sgt. L.J. Mathews, team leader for the Marine EOD response unit, noted that Marchante consistently exposed himself to enemy fire in order to provide medical assistance to the casualty.

“His decisive actions saved the life the Georgian scout platoon commander and are deserving of recognition for valor,” affirmed Mathews.

Overall during that time, Marchante conducted over 100 combat patrols and 50 convoys in support of the 33rd and 31st Georgian Light Infantry Battalion. He established himself as the most knowledgeable medical provider for over 400 Marines, Georgian soldiers, Afghan National Army soldiers and Afghan interpreters.

Along with being continually sought out to provide medical care ranging from scorpion stings to gastrointestinal concerns, Marchante also mentored and tutored the Georgian medics. He also rendered medical care to local nationals, including treating one child suffering from an open fracture. Because of that care and compassion, he helped strengthen the relationship between the Georgian soldiers and the local residents, considered one small victory in the difficult counterinsurgency fight.

As were his efforts on July 19, 2011.

Keeping the Lights on for those Deployed at Naval Hospital Bremerton
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs --
Naval Hospital Bremerton’s staff members came together on Dec. 6 to remember those away from home for the holidays on deployment with the annual Tree Lighting Ceremony.

Along with the hanging of ‘Individual Augmentee (IA)’ ornaments by designated sponsors of those currently deployed, the event also gave staff and family members an opportunity to share in a festive, seasonal observation with the sounds of music of the holidays.

“Naval Hospital Bremerton continues to support the fighting force by sending outstanding Sailors out on deployments. Naval Hospital Bremerton would like to extend our greatest sense of gratitude and compassion to you and your families, especially to those of you with absent family members,” said Religious Programs Specialist 1st Class Claire Hickman, master of ceremony.

Hickman requested to those in attendance who are facing deployment, know or have someone currently deployed, or have been deployed at any time, to stand and be recognized.

Almost the entire crowd – active duty and civilian staff, family members - rose as one.

“It’s always hard enough to be deployed, especially as an Individual Augmentee when we go alone. It’s really hard to be deployed over the holidays. We do a good job to remember those overseas and events like this help support them and our families who miss them. Our Tree Lighting Ceremony will give us a visual reminder every day of those deployed. We will keep them in our minds until they are home, safe and sound,” said Capt. Christopher Quarles, NHB Commanding Officer.

As the names of the 20 forward deployed NHB staff members – all but one currently assigned down range supporting Operation Enduring Freedom in Afghanistan - were formally read, either a visiting family member or co-worker stepped forth to place an IA ornament on the tree in their remembrance and honor.

Trisha Jantzi of NHB’s Family Medicine department took part in the ornament hanging in honor of Hospital Corpsman 3rd Class Kayla Blum.

“I was asked and was more than happy to take part on her behalf. I keep in constant contact with Kayla. When I told her what was going on, she said that’s great and thanked me,” related Jantzi.

Along with Blum, deployers remembered were Cmdr. Kenneth Sausen, Cmdr. Richard Lawrence, Lt. Cmdr. Steven Sarro, Lt. Cmdr. Phillip Hanson, Lt. Cmdr. Karen Woo, Lt. Cmdr. Jonathan Miller, Lt. Cmdr. Marc Silfies, Lt. Derek Olson, Lt. Isaac Hurley, Lt. Nathan Lee, Lt. Rio Corpuzmoss, Lt. Evan Romrell, Lt. Louis Sanchez, Lt. j.g. Justine Cisterino, Hospital Corpsman 1st Class Benjamin Chapin, Hospital Corpsman 2nd Class Patrick Barrantes, , HM3 Alexander Zeisberg, HM3 Nathan Nicholson, and HM3 Derek Kuzniar.

Hanging an ornament for Olsen was Lt. Clark Hartley.

“I was honored to volunteer. Whatever needs to be done, that’s what we do,” said Hartley.

Providing musical accompaniment for the Holiday Tree Lighting Ceremony was Navy Band Northwest Quintet of Ian Wheeler and Zach Conway on trumpet; Andrea Smith and Ben Dixon on Trombone and Collin Moos on tuba.

“As we unite around this beautiful tree let, us rejoice over those who have returned home safely, pray for those who are currently deployed, and remember the sacrifice of all those who have served,” Hickman said. 

 

Confidential Communications to Chaplains: You Hold The Key

From Naval Hospital Bremerton Pastoral Care Department – There is confidence in being able to privately confide with a Navy chaplain.

However, a recent study showed otherwise. During a recent campaign to educate the Navy on chaplain confidentiality, a survey was conducted by the Navy Chief of Chaplains that indiscriminately asked 5,049 sailors if he/she believed that any information shared with a Navy Chaplain was kept confidential.

Unfortunately, an overwhelming 63 percent stated they believed the information was not kept confidential and 65 percent of the respondents believed certain matters were required to be shared with the command.  These statistics in particular exposes a long time suspicion of the Navy Chaplain Corps; Sailors don’t completely believe or trust in the sanctity of chaplain confidentiality.

Despite the many myths or sea stories floating around the Navy in relation to chaplain confidentiality, one thing has remained true since 2008; complete chaplain confidentiality is ardently supported and protected by Department of the Navy (DON). 

According to SECNAVINST 1730.9, Sailors and their families are given unconstrained ability to discuss personal matters in compete privacy with a chaplain.

DON believes such disclosure establishes a sacred trust, facilitates increased morale and mission readiness, and benefits both the individual and the institution.

Plainly put, the Navy benefits from the pastoral care given to its people and pastoral care can only be done properly under the protection of confidential communications. Confidential communications includes acts of religion, matters of conscience, and any other information conveyed to a Navy chaplain.  These communications can also be conveyed through oral or written means, but not limited to, letters and electronic media.

The DON’s advocacy of confidential communication is so strong that chaplain confidentiality extends beyond the end of the counseling relationship and actually extends beyond the death of the individual being cared for.  

Navy chaplains not only have the professional obligation to keep all private information disclosed to them confidential, they along with commanders, are required to honor the sanctity of any confidential relationship between service personnel and themselves.

In all, Navy chaplains are bound by the sacred trust of absolute confidentiality. Neither the holding of additional professional credentials, nor the requirements imposed by state law relieve the chaplain of this responsibility. Navy chaplains knowingly enter into a contract with the understanding that absolute confidentiality must be maintained at all times.

Another interesting fact not widely known across the Navy is that Religious Program Specialists (RPs) are obligated to keep the same confidential discretion that chaplains are. 

Any confidential information shared with a RP is considered an indirect form of communication and must be shared with the chaplain immediately. Similarly, lay leaders, directors of religious education, and other support personnel who inadvertently become aware of confidential communications must keep such matters confidential, and immediately refer the matter to the chaplain.

According to the Navy Chief of Chaplains, there are five basic tenets of SECNAVINST 1730.9 and confidential communications: (1) Sailors, Marines, Coast Guardsmen, and families have the right and privilege to confidential communications with Navy chaplains. (2) Chaplains have the obligation and responsibility to protect and guard what you share in confidence. (3) Your command honors and respects the sacred trust between you and your chaplain. (4) Chaplains support you with dignity, respect, compassion, regardless of your individual beliefs. (5) Your chaplain is available 24/7 to provide you with a safe place to talk without fear or judgment and serve as an advocate to get you the support you need. The only person who can divulge confidential information shared with a chaplain is you; the person being cared for. You hold the key to your own confidentiality. 

Hopefully, the more proactive chaplains are in educating their commands on the truth about confidential communications; the more fleet folklore will dissipate and be replaced with trust and faith in complete chaplain confidentiality.

The Navy not only recruits qualified professional chaplains to care for the spiritual needs of its treasured personnel but entrusts those chaplains to honor the sacred bond of absolute confidentiality. Actions inconsistent with the guidelines listed in SECNAVINST 1730.9 may result in administrative and/or disciplinary action and may include the loss of chaplain credentials. Absolute chaplain confidentiality is paramount in the Navy and will be honored at all costs. Let the stigma be removed!

 If you have any questions in relation to confidential communications or chaplain confidentiality contact your command pastoral care department or visit www.chaplain.navy.mil.

In more Navy Chaplain news, Navy News Service reported that the Chaplain Corps launched its first official blog on its 238th anniversary, Nov. 28, to facilitate a unique and constructive two-way dialogue between the Chaplain Corps' leadership and their stakeholders, including service members and their families.

This new blog, hosted on the DoD Live platform, will help to inform and create a dialogue on how chaplains support the religious and pastoral care needs of Sailors, Marines, Coast Guardsmen, civilians and their families.

Navy chaplains and religious program specialists operate across a broad spectrum of environments to fulfill the mission of the Chaplain Corps: to inspire hope and strengthen spiritual well-being through the delivery and coordination of effective religious ministry at sea and ashore.

The blog will focus on how the Chaplain Corps meets its mission through the following core capabilities:

To provide and facilitate religious ministry.
Care for all with complete confidentiality.
Advise leadership on morale, the moral and ethical command climate, and religious matters that affect the command's mission.

Blog topics will include the following areas where chaplains are deeply involved: casualty support, wounded warrior care, suicide and sexual assault prevention and humanitarian assistance.

"As chaplains, we are appointed to support the free exercise of religion for all in the Naval service and their families and to support them in any way we can. This blog will help us better share our story and generate dialogue on what it means to answer the call to serve in Naval chaplaincy," said Chief of Navy Chaplains Rear Adm. Mark L. Tidd.

Visit the new Chaplain Corps blog at http://chaplaincorps.navylive.dodlive.mil/.

For more information on the Chaplain Corps, visit
www.chaplain.navy.mil and www.facebook.com/chiefofnavychaplains

Providing Infection Control Practices Down Range a Joint Effort for Navy Nurse
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- A Navy perioperative nurse with extensive knowledge in Infection Prevention and Control (IPC) from Naval Hospital Bremerton (NHB) shared her October-December deployment experience as the Navy’s first-ever representative with the Army's Infection Control Team in Afghanistan.

Cmdr. Fran Slonski, NHB Quality Management department head, assisted in support of Operating Enduring Freedom as part of a six-member team made up of active duty and reserve Army, Air Force and Navy IPC experts in conducting an extensive review of Role 2 and Role 3 (Role designations explained below) U.S., Coalition and Afghan medical treatment facilities to identify best practices, challenges and capabilities in the area of IPC and Infectious Disease (ID). 

“Our team was tasked with surveying all forward deployed operational medical battalions and their infection control practices. Our mission was to survey the medical units and provide on-the-spot education on IPC practices and recommendations for improvements,” said Slonski.

The team Slonski was assigned made 24 flights in 37 days throughout Afghanistan. They visited 11 medical units and conducted assessments and personnel training, as well as provided medical teams with clinical practice guidelines to use as resources for implementing IPC practices.

“We provided every site with a lecture on infectious diseases and resources for the medical teams to use for clinical practice guidelines,” Slonski said.

Infectious diseases in a war-time setting can be common as well as chronic. They can incapacitate and impair. There’s viral afflictions such as stomach flu (gastroenteritis) and upper respiratory infection. There’s food, water-borne and parasite-borne concerns such as malaria from mosquitoes and leishmaniasis attributed to the bite of an infected sand fly. There’s also worrying war wound infections and associated antibiotic-resistant organisms.

In the austere Forward Operating Bases manned by American and Joint Coalition forces throughout Afghanistan, along with dealing with explosions, gunfire, weather fluctuations, smoke, dust, and less-than-ideal sanitary conditions, there’s an ongoing struggle being waged directly against infectious diseases. Infectious diseases can debilitate any servicemember, at any time, at any place, during any deployment.

Battlefield and war-related infectious diseases issues in Afghanistan are part of a continuing military medical awareness campaign to prevent, control, and ultimately defeat. During the American Revolutionary War, the Continental Army under the command of George Washington was inoculated against smallpox, which some historians’ state was critical to the eventual outcome. In the Civil War, Federal troops had 110,000 troops killed in action, but lost twice that number - 224,580 - due to disease. Confederate troops suffered 94,000 killed in action, with 164,000 killed due to disease. There was less that 400 battlefield fatalities in the Spanish American War, with five times as many personnel who suffered, many fatally, from contracting yellow fever. 

In the Role 2 and Role 3 settings, Slonski and the team stressed enhanced awareness on hygiene and sanitary practices, such as the relatively simply process of applying a liberal use of hand sanitizing solution before caring for a patient.

“We found that there needs to be enhanced pre-deployment training in dealing with infectious disease for all personnel on all facets of deployment from tactical to medical delivery,” Slonski stated.

Capt. Brenda S. Davis, Navy Bureau of Medicine and Surgery, Assistant Director, Nurse Corps Policy and Practice, notes that the opportunity to increase nursing knowledge and improve nursing practice through joint efforts continues to expand within the operational environments.   Slonski’s efforts and knowledge gained through working with Army counterparts will be vital to Navy Medicine's participation in joint efforts, as well as helping to determine IPC/ID personnel assignments within theater, IPC/ID pre-deployment training needs, and logistics for equipment and supplies needed to support microbiology studies to best prevent servicemembers from acquiring serious wound infections while hospitalized in-theater. 

Findings of the team were reported to U.S. Central Command for further coordination.

Editor’s Note: The term "Role" describes the tiers in which medical support is organized, with Role 3 describing the capabilities of a theater-level hospital.  A Role 3 MTF, such as the Navy-run Hospital at Kandahar Airfield, includes additional capabilities such as specialist diagnostic resources, specialist surgical and medical capabilities, preventive medicine, food inspection, dentistry, and operational stress management teams. Role 1 refers to emergency medical care in the field, historically handled by independent duty corpsmen. Role 2 has been traditionally defined as Battalion Aid Station, where the wounded are linked up with a nurse and physician in the chain of evacuation. Landstuhl Regional Medical Center, Germany, is the
largest American hospital outside the United States and an example of a Role 4 facility. Role 5 sites are rehabilitation facilities such as Naval Medical Center San Diego.

Naval Hospital Bremerton Staff Run for the Super Bowl
MC1(SW/AW) James Evans Coyle, Assistant Public Affairs Officer -- Naval Hospital Bremerton staff members got a leg up on Super Sunday by participating in a 1.5 mile ‘Fun Run’ on February 1, 2013. The event was sponsored by the Second Class Petty Officers Association and took runners on an out-and-back course from the command through Jackson Park Navy Housing and back.

The runners came together for the Fun Run as an unofficial Super Bowl weekend kick off celebration to show football fan solidarity as well as enjoy the physical fitness aspect of the event.

Second Class Petty Officers Association President, Hospital Corpsman 2nd Class Kyle Hewitt said the Super Bowl presented the association with an interesting opportunity to use as motivation to get staff members to come out and get in a cardio-workout during lunch time.

"I know that people just sit around and watch the game but at least they can say they ran a 1.5 miler the Friday before the game. We had a good turnout of 15 people. It's good to see people want to get involved in their own physical fitness and as a group you have that extra motivation as opposed to just going out by yourself," said Hewitt.

The Fun run also provided the opportunity to focus on preparation for the semi-annual Navy Physical Fitness Test (PRT), which has become a hot topic in retention and advancement in recent years. Command PRT coordinators continue to strive for ways to get as many people active as possible, and impromptu command fun runs are one example. Lt. John Spannuth, NHB Family Practice nurse practitioner, recently coordinated a similar fun run during the fall, and NHB’s Health Promotion offers quarterly fun runs on the first day of spring, summer, fall and winter.

“It’s all about command participation and the chance to get out as much as possible that will give you that extra edge of getting the above average score in the PRT,” said HM2 Christopher Peacher.

With the success of the Super Bowl Fun Run Hewitt said he will look ahead to other sports themed runs at NHB.

“We’ve got the Daytona 500, then NCAA March Madness Basketball, then the NBA playoffs and on it can go,” said Hewitt.

Super Sunday Support for Special Olympics Washington by Naval Hospital Bremerton
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs --
‘Super Sunday’ started long before kickoff for Naval Hospital Bremerton staff members who volunteered in a variety of ways at the Special Olympics Washington SW Region Basketball Tournament held on Feb 3.

Several dozen NHB personnel assisted at the tournament by handling such duties as time keeping, scoreboard management and medal presentation. They also provided a lot of vocal, cheering support to the over 100 teams and approximately 1,000 athletes who took part in the annual sporting event that was held in five venues throughout the greater Bremerton-area.

“I don’t usually have such a good reason as this to get up at 6 a.m. on a Sunday,” said Hospital Corpsman 2nd Class Jay Hays, of NHB Oral Surgery, who helped keep score of the round-robin, whirlwind slate of basketball games.

Eva Levingrub, Special Olympics Washington SW Region Sports & Programs Manager noted that the athletes from Kitsap county and surrounding areas had been practicing for the last two months refining their skills. The tourney was the culmination of their hard work and they were all excited and ready to compete for the gold. 

“These events are not possible without the help of great volunteers to help us,” Levingrub said.

Camaraderie and competition were the hallmarks of the day. Shared smiles and infectious, energetic enthusiasm were evident from the court to the sideline.

“I love the atmosphere! I love the energy! The players on every team are so supportive of each other. I’m so glad I came. I have volunteered before when I was back in Virginia,” said HM2 Chayra Fernandez, who helped hand out awards to the various players after their games were completed and provided encouragement throughout the day to players on the court.

Besides the full-court games, there was also skills-competition for numerous squads to showcase team and individual skills with passing and shooting drills. Regardless of the outcome either on the court or in the skills competition, the final score always seemed to secondary to the lasting smiles on all players involved. They would each shake the hands of members of the opposing team and also thank the referees after the game.

“It’s always a lot of fun for everyone involved to be part of this,”
said Bill Burton, Bremerton Kitsap Athletic Teams (BKAT) coach. BKAT fielded 10 hoop squads for the tournament.

Burton’s daughter, Katie, an ice skate athlete for BKAT, is an American Red Cross volunteer at NHB and sang the National Anthem before the games began with other members of the BKAT ice skating team. “Having the (Naval) hospital here is always so great,” Katie said.

The games played during the Winter Basketball Tournament served as a qualifying round for the upcoming Washington State Winter Games, which will be held in Wenatchee in March.

Naval Hospital Bremerton Completes SAPR-F Training
By MC1(SW/AW) James Evans Coyle, Naval Hospital Bremerton Public Affairs --  Naval Hospital Bremerton wrapped up all-hands training on Feb. 1 with comprehensive and extensive Sexual Assault Prevention and Response-Fleet (SAPR-F) training.

SAPR-F instructor Lt. Patricia Butler said the new SAPR-F training, enhanced with a realistic 30-minute video production featuring Sailors on a ship who become caught up in a sexual assault situation, has encouraged individuals taking the training to keep focused on the main point.

“The new SAPR training offers many important things to Sailors. What’s really becoming clear to everyone is there are so many resources people can use and more than anything people need to speak up if they see something or know someone who may be having escalating problems with a shipmate,” said Butler.

Butler added that with each group there are diverse scenarios and engaging discussions. The significance of Sailors who have been out in the Fleet brings a vast amount of input, knowledge and awareness to each SAPR session group.

“There are different experiences brought in with each group. We’ve given the training to many people with stories of what they’ve come across in their Navy careers. It makes for a wide variety of discussion, which gives the training a better overall learning potential to listen and know what to watch for and do the right thing,” said Butler.

The Chief of Naval Operations Adm. Jonathan W. Greenert said the SAPR training will help make sure everyone gets the word that any sexual assault in today’s Navy is, “completely unacceptable” and “we’ve got to face the facts - sexual assault is an attack on a Sailor,” said Greenert.

“This is a very serious situation for the United States Navy and all the services,” said SAPR-F Instructor Lt Rachel Allnutt.

According to the 2011 Fiscal Year Report on Sexual Assault in the Military released in April of 2012, the total number of cases under investigation and reviewed for possible disciplinary action was 1,518.

 “No one wants to be faced with the degrading and demeaning consequences when there is a sexual assault. SAPR training will help ensure we all watch out for each other. With everyone’s continued diligence and awareness, we’ll help eliminate the problem,” Allnutt said.

NHB SAPR-F instruction staff held more than 30 SAPR-F awareness classes for hospital staff and Branch Health Clinic Puget Sound Navy Shipyard, Branch Health Clinic Bangor, and Branch Health Clinic Everett.

Naval Hospital Bremerton joins in ‘Ready Set Go 5210 Kitsap’ Community Kickoff Event
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton’s Health Promotion, in conjunction with Kitsap Public Health District, and YMCA of Pierce and Kitsap Counties, showcased the ‘Ready, Set, Go! 5210 Kitsap’ Community Kickoff Event at the Norm Dicks Government Center, Bremerton, Wash on January 29.

NHB’s Pediatrics Department nurse Lt. Lindsay McQuade addressed the audience of civic and community concerned citizens and elected leaders from the greater Kitsap area by sharing an healthcare example on how the 5210 campaign is being implemented in providing high-quality, patient-centered care.

“Prevention is easier that treatment. We contacted our Health Promotion department for the resources and prevention aids needed to help our patients. The 5210 campaign is a perfect way to reach out to the population,” said McQuade.

The 5210 campaign is based on scientific rationale that incorporates five fruits and vegetables daily into a person’s eating habits; advocates two hours or less for recreational screen time (television and/or computer) usage daily; encourages at least one hour of daily physical activity; and replacing sugary drinks with water and low fat milk.

Hoisting a 16-ounce soft drink bottle, filled with the amount of sugar in the serving, McQuade explained that using such a basic visual aid is an effective tool that kids can reach out and see for themselves exactly what’s in the beverage.

“Children pick up from their parent’s habits. Having a soda bottle filled with the amount of sugar in it is a good conversational tool during their appointment. It is a great way to segue into explaining about the 5210 campaign experience. We even hand out little ‘5210 Prescription Booklets for Healthy Living,’ that the kids can take with them as a ready resource to use at home as a healthy living guide,” McQuade said.

As is the case at various locales at their military treatment facility, NHB Health Promotion set up an informational booth at the event that displayed juice and soft drink containers by focusing on using the ‘sugar math’ formula to break down the actual contents of each beverage. Juice drinks have approximately 12 teaspoons of sugar per bottle. Juice products labeled ‘–ade,’ ‘drink,’ or ‘punch’ often contain five percent juice or less. The only difference between such products and soda is that they are fortified with Vitamin C. Even a 16.9 ounce soda advertised with ‘no caffeine’ has 55 grams of sugar. Four grams equate to one teaspoon. The ‘sugar math’ shows that means there’s 13.7 teaspoons of sugar in that one soda.

“So along with such drinks having very limited or no nutritional value, there’s a lot of empty calories. There’s also a lot of sodas that contain caffeine which is an ingredient children don’t need,” said Janet Mano, NHB Health Promotion coordinator.

According to Mano, the 5210 campaign promotes a healthy lifestyle by focusing on four basic areas – watching what people eat, reducing the amount of sedentary time (being in front of a TV or computer), being more active, and cutting back on sugar drinks.

“We’re targeting our beneficiaries with our public health, prevent medicine, and health promotion approach. Even if a person changes their behavior in just one area they will improve their health and achieve benefits,” said Mano.

McQuade attests that the 5210 campaign is not just being shared at Pediatric appointments, but is also explained during routine wellness visits and during such annual events as the Back-to-School/Sports Physicals. “There is a need. We’re reaching out to our patient population,” she said.

Along with McQuade sharing from the healthcare perspective, there were testimonials from other local advocates and experts from school, workplace and early childhood sectors on the need for such a campaign as 5210. Each speaker voiced the need that the 5210 campaign is a proven model that works. For some it starts at the dinner table trying to add fruits and vegetables and become more aware on portion sizes. Others shared on making minor but effective changes on their jobs such as replacing sodas with other beverages. Others noted that educating young students on basic food groups and introducing additional fun ways to exercise have already proven beneficial.

One of the highlights of the kickoff event was the local success story of Jonathan McHenry, who participated in the ABC TV reality show ‘Extreme Makeover Weight Loss Edition.’ McHenry, a husband, father of two, and worker in the fast food industry, had watched his weight steadily increase to such a degree that he lost control to handle it. The low point, he shared, was when he took his family to an event in Tacoma and couldn’t sit in his assigned seat because he was too large and used one of his children to mask his embarrassment. “I was heart-broken, It was time to take steps to get my life back. I didn’t want my kids to remember me as someone who ate himself to death,” said McHenry, adding that he had watched shows like ‘Biggest Loser’ while consuming ice cream, and would procrastinate that some day he would achieve the same level of determination.

“I would cry when someone made their goal,” McHenry shared. When he was 29 years old, he tipped the scale at 555 pounds. He made a tape and sent it in to several shows to become a ‘contestant.’ His wife gleaned a sliver of hope. But it wasn’t until he actually got selected and became immersed in the weight loss/life style change boot camp that McHenry knew he was going to make it. He has lost 250 pounds and is still making incremental progress. His defining moment in his weight loss struggle was when he was tasked during the show with hauling a two-ton plane for 1.5 miles.

“Pulling a 4,000 pound plane, attached by a strap, was a metaphor. It took little steps to finish. I had to keep constantly moving to reach my goal and be able to look back at what I did,” McHenry said, noting that accomplishing such a task made him a hero to his children, and that emotionally uplifting feeling reaffirmed to him that his on-going journey was progressing in the right direction. One small step at a time.

Dr. Scott Lindquist, Kitsap Public Health District Director and Health Officer, shared during his key note address that there is a local, national and global need for improving the health of communities we live in. Lindquist cited that the United States ranks first in obesity amongst western nations with over 28 percent. Locally, Kitsap County struggles as does much of the country. The obesity rate is over 50 percent.

“5210 is a strategic investment. It works,” Lindquist said.

 According to the Kitsap Public Health District on data compiled from the Behavioral Risk Factor Surveillance System and Healthy Youth Survey, 31 percent of 8th graders and 28 percent of adults achieve five fruits and vegetables on a daily basis in the Kitsap area. A diet rich in fruits and vegetables provides not only provides vitamins and minerals which are important for supporting growth and development and for optimal immune function in children, but the daily intake can also help with lower rates of chronic diseases such as heart disease, stroke, high blood pressure, and diabetes.

The American Academy of Pediatrics (AAP) estimates that the average child watches an average of 5-6 hours of television a day, which is associated with the nation-wide increased overweight and obesity in youth, along with lower reading scores and attention problems. There is a positive trend in the Kitsap area - Eighty percent of 8th graders average two hours or less recreational screen time, well above the national average.

Advocating one hour or more of physical activity is accomplished by 29 percent of 6th graders, 48 percent of 8th graders and 41 percent of adults in Kitsap. Regular physical activity is essential for weight management and helping with the prevention of chronic disease. While it’s noted that many school age children are active, physical activity declines during adolescence. Children raised in families with active lifestyles tend to stay active as adults rather than other children brought up in families with sedentary lifestyles.

The consumption of sugar-laden drinks has increased prominently over the past two decades.  Consumption by children is associated with overweight, obesity, displacement of milk-drinking and dental cavities. The recommendation is that children 1-6 years old consume no more than 4-6 ounces of juice per day and youths 7-18 years old drink no more than 8-12 ounces. Having children drink low or non-fat milk products significantly reduced dietary saturated and total far, as well as calories.

“Q-Flow” System streamlines service for NHB Pharmacy Customers
By MC1(SW/AW) James Evans Coyle, Naval Hospital Bremerton Public Affairs --
Naval Hospital Bremerton’s (NHB) implementation of the Q-Flow system on January 16 is providing a more convenient and organized prescription distribution process for both the patients and the staff at the busy Pharmacy.

Assistant Hospital Pharmacy Department Head, Lt. Heather Rosati explained that the computer web-based software system enables Pharmacy staff to collect more data on such important issues like wait times, possible deviation of prescription levels, and effective monitoring for the implementation of needed staff members. The new Q-Flow also tracks the increased number of people waiting to get their prescriptions.

“The old system really had to go,” said Rosati. “It was from the 1990s and there was no information available with what it provided,” said Rosati.  

The new Q-Flow system adheres to Navy Medicine’s priorities of providing patient-centered health care and best value by helping to optimize NHB’s use of medical informatics and technology to ensure the highest quality of care for patients.

According to NHB Director for Clinical Support Services, Cmdr. David W. Hardy, the biggest initial adjustment for people will be getting used to where the new Q-Flow kiosk is physically located in the Pharmacy. It is now situated closer to where beneficiaries enter from the Quarterdeck into the main Pharmacy area. The new kiosk is located opposite the patient service windows, next to a column by the exterior windows. 

“For people who’ve been coming here for ten years or more and maybe they only get prescriptions here once a month, those people will have it in their mindset to walk where they always have walked to get a ticket to get in line. The whole process of getting their prescription now starts away from the counter. This gives the Pharmacy an overall better traffic flow for the people,” said Hardy.

In addition, Hardy noted certain days of the week - such as a day before or after a long weekend - can traditionally be busier than others, and during the winter months the Pharmacy can handle more than 2,000 prescriptions per day.

“A big benefit with the arrival of the Q-Flow to the hospital will be a system that can help identify the needs of our Pharmacy,” said Hardy. “We can look at all of the numbers, times of the day, days of the week, and know that we’ll either need more staff or be more prepared to shift around the staff we currently have to handle the increased number of Pharmacy customers,” said Hardy.

Rosati noted the old method of filling a standard prescription was ultimately very limited and the Q-Flow system now provides more information is enabling staff members to gain momentum as the Pharmacy engages with more patients.

“Any patient or staff member looking for a prescription would get a number and wait to see someone at a window. Their number would be called and the Pharmacy Tech would look their prescription up by name. They were then told to wait for their name to appear on an overhead screen. The Q-Flow system tells us what time they came in, what the prescription is, and how many people are waiting in the ‘queue.’ The new system can even be broken down to the point of active duty, civilian and the prescriptions that have been entered from different departments of the hospital, like Emergency or Family Medicine,” said Rosati.

Lt. Hanh Tang, Hospital Pharmacy Department Head, added that the information on the actual ticket of the Q-Flow system now given out to the customer is a reassuring professional improvement on the old method.

“The ticket tells you how many people are in front of you and the hours the Pharmacy is open. If you had to leave for some reason you can quickly scan your ticket and the system will tell you the status of your prescription,” said Tang.

The noted new kiosk is noted by a "Pharmacy Check-in" sign mounted above. It may take our

Patients and staff some time to get familiar to the new location and the new system.

Tang attests that the check-in screen for the kiosk was redesigned to better serve Pharmacy patients and staff, and everyone utilizing the new system should carefully read all available options when they check in for pharmacy services.  The services options are for Retiree; Dependent; Active Duty Not in Uniform; Active Duty in Uniform; Staff Member on Duty; NHB Emergency Room Prescription(s); Discharged from NHB Inpatient Stay or Post Surgery and/or Operation.

Pharmacy has also implemented a 2-ticket system to streamline the workflow and give patients the ability to check status of their prescription(s) at the check-in kiosk.

With any new way of doing things, Hospitalman Christopher Bennett said he’s noticed patients acclimating themselves to the new Q-Flow system at NHB with relative ease.

“It’s been a little bit of an adjustment period. I’m sure that people who haven’t been here in a while will notice the new way we do things and it will maybe hit them as they’re leaving and they will think, ‘That somehow went quicker than I’m used to,’” said Bennett.

Additionally, for those who chose not to visit the command to pick up their medicine, there are cost-saving options available to all beneficiaries for pharmacy prescription drugs.

In conjunction with TRICARE home delivery, NHB Pharmacy offers two economical alternatives for beneficiaries. Pharmacy refills are free (for beneficiaries) with no co-pay requirements. Home deliveries for generic prescription drugs are also free to beneficiaries.

New copayments for prescription drugs covered by TRICARE will go into effect February 1, 2013. The Fiscal Year 2013 National Defense Authorization Act requires TRICARE to increase copays on brand name and non-formulary medications that are not filled at military clinics or hospitals. There is no increase to copays for generic medications.

TRICARE Pharmacy copays vary based on the class of drug and where beneficiaries choose to fill their prescriptions. The copay for generic medications stays at $5 when a prescription is filled at a network pharmacy. There is no co-pay when generic prescriptions are filled through TRICARE Home Delivery. The new copay for a 30-day supply of a brand name medication purchased at a retail network pharmacy will be $17, up from the current $12. Beneficiaries using TRICARE Home Delivery will pay $13 for brand name drugs, up from $9. However, the Home Delivery price is for a 90-day supply.

The greatest change in copays applies to non-formulary medications. The $25 copay for these drugs increases to $44 at retail pharmacies and $43 through Home Delivery. The TRICARE Uniform Formulary is a list of all the medications TRICARE covers. For more information: http://www.tricare.mil/CoveredServices/BenefitUpdates/Archives/PharmacyCopayChanges.aspx

For fiscal 2014 and beyond, the new law directs that copays increase annually by the same percentage as retiree cost-of-living adjustments. In years when a COLA increase would total less than a dollar, it will be delayed a year and combined with the next adjustment so increases will always be $1 or more.

Pharmacies at military hospitals and clinics will continue to provide medications with no copays. Visit www.TRICARE.mil/pharmacycosts for more details.

Home Delivery offers convenient and free automatic prescription refills that can be shipped to any address in the U.S. or Fleet and Army Post Offices overseas. To sign up for home delivery for your pharmacy refills, click here: www.tricare.mil/homedelivery or dial 877-782-8731.

Naval Hospital Bremerton staff recognized for supporting Kitsap Veteran's 2012 Fall Stand Down
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs --
Kitsap County Commissioner chair Rob Gelder presented certificates of appreciation to Naval Hospital Bremerton staff members for their volunteer efforts at the Kitsap Veteran's 2012 Fall Stand Down on January 18.
 
"
On behalf of the Kitsap County Commissioners and the Kitsap County Veterans Advisory Board, I thank those who provided support with their time and effort. We don’t say ‘thank you’ enough and we could not do the Veteran’s Stand Down without the volunteers supporting those who went before them,” said Gelder, Kitsap County District 1 commissioner, who represented Commissioner Charlotte Garrido, District 2 and Commissioner Josh Brown, District 3, in the presentation ceremony.

“It was a great experience to be able to pay back to those who have served. It gave us the opportunity to share what we do, as well as spend quality time to hear what they did during their time on active duty. I learned a lot, not only about them, but also about ourselves. Helping out that day meant just as much to us as it did to them,” said Veteran Stand Down volunteer Hospital Corpsman Chief Brian Dike.

The Kitsap Veteran's Fall Stand Down was held September 22, 2012. Joining Dike as volunteers were Hospital Corpsman Master Chief Tom Countryman, Hospital Corpsman Senior Chief Michael Hess, Hospital Corpsman Chief Noel Gravina, HMC Farrah Ocasio, Hospital Corpsman 1st Class Dana Therkildsen, HM1 Rejoy Sison, and Hospital Corpsman 3rd Class Michael Brownfield.

“Supporting operational readiness missions is what we do. One of the ways we do that is giving back to the community. Our command has always been actively involved in providing support to civic projects throughout our area. Its part of who we are and what we do,” said Capt. Christopher Culp, NHB Commanding Officer.

The Veterans 2012 Fall Stand down, coordinated by Kitsap County Veterans Program, City of Bremerton, Kitsap SUN and Kitsap Area Veterans Alliance, provided an estimated several hundred veterans and family members a host of services and information, such as legal assistance; guidance on how to change child support payments; women, men and children clothing; hot meals; advice on dealing with foreclosure; hygiene items and shaving gear; groceries; haircuts; VA health benefits and VA claim information; employment referrals; dental screenings; vision screenings; financial assistance; sleeping bag and camping gear; housing options; Operations Noble Eagle, Enduring Freedom, and Iraqi Freedom benefits information; free voice main and mail address, and other services such as free shuttle services to the event by Suquamish Warriors, Salvation Army, Disabled American Veterans, and Washington State Department of Veterans Affairs Building 9.

Naval Hospital Bremerton SARP Family Program bolsters professional and personal mission readiness
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- The new patient-centered Family Program at Naval Hospital Bremerton offered by the Substance Abuse Rehabilitation Program (SARP) that began on January 7 actively supports Navy Medicine's focus on readiness.

“Alcoholism and addiction cause a great deal of dysfunctional behaviors and attitudes for the individual who is suffering from the disease. The disease also affects the family’s psychological, emotional and spiritual dynamic as a whole unit and for individual family members,” said Hospital Corpsman 1st Class Morgan Notel, SARP counselor and Family Program facilitator.

The overall mission of NHB’s SARP is to offer help and hope to individuals – active duty, dependents and retirees - and their family members affected by alcoholism.

“In regards to mission readiness, rehabilitation provides the opportunity to examine the reasons they drink/use. SARP provides a safe and confidential environment for the person to look within themselves as a person, not as their rank or position. By providing this environment, SARP allows the active duty member to be ready to go back to work and support the readiness of the mission, along with their personal mission of healing from their own personal wounds. The Family Program improves the morale at home for all family members and provides each member the opportunity to heal. It also provides fulfillment in the home, which allows the active duty member the ability to go to work and stay focused on the mission of their command, ship, and/or detachment,” said Notel.

Notel, a certified Alcohol and Drug Counselor with a Master's of Science degree in Counseling, attests that the NHB SARP staff found that there was great need for a program to support the family while the alcoholic/addict was going through a prescribed treatment program. “We understand that this is a family disease and that everyone plays a role in the dynamic. Everyone needs the opportunity to heal from the disease,” she said.

“The Family Program supports every family member. Alcoholism and addiction are a family disease and it affects every member of the family. When the alcoholic or addict is actively using, people who are involved with them play certain roles to enable the alcoholic/addict. When they discontinue use and begin to get better, there is a shift in the family member's roles, especially the spouse,” explained Notel, who has been a SARP counselor for four of her 15 Navy career years.

According to Notel, a family, much like the alcoholic, will initially deny the reality of the disease. Family members will then enable the progression of the illness through excuses and cover-up(s). Also like the alcoholic, family members will usually present a variety of somatic (physical) disorders and present themselves to other health care practitioners in an effort to relieve the anxiety and stress related directly to the disease of addiction.

By offering a program for all family members, it allows everyone the opportunity to come to grips with awareness and education on addictive behavior such as alcoholism. “This program is very important. Alcoholism/addiction affects the entire family. Everyone learns how to live and act according to the active alcoholic/addict,” said Notel.

Historically, treatment focused on the addicted person only and the untreated family members would continue to suffer the dysfunction caused by the disease. “The recovering alcoholic/addict can find himself/herself in an emotional climate that breeds anger, resentment and/or relapse. SARP understands the dynamics of co-addiction and co-dependency. We offer opportunities for the family to gain an understanding of the psychosocial stressors and maladaptive reactions generated by the disease of alcoholism/addiction. We assist in refocusing family members in their personal responsibility of understanding their role in the recovery process,” Notel said.

“Each family member plays roles in the dynamic,” Notel shared, giving the example that there are three rules that children of alcoholic/addicts learn: "don't talk; don't trust; and, “don't feel."

“These are rules that children make for themselves in order to live in this environment. These rules provide utility and physical and/or emotional protection for the time and end up being carried through adulthood or until they change the rules. It is important that children and/or adults of alcoholism and addiction understand that they "can't change alcoholism/addiction; they "can't control it"; and, "they can't cure it." What I do is spend time with these individuals and assist them in changing their rules that no longer work for them to rules and values that do currently work for them,” Notel said.

The foundation of the SARP Family Program relies on educating family members about how the addiction not only affects the body physically from a medical standpoint, but also mentally from a non-judgmental and emotional viewpoint. The education is specifically designed for those individuals whom are affected by drugs and/or alcohol or any other addiction.

The lecture series portion of the Family Program will also provide education and insight on how addiction may be affecting their lives and how they can manage their behaviors around that addiction. This also allows family members the opportunity to explore and process the situation in their life with the ability to refer themselves into the Family Program for further guidance. There are also counseling sessions available where Notel provides professional guidance to help resolve personal conflicts and emotional problems in a non-judgmental and confidential manner.

“The main part of the Family Program is one-to-one counseling. During the session there is therapeutic intervention along with educational opportunities. The lecture series provides education regarding alcoholism and addiction and how it affects the family, friends, and peers. Attendees do not need a referral for the lecture series. They only need to contact me to sign up for the series. You do not need to have someone in treatment to attend. If you are an adult child of an alcoholic or a family member and/or friend who is currently using you qualify. It will be held quarterly, and a topic will be given weekly. The start date is still to be determined,” Notel said. 

Available also are couples-therapy, co-dependency support group, referral network with other health-care practitioners and a combination of other services depending in the needs of family members available.

Scheduled lecture topics include; Family Sculpture-Healthy vs. Unhealthy; Medical Aspect of Addiction; Marriage and addiction/recovery; and Co-dependency and Healthy boundaries.

SARP has several levels of treatment available to help people recover from the addiction. The choice decided upon depends on the type of addiction. SARP staff members help guide and assist in making the best decision to help achieve lasting results.

 “Alcoholism/addiction is a family disease and the family members also need to have an interest in gaining education and support to have the healthy, happy and loving relationship they deserve,” affirmed Notel.

Counseling sessions are offered Monday-Friday at NHB SARP from 10:30 a.m. to 2:30 p.m. HM1 Notel, and can be reached at 360-475-5348 or via email
Morgan.notel@med.navy.mil.

Naval Hospital Bremerton’s Simulation Lab Provides Latest in Medical Training
By MC1 (SW/AW) James Evans Coyle, NHB Public Affairs -- Naval Hospital Bremerton’s Simulation (Sim Lab) expanded training options were on full display for doctors, nurses, hospital corpsmen and other staff on Jan 14. 

NHB’s Simulation Center has existed for more than three years to provide healthcare providers with a chance to accurately replicate the experience of giving patient care. These tasks can range from the mundane to highly complex and can cover every skill level.

“The mission (of the Sim Lab) is to develop and maintain the skills of our healthcare staff and become the go-to source of skills development for regionally based military personnel,” said NHB’s Sim Lab Program Manager Hospital Corpsman 2nd Class Blake Hite.

According to Hite, the Sim Lab goal is to develop both didactic and kinesthetic skills through the use of low, medium, and high fidelity simulation. These realistic simulations build communication skills, develop leaders in high stress situations, and keep important yet sometimes rarely used skills honed.

With the latest addition of their state-of-the-art “SimMan,” a medical mannequin with cutting edge technology, the Sim Lab can ensure the training learned equates to increased benefits for actual patients.

“The SimMan can be programmed for many different types of medical conditions such as cardiac arrest, various bronchial and endoscope procedures. Sim Man 3G is our newest mannequin, unfortunately he is not quite ready to go live yet but when he is it will be impressive. He has everything from fluctuating pupil sizes from LED lights to the ability to be put on a ventilator. This mannequin will be almost completely wireless and will really push the immersion to a new level. The more immersed a student is the more realistic we can make things seem, especially with stress and working on communication,” said Hite.

“Our Simulation Center is capable of a broad range of skill training, such as suturing, birthing drills, intubations, inserting NG tubes, central line insertions using sonosites, and many more. We can even do certain procedures such as broncoscopies and endoscopies. The birthing simulator and emergency neo-resuscitation situations are frequently utilized by doctors, nurses and hospital corpsman,” Hite continued.

According to Medical Simulation Contractor Doug Jones the SimMan’s human-like responses will eventually become a reality when the SimMan will be able to talk directly to the doctors and nurses engaged in the training.

“The way it will soon work is that I or one of the other simulation instructors will be on a wireless microphone from another room and we’ll be able to create a scenario through the voice box of the SimMan complaining of various ailments and disorders,” said Jones. “The doctor or nurse will come in, SimMan will say, for example, “I’m having chest pains.” People involved in the training will also see that SimMan’s heart rate has maybe skyrocketed. The people training can then administer medication.” said Jones.

“Our patients benefit the most! The advantage is we don't have to learn in a real life situation. We can practice the skills we will need in cases and work out the kinks before we go on to do the real thing,” added Hite.

NHB’s Training and Education Department Head, Lt. Cmdr. Ronald Cleveland attests that the SimMan and the Simulation Center’s mission of, ‘Quality Care, Patient Safety and Lead Team Dynamics’ will continue to be available to other health care facilities in the local community.

“We’re incorporating more PQS (Personnel Qualification Standards) needed by all ship-board medical personnel in this area who are using and will continue to utilize our Sim Lab. We’ve specifically been an excellent resource for Sailors going out in the field,” said Cleveland.

Meritorious Unit Commendation presentation highlights Commander Navy Medicine West visit to Naval Hospital Bremerton
 By Douglas H Stutz, Naval Hospital Bremerton Public Affairs –
Naval Hospital Bremerton (NHB) was formally presented the Meritorious Unit Commendation (MUC) by Rear Adm. C. Forrest Faison III, Commander Navy Medicine West and Naval Medical Center San Diego on Jan 8.

The presentation highlighted the two day visit of Naval Hospital Bremerton and associated Branch Health Clinics at Naval Base Kitsap – Bangor, Puget Sound Naval Shipyard and Naval Station Everett.

“This commendation just documents what we already know. The MUC recognizes a great team. It is a real privilege to see such an incredible team provide medical help to our Sailors, Marines and families. Every day you rise to the occasion. I am so incredibly proud of you. On behalf of all those you help, thank you,” said Faison.

Faison’s visit also included several All Hands Admiral’s Call, dined with approximately 20 recently returned Individual Augmentee staff members, and with the current residents in NHB’s Puget Sound Family Medicine Graduate Medical Education program. He also met with NHB Sailors and civilians of the quarter and year.

Capt. Christopher Culp, NHB Commanding Officer notified NHB staff members last month on receiving the command’s second commendation. The initial MUC was awarded for meritorious service from Dec. 1, 1996, to Dec. 31, 1999, for providing timely compassionate care in Navy Region Northwest as well as meeting readiness mission needs while deployed to Haiti with Fleet Hospital Five. 

“As we haul down the previous MUC that has flown for the past 10 years, it has transcended time and become part of the fabric of the command. The command itself has maintained the personality and presence that encompasses what the MUC stands for, and this MUC is a direct reflection of Capt. (Mark)  Brouker’s tenure and accomplishments,” shared Culp.

The Meritorious Unit Commendation for Naval Hospital Bremerton covered the period July 1, 2008 through Sept. 30, 2011, which was during Navy Medicine West Chief of Staff Brouker’s previous tour and 3-year tenure as NHB’s commanding officer from July 18, 2008 to Aug. 4, 2011.  

The current MUC covered all staff assigned to all active duty component unit identification codes (UIC) within the hospital. The citation, signed for the Secretary of the Navy Ray Mabus by
Adm. Jonathan W. Greenert, Chief of Naval Operations, recognized personnel of NHB consistently demonstrated exceptional patient and family centered care, graduate medical education, and fleet support while meeting its readiness mission. The citation also cited exceptional performance in multiple areas including dental readiness, Graduate Medical Education excellence, fleet support, tsunami support, environmental excellence and patient care.

Naval Hospital Bremerton’s First Baby of 2013 enjoys support from NW Beginnings staff and NHB Oakleaf members
BREMERTON, WASH.  The New Year celebration at Naval Hospital Bremerton’s Northwest Beginnings Family Birth Center officially began over 17 hours into 2013 with the arrival of the first baby born.

Proud parents, Doug and Jordyn Lason, celebrated the birth of their son, Corey Matthew, who was born Jan. 1, 2013 at 5:39 p.m. Pacific Standard Time, and weighed 6 lbs, 1 oz.

Lason is an Electrician’s Mate 2nd Class assigned to fleet ballistic missile submarine USS Nebraska (SSBN 739) Blue. Both parents are natives of West Branch, Michigan and currently reside in Silverdale, Wash.

New born Corey is the family's second child. Both mother and baby are doing well. “The staff here are great. We were admitted yesterday and didn’t think the entire process would take as long as it did,” said Doug, a very proud father.

It was Lason’s 2-year old daughter, Zoey, who decided on the name Corey for the new addition to the family. “She came up with the name one day and it just fit. We then added his middle name later on. Corey Matthew flows,” shared Doug.

The staff at Northwest Beginnings Family Birth Center was busy taking deliveries from the stork throughout December, especially on the last day. There were 66 new babies for December, five births recorded on Dec. 31, including one that was born 45 minutes before the New Year. Overall, Naval Hospital Bremerton recorded 804 births for 2012, an average of 67 per month.

In honor of the first NHB New Year’s Baby of 2013, the NHB Oakleaf organization took the lead to recognize the family by presenting them with a gift basket that included such items as bathing supplies, blankets, books, clothing, diapering items, toys, and sparkling cider for a celebration toast.

According to Laura Stetler, NHB Oakleaf president, they originally proposed the idea of providing support for the first baby born in 2013 to the hospital leadership in November and were granted approval for their enthusiasm.

“Oakleaf member Lisa Danenberg brought the idea to Bremerton from Naval Hospital Jacksonville. This is one of our ways to actively share support for Navy families in our area.,” said Stetler, who worked with the command leadership, and Labor and Delivery to coordinate presentation of a basket of donated gifts from Oakleaf to the family.

“We are all very happy to help out in any way that we can,” said Danenberg.

Oakleaf is a volunteer-run nonprofit organization comprised of Medical, Dental, Nurse, and Medical Service Corps officers’ spouses in the Puget Sound area. NHB Oakleaf builds community through social activities and interest groups and supports our military hospital community through charitable projects.

 “NHB Oakleaf members enjoy getting involved in celebrating the Navy community here at NHB and the larger Kitsap community. The New Year’s Baby is a fun way to support the Navy family of NBK,” Stetler said, adding that those seeking more information about NHB Oakleaf can visit www.nhboakleaf.org  or email the group at nhboakleaf@gmail.com. NHB Oakleaf can also be located on Facebook as Naval Hospital Bremerton Oakleaf.

 Naval Hospital Bremerton detects, deters, defends with Mock Disaster Drill
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton held a base-wide mock disaster drill on August 16 to train the command on handling an armed intruder and subsequent mass casualties

The scenario tested how Naval Hospital Bremerton and Naval Base Kitsap (NBK) Naval Security Force (NSF) personnel responded to an active shooter inside the military treatment facility. The mock drill also evaluated how NHB staff members initially responded, triaged and treated wounded/injured personnel and coordinated the transport of the injured to appropriate casualty receiving areas. The exercise included additional assessment of NHB’s communication, cooperation and coordination with Harrison Medical Center Bremerton, Commander Navy Region Northwest and civilian/county fire/emergency medical services to transport severely injured patients to the Harrison Emergency Room for treatment.

“We utilized this event to evaluate the effectiveness of our command in working with NBK NSF to detect, deter, defend and mitigate an armed, barricaded, hostage, active shooter incident. This wasn’t just a table-top exercise. This was full-blown and all-out, with many people involved in handling their responsibilities step-by-step. Our requirements are to train and practice holding two patient surge exercise per year, with one of them involving an external community agency,” said Terry Lerma, NHB Emergency Management coordinator.

The scenario occurred in NHB’s main building where staff members were ambushed by an unknown assailant. Staff members then carried out an evacuation and activated emergency response procedures to deal with the active shooter/armed intruder.

“Our goal was to have the incident evolve rapidly, which meant that immediate response was required. The first NHB Naval Security Force on the scene had to aggressively search, seek and stop the shooter. Until that happened, our rescue efforts were delayed,” Lerma explained.

Lerma cited that there is the potential at any time for a catastrophic event, such as an active shooter causing a mass casualty situation on the NHB compound. Planning and training for such a situation to rapidly react and respond to such a threat is part of the overall command readiness.

Compiled statistics by Federal Emergency Management Agency show that since Aug. 2011, there were 44 open shooter incidents across the U.S., with seven of those being at Hospitals/clinics.

“This planned exercise allowed Naval Hospital Bremerton to maintain required high standards of readiness and stay prepared for emergency conditions be they man-made or natural disaster,” explained Lerma.

The mock drill was coordinated not to impact patient flow or interrupt service to any eligible beneficiary seeking medical and health services at the facility.

There were three fatalities in the mock exercise, along with 17 simulated mass casualty victims triaged and taken into the emergency room at NHB, with six then sent in ‘critical condition’ to Harrison Medical Center Bremerton .

According to Lerma, one of the successful lesson learned in the event was the coordinated liaison with Harrison Medical Center Bremerton. The exercise provided both medical facilities with the opportunity to interact and test their response capabilities and identify opportunities to increase those capabilities.

“The communication with our colleagues at Harrison went extremely well. Once they activated their command center for the exercise, they contacted us and we were good to go with them in relaying information on the patients being transferred their way. That liaison piece had not been there before and it was invaluable,” he said.

Chronic Pain management to Benefit the Beneficiary
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton hosted members of the Navy Comprehensive Pain Management Program (NCPMP) for a fact-finding, brain-storming collaboration visit on August 8 and 9.

“The pain management team was here to meet and gather information on program capabilities we have at NHB. We all want to know how to implement better methodology with our stakeholders in all of our departments and clinics to help our beneficiaries,” said Cmdr. Brendan Melody, NHB Director of Administration.

According to Capt. Ivan Lesnik, Navy Medicine West NCPMP Lead, the general objectives for this BUMED initiative program are to aid in the restoration of function and relief of pain by broadening access to evidence-based, standardized, multimodal, and interdisciplinary pain care across Navy Medicine, ensuring treatment efficacy through practice guidelines, education, and analysis of treatment outcomes.

“There is a crisis in effectiveness in handling pain. The number one issue from beneficiaries and active duty personnel is about pain. Pain is the most common complaint. Its loss of function and it impacts quality of life. We have used the tools that we have but that’s not enough,” explained Lesnik.

“Establishing a multidisciplinary approach within the Medical Home environment which is focused on improving the patient's quality of life while training the Medical Home Port team in the various modalities and approaches available is absolutely the right approach. The concept definitely aligns with the integrated and coordinated team care tenants inherent to Patient-centered Medical Home. It will provide the Medical Home teams with multiple alternative treatment options for managing chronic pain in lieu of a purely pharmacological approach. Patients are inundated with advertisements depicting various medications to use in the treatment of pain, even though there are multiple other options available that can be as equally or more affective,” stated Cmdr. Patricia M Taylor, NHB Deputy Director for Medical Services.

The Navy response to improve handling pain capabilities is based on the 2010 National Defense Authorization Act and 2011 Assistant Secretary of Defense for Health Affairs memorandum requiring standardized, comprehensive, multidisciplinary pain management in the Military Health System.

“This is really about pushing our care to the deck plates, especially improving access to care with a big emphasis on restoring function and capability. Anything that erodes readiness is a deterrent. The major pain areas continue to be the lower back, joint and shoulder pain for the junior and senior enlisted personnel,” Lesnik said. 

Lesnik attests that chronic pain is at a current state where it is a disease and economic burden to the entire country.

“From the utilization of care standpoint, the most common office visit complaint is chronic pain, which is directly associated with loss of function, quality of life and workdays. Chronic pain impairs readiness and is a common medical evacuation cause,” said Lesnik.

Lesnik notes that special emphasis will be placed on improving quality of life and functionality, decreasing pain, increasing patient satisfaction, reducing pain-related costs, lessening limited-duty days, and improving access to care for complex acute, high-risk acute and chronic pain patients.

“The vision is readiness through restoration of function and relief of pain. Navy Medicine’s solution at our military treatment facilities, hospitals and clinics is to have multidisciplinary pain care teams that we call R4 Pain teams. R4 is reference to readiness, restoration of function, relief of pain and research,” Lesnik said, stating that the plan is to have R4 Pain Team and R4 Regional Subspecialty Support team assets available for providing a range of assistance for everything from direct clinical care to reviewing complex cases to embedding with specific specialty areas to help mitigate chronic pain.

“Chronic pain really is very patient-specific and requires a thorough assessment of the patient's physical and psycho-social elements to determine the best course of action. The multidisciplinary approach outlined in the Navy Comprehensive Pain Management Program will improve communication between the various disciplines involved in the patient's care and should improve patient participation and health outcomes,” Taylor said.

Native Art Donated To NHB
By Doug Stutz, Naval Hospital Bremerton  Public Affairs – Naval Hospital Bremerton (NHB) accepted two donated pieces of art on Aug. 10 of a locally-renowned artist whose relief sculpture work adorns NHB’s outside featuring classic symbols of the Haida, the indigenous nation of the Pacific Northwest Coast.

“On behalf of the skipper, Capt. Culp, and all the staff members, and everyone that walks through these doors, we really thank you,” said Capt. Maureen Pennington, NHB Executive Officer, to the donators, Liz Leske and Ray Leske, during the presentation on the quarterdeck.

Liz Leske, along with Claire Toth, Cat Toth, and Casey Toth, contacted NHB to donate an Oliver Tiedeman painting and mask in honor of their parents, Richard C. and Marylou Toth.

“They loved Oliver Tiedeman’s work and wanted to share it with as many people as possible.  Because Naval Hospital Bremerton incorporated Tiedeman’s art in its buildings, my siblings and I feel this would be a perfect place for the painting and mask to be displayed,” said Liz Leske, a resident of Gig Harbor, Wash.

The vertical 72 inch by 36 inch Tiedeman painting depicts a totem pole carving with swirling birds around it and the 10 inch by 12 inch ceremonial mask features two of the predominant color schemes of the Haida – rust and green – dominated by two larger-than-life eye sockets decorated with stripes of color to all points of the compass.

Oliver Tiedeman (born Apr. 11, 1919 and died Mar. 23, 1986) was a Tacoma, Wash. Artist who worked professionally in Nisqually and specialized in Northwest Native American art and associated murals.  Tiedeman originally crafted the numerous Native American art symbols for NHB in 1977.  The symbols combine Haida representation of the Sun, Moon, Beaver, Raven, Copper, Frog, along with Gunarrh and the Whale, and Sea Monster.  Additionally, several features the Haida’s symbolic hand design to signify the healing hand of the physician.

“This is the perfect place for this art.  We love the artist and it’s amazing how much an artist can add to a place,” said Pennington.

There are 58 concrete panels, ranging from 7 feet to 22 feet, done by Tiedeman at NHB.  He began to work on the project in 1977, took approximately a year to complete, and was ready when the facility opened on May 7, 1980.

Just outside the main entrance to the hospital’s quarterdeck, there are panels of Sun and Moon.  Sun was considered brother of the Moon, and Raven (in the lower portion of the Sun panel) was a uniting factor in the Haida mythology.  Moon, with Salmon Trout design (on the lower portion of the Moon panel) is utilized as a similar design shape.  Moon discovered man and sent down arms or rays, pulling him up into the heavens, where man is seen during the full moon.  Sun whisked a chief’s daughter up to his arms, where she discovered was brother to Moon and they both bring light to earth, day and night.

Naval Hospital Bremerton Health Promotion supports Stennis Pre-Deployment Fair
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton’s Health Promotion provided a wide variety of health and wellness information for the USS John C. Stennis (CVN 74) Pre-Deployment Fair held Aug. 7, at Naval Base Kitsap Bremerton.

“At the event for the families of the Stennis we were able to do some "on the spot" health promotion as well as market our family focused resources.  We had calendars of classes for the Wellness Center.  These included prenatal and new parent classes and child car seat installations.

Families with children who are new to Washington are particularly interested in the Washington State Car Seat Laws, which require children to be in booster seats until they are 8 years old or 4'9",” said Janet Mano, NHB Health Promotion Division Head.

 The Stennis Pre-deployment Fair also featured services from such local support group as NBK Fleet and Family Support Program, Morale Welfare and Recreation program, American Red Cross, USO, TRICARE, the Stennis command ombudsman program, Legal office, Public Affairs office, Administration office, Family Readiness Group, as well as ship and shore Pastoral Care staff and chaplains.

The Stennis Pre-Deployment Fair was the perfect venue for Health Promotion to share information to the estimated crowd of 400 who showed up for the event. The NBK-Bremerton based carrier and its strike group departs four months early on deployment late this summer to the U.S. Central Command area of responsibility, DOD officials announced at the Pentagon July 16.

“We thank Health Promotion and all the other local representatives for their support of our families and helping to make our deployments easier to handle. This event has been a success. There is a lot of really good, necessary and right information being shared,” said Lt. Cmdr. Rob Wills, Chaplain, Stennis Command Religious Ministry Department.

“I’m glad this event was here. I needed to make sure my wife is fully informed of all the resources and services we have available from the ship and with commands ashore like Naval Hospital’s Health Promotion,” said Aviation Ordnanceman Chief Select Matthew Renniger.

According to Mano, NHB’s Health Promotion has established strong collaborative relationships with many of Navy Region Northwest commands. This networking has allowed Health Promotion to integrate health and wellness into a wide variety of command and community programs.

“For example, this year we have participated in 15 safety events throughout the region.   This year we have participated in Ombudsmen meetings, "all hands" meetings with Navy Region Northwest, Naval Base Kitsap (NBK) Bangor, Naval Undersea Warfare Center Keyport and Puget Sound Naval Shipyard (PSNS), and been involved in such events as Military Appreciation Day, NBK Right Spirit campaign and a PSNS ‘Fit Walk,’ to name but a few,” Mano said.

The overall mission of Health Promotion is to provide quality products and services to every eligible beneficiary concerning health and wellness by combining involvement, optimal command participation and on-going support for individual health behavior change, health promotion and prevention.

Eligible beneficiaries can take advantage of a wide variety of programs offered by NHB’s Health Promotion, including Health Risk Assessment; Injury Prevention; Nutrition; Physical Fitness; Sexual Health and Responsibility; Stress Management; Suicide Prevention; and Preventive Health Assessments; injury prevention; nutritional tips; physical fitness; psychological health with stress management and suicide prevention; tobacco cessation; Alcohol and Drug Abuse Prevention; and weight management.

Mano attests that Health Promotion is a strong advocate of the Navy and Marine Corps Public Health Center philosophy that defines Health and Wellness as “ensuring healthy living through various sources and education by providing tools to assist individuals in gathering helpful information. The mission is to provide quality Health Promotion products and services with a vision of producing a healthy and fit force. Health promotion and wellness, along with healthy living, continues to address prevention, community health promotion and general wellness.”

There are numerous classes available at Health Promotion for healthy eating and active lifestyle such as “Stress Workshop” that provides an summary of research on the neuroscience of happiness, including nutrition, sleep and exercise; Nutrition and Weight Management classes such as “Mission Nutrition: 3 day healthy eating and weight management class, and “Intro to Nutrition,” “Diabetes Prevention” and “Heart Healthy Living” Classes. There are also monthly field trips such as the Commissary “Healthy Shopping” tour and Fitness Center tour. The “Bariatric Screening” class includes appointments with a registered NHB dietitian as well as a mental health provider.  The “Shipshape” 8-week program is specifically designed to assist active duty members in meeting Department of Navy body composition standards and spouses are also eligible attend.

Naval Hospital Parenting Resources include Childbirth classes that prepare for labor and birth and what to expect during the hospital stay.  Choose between three consecutive Wednesday evenings, or a full day Saturday; Lactation class is held the 4th Wednesday evening of each month to help you prepare for breastfeeding.  Those interested can contact TRICARE to register for Childbirth and Lactation classes at 800-404-4506. For more information call OB-GYN clinic 475-4209. Baby Basics classes: Great information from New Parent Support and Naval Hospital pediatricians for when the new parent brings the new baby home. Call TRICARE 800-404-4506 to register for Baby Basics or Health Promotion 475-4541 for more information.

Car Seat Fittings:
  Events and appointments through Naval Hospital Health Promotion. Call (360) 475-4541 or e-mail nhb.healthpromotion@med.navy.mil to make an appointment.  Fleet and Family Program 
www.navylifepnw.com  866-854-0638 Parenting Classes, family and child counseling, Exceptional Family Member Program, family advocacy, ombudsman program, deployment support.  New Parent Support Team: includes home visitation, parent -education and prenatal and postnatal care. For more information, call 360-475-7483 or www.navylifepnw.com   www.militaryhomefront.dod.mil.

For physical activity, MWR Fitness Centers: www.navylifepnw.com for hours and class schedules.  Certified Navy Fitness Specialists will work to develop a safe and effective plan to meet desired/required fitness goals.  Family friendly workout areas are available at NBK Bangor and NBK Bremerton. NBK Bangor 315-2134, NBK Bremerton 476-2231; Naval Hospital 475-4546. The Therapeutic Lifestyle Choices (TLC) classes at NHB offer gentle and safe classes which can be modified for all fitness levels. Wellness Classes include yoga, tai chi and Pilates classes throughout the week. Training is also available for Back Injury Prevention, Office Yoga, Everyday Stretching and Strengthening and Relaxation topics are available on request to Health Promotion.  E-mail nhb.healthpromotion@med.navy.mil or call 475-4541.

65th MSC Birthday Celebrated At NHB
By MC1 (SW) Charlemagne Obana, NHB Assistant PAO – Naval Hospital Bremerton (NHB) Medical Service Corps (MSC) association members celebrated the 65th MSC birthday with NHB Sailors and staff at a ceremony on the quarterdeck Aug. 3.

“We are a diverse community in the Medical Service Corps.  We consist of 31 clinical, administrative, and scientific sub-specialties. At Naval Hospital Bremerton, we have 50 Medical Service Corps officers filling about 17 of those sub-specialties,” said NHB MSC Association President Lt. Jeremy Howell.

 “What I really want to do today is stop and thank you for the wonderful service you have given to this hospital, to our medical department, and to our Navy.  I wish you a very happy birthday,” said NHB Commanding Officer Capt. Christopher Culp.

Howell made Culp an honorary MSC for the day and awarded him a NHB MSC association t-shirt. 

NHB Director for Administration Cmdr. Brendan Melody also awarded Culp an MSC specialty collar device.

Guest speaker, Capt. (ret.) R. Gregory Craigmiles, first commanding officer of the Navy Medicine Training Center (NMTC), Fort Sam Houston, Texas, highlighted the diversity of MSC officer careers by going over his 30 year career path.

“When someone says they’re in the Medical Corps, you automatically know they’re a physician.  When someone says they’re in the Dental Corps, you automatically know they’re a dentist and when somebody says they’re in the Nurse Corps, you know they’re a nurse,” said Craigmiles.

“But when somebody says they’re in the Medical Service Corps, it begs a second question always.  What do you do in the Medical Service Corps?  My career took several digressions that reflect some of the diversity in the Medical Service Corps.  I came in as a medical technologist, then transitioned to information technology, and then finally wound up in education and training.”

In addition, NHB MSC posted static displays on the quarterdeck with official birthday messages (from directors of the Medical Service Corps, Medical Corps, Nurse Corps, Dental Corps, and Force Master Chief), a complete listing of all the MSC sub-specialties, and a variety of photos of NHB MSC officers working in the hospital and on deployment.

The event closed with a ceremonial cake cutting.

Naval Hospital Bremerton hosts Navy Surgeon General for official visit
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Vice Adm. Matthew L. Nathan, Navy Surgeon General and Chief, Navy Bureau of Medicine and Surgery, visited Naval Hospital Bremerton on August 1 as part of his tour to the Pacific Northwest.

Nathan’s visit included meetings with command leadership as well as informal chats with enlisted staff members over lunch in the hospital’s Terrace Dining Room and several All-Hands Calls with the surgeon general in the Ross Auditorium. He also engaged with Capt. Christopher Culp, NHB Commanding Officer in daily grand rounds with residents of NHB’s Puget Sound Medicine Residency program.

“It was just Dr. Nathan and Dr. Culp with the residents during that time. He was engaged as a professor of medicine and tutored the residents through a case so expertly that they all were stoked,” said Culp.

The All-Hands Admiral Call for enlisted personnel gave the surgeon general a captive audience to discuss a wide variety of topical interests for the assembled staff members.

“This is our time to talk and I enjoy mixing it up with Sailors. This is where I can hear your concerns and questions. No one here was forced to join. You volunteered and as such, you represent one percent of our nation who serve in the armed forces,” said Nathan, adding that based on health, physical condition, academics and disciplinary issues, only one in four Americans eligible to join the military are actually qualified at this time. “That’s the lowest percentage in the history of the country. You represent a group of elite Americans. Thank you for your service and thank you for being part of something bigger than yourself.”

“As a country and as a Navy, we are coming off of 10 years of war. As Navy Medicine, we’ve been all in, whether on land, above the sea, below the sea or on the sea. Of all the rates that have gone to Iraq and Afghanistan, over 50 percent of the wounded have been Navy Medicine personnel. Nearly one-third of those killed in action have been Navy Medicine,” continued Nathan.

Nathan stated that one reason that Navy Medicine is so engaged is the involvement of the enlisted personnel. “We put more responsibility on you, the enlisted, than other services do on their medical personnel, not to be derogatory to our other services. That’s just the rule. It’s because we came from the sea. We all started as Sailors. Our legacy is 236 years old from wooden ships where those before us had to know their job and 10 others. Your heritage is from the sea. Your responsibility, accountability and demand for professionalism started 236 years ago. That’s why I’m proud of the Navy. And all of you.”

Nathan attests that Navy Medicine is more involved than ever before in making lasting positive difference and staying engaged.

“The United States Navy is a great ambassador and projector of power. We send our ships and Sailors all over the world. Our number one job is to support the war fighter which we have paid with blood and treasure. Our hospital corpsmen are the most decorated rate in the Navy, because when things get bad and everyone runs out, we run in,” Nathan stated.

Landstuhl SELRES take top honors in Warrior/leader Competition
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- For first time since the Warrior/Leader competition began at Landstuhl Regional Medical Center, Germany in 2006, two Sailors claimed top honors in the event held in late June.

 Hospital Corpsman 2nd Class Charles W. Setzer II and HM3 Malachi Mansfield, Navy Reservists deployed from Operational Health Support Unit (OHSU) Bremerton to Navy Expeditionary Medical Unit (NEMU) Germany, distinguished themselves in the mental, physical and professional challenge of the Warrior/Leader competition that involved marksmanship, military comportment, and fitness capability. Mansfield was recognized as the LRMC Warrior Award recipient for the 3rd Quarter, Cycle 2012, and Sezter took the LRMC Leader Award.

 “I viewed the Warrior/Leader Competition as a personal challenge. Since the Navy had never won this event in the past, I wanted to be the first Sailor to succeed. Throughout the process and after the announcement, I wanted this to serve as a morale booster for my fellow Sailors and wanted to set the standard and be a role model for others,” said Setzer. The Reno, Nev. native has been assigned to NEMU 13 for approximately four months.

 The Warrior/Leader Competition is a tri-service competition conducted by the First Sergeants representing each service that began in 2006. Each service selects both a "Warrior" (pay grade E-3 or E-4) and a "Leader" (pay grade E-5 or E-6) to represent their respective service branch - Army, Navy and Air Force – at LRMC. The 3rd Quarter competition took place June 23,  27 and 28.

“I wanted to participate in this competition as a personal challenge. I learned that I could take on duties and challenges that would bring me out of my comfort zone. This competition brought me out of my comfort zone and also exposed me to new experiences,” Mansfield said. The Greely, Colo. Native. has also been at LRMC for almost four months.

Mansfield drills out of Navy Operational Support Center Denver, Colo. with Operational Health Support Unit Bremerton Detachment O and Setzer had just moved to NOSC Springfield, Ore. before his deployment where he was drilling with OHSU Brem Det G. Both Selected Reserves gaining command is NHB.

 According to Hospital Corpsman Senior Chief (Fleet Marine Force) Jeffrey A. Chunglo, Navy Company First Sergeant/Senior Non-Commissioned Officer in Charge, Deployed Warrior Medical Management Center, all competitors had to qualify on an Army run rifle range. To qualify, they had to score a minimum of 24 points or the maximum of 40. Depending on the range, the size of the targets can be adjusted to simulate a 300 meters range. The actual distance can be a close as 50 meters. They also incorporate different stances - prone, kneeling and standing.

“The first day Mansfield ever picked up an M-16A2 rifle was on the morning of the qualifications. He qualified as "Marksman," missing “Sharpshooter” by three points. He distinguished himself with his performance on the rifle range. It is amazing that he was able to handle a weapon, perform initial sight adjustments and qualify without ever handling a weapon before, or without guidance,” said Chunglo, adding that Setzer qualified as “Expert.”

The next phase of the competition was a "Presentation Board," akin to a Navy command’s Sailor of the Quarter board. Each First Sergeant served as a Board member. Chunglo explained that when reporting for the Board, each Warrior/Leader gets graded on their uniform appearance, facing movements and military bearing. They then "formally introduce themselves" to the Board and recite their service specific creed. Following this, they are asked three random questions from each First Sergeant covering their service specific history, traditions, policies, customs, and general knowledge. They are graded on their response and military bearing when addressing each First Sergeant. 

“Each candidate was asked service-specific questions from a panel of First Sergeants representing the Army, Navy, Marines Corps and Air Force. All questions were randomly asked, directly from their specific service manual. HM3 performed very well at the Presentation Board, scoring well above his competition,” Chunglo said.

The final event featured a grueling "Cross Fit" style physical fitness test. Mansfield and Setzer were graded with everyone else on such events as a timed run, a floor to ceiling repetitive rope climb and manhandling a "tire flip.” All events were then computed for overall time.

“HM2 Setzer was excellent in all phases of the competition. He scored Expert on the rifle range and finished in the top percentage of the physical fitness challenge. His most noteworthy performance was at the Presentation Board. His performance was graded as perfect from all First Sergeants,” shared Chunglo. 

Chunglo notes that along with this being the first time that NEMU has ever won this competition, to claim both the Warrior and Leader competition is a definite achievement.

“Both of them volunteered for this competition as a personal challenge and to represent the Navy. They have set the bar very high for the remainder of our deployment and the competitors to follow. I am extremely proud of both of them for volunteering for the competition, yet along winning. They both worked very hard preparing for the competition and are to be commended for a job well done,” Chunglo stated.

NEMU Unit 13 consists of 108 active duty and Reserve Sailors deployed for approximately one year to LRMC. While serving as doctors, nurses, medical technicians and other support roles, NEMU integrates seamlessly with other medical servicemembers from the Army and Air Force to help care for the Wounded Warriors who arrive for medical care at LRMC from as far afield as Afghanistan. Since the Global War on Terror began in 2001, LRMC has received and cared for approximately 67,000 Wounded Warriors from downrange.

“I have worked in multi-service command in the past, and the command at LRMC has been the best I have ever experienced. I have been able to build relationships that have helped with my personal development. Everyone throughout the command is open and accepting of others and fosters an atmosphere of cooperation. All departments and clinics are integrated and promote the team concept,” said Setzer.

“My experiences are extremely valuable. I have been able to broaden my horizons working within a joint command. The most gratifying aspect of performance here at LRMC has been the opportunity to take care of the wounded warriors. Working with wounded warriors has been a humbling experience,” added Mansfield.

LRMC is the largest American hospital outside of the United States, and the only American tertiary hospital in Europe. LRMC provide primary care, tertiary care, hospitalization and treatment for more than 245,000 U.S. military personnel and their families within the European Command. LRMC is also the evacuation and treatment center for all injured U.S. servicemembers and civilians, as well as members of 51 coalition forces serving in Afghanistan, Iraq, as well as Africa Command, Central Command and European Command.

NHB Chiefs Partner Up For Trident Triathlon
By MC1 (SW) Charlemagne Obana, NHB Assistant PAO –  Naval Hospital Bremerton (NHB) Chief Hospital Corpsman (FMF) Noel Gravina, NHB surgical services directorate leading chief petty officer  and Chief Hospital Corpsman (SW) Julie Sanchez, NHB human resources leading chief petty officer teamed up to take on the month-long Naval Base Kitsap (NBK) Trident Triathlon challenge in July.

“SECNAV (Secretary of the Navy) came out with the 21st Century Sailor initiative and part of that is physical fitness which is very important especially if you’re a corpsman.  I came back from deployment last year and I realized how important it is to be physically fit for you to be able to treat patients and move them,” said Gravina.

“I’m doing the run and the bike portions of the triathlon challenge.  Professionally, this just helps me do my job better and longer because if I’m healthy, I can stay in the Navy longer.”

NHB health promotion tailored the challenge to attract a wider audience.

“We customized it [at NHB] to be accessible to more people because we want to encourage everyone including beginners to do this great cross training,” said NHB Health Promotion Coordinator Janet Mano.  “So, we broke it down into the three different distances to make it go from an introductory level all the way to a much higher level.  We also let people do it as a team.”

NHB staff members were invited as individuals or teams to complete the following events with corresponding distances according to their fitness level: the Ironman which required swimming 2.4 miles, biking 112 miles, and walking/running 26.2 miles, Half Ironman which halved those required distances, and the Sprint which required swimming half a mile, biking 12.4 miles, and walking/running 3.1 miles.

“They could try a new activity they haven’t done as a beginner…or it might be an incentive for someone to get on a bike for the first time in years.  We get in our fitness comfort zones and we wanted to give them a non-competitive motivation to get out of your fitness rut,” said Mano.

 “Initially, I wanted to do all three [parts of the Ironman] event except I found out I’m not a very good swimmer.  So, I asked Chief Sanchez to be my teammate and it worked out really well because now we’re motivating each other,” said Gravina.

Sanchez, a highly capable swimmer since childhood, used the side stroke to complete the swim portion for her team.

“My physical capabilities stood up to my determination to knock it out in one fell swoop.  At lap 50, I thought to myself I’m over half way there, I’ll just keep going and do the whole thing,” said Sanchez about completing the 2.4 mile swim in a single 1 hour and 52 minute session at the NBK Bangor pool on July 21.

Gravina has been working out twice a day to make the deadline.  He completed the run portion July 24 and is in the home stretch with the biking.

“I have about 30 miles left to do on the bike, and I’ve been averaging 18 miles a day,” said Gravina.

NHB health promotions is tentatively planning on making this challenge to staff a perennial event.

“This was the first year offering it, and I hoping and planning to offer it annually and grow it over the years,” said Mano.

“It was actually a lot of fun especially with chief Sanchez.  Sometimes, when you don’t have a goal, it gets boring, but when you have a specific goal to achieve then you’re driving toward that,” said Gravina.  “I would definitely participate in this again.”

NHB to hold Back-to-School & Sports Physicals Aug 15 & 29

Naval Hospital Bremerton will assist families preparing for the upcoming school year and sports seasons by offering after-hours School/Sports Physicals.

The physicals will be available from 5:00 p.m. to 7:00 p.m. on Wednesday, August 15 and Wednesday, August 29, 2012, on the second floor of NHB’s Family Medicine Clinic and is co-sponsored by NHB Family Medicine and Pediatrics, and Branch Health Clinic Bangor Family Medicine clinics.

 In order to make the visit go smoothly students and parents are asked to come prepared.

It is strongly encouraged for parents/students to complete all school/sports physical forms prior to the appointment as this task is tedious and time consuming. If a medication for school form is also required, please have it completed as well.  All students under age 18 must be accompanied by their parent or legal guardian. Please wear comfortable clothing for the physical exam. 

 Other required items to bring include your ID card and Immunization Record/shot card. The visit will include the following: visual exam, height/weight, vital signs (blood pressure, pulse, respiration) and the physical examination itself. 

 In order to qualify for the appointment, students must be TRICARE Prime beneficiaries enrolled in Family Medicine at NHB or Bangor, or Pediatrics. To make an appointment, contact TRICARE Regional Appointment Center (TRAC) at 1-800-404-4506 and ask for a Sports/School Physical appointment.

NHB CSADD urges “WAIT 2 TXT,” “TXTING KILLS,” and “DNT TXT”
By MC1 (SW) Charlemagne Obana, NHB Assistant PAO –  Navy Hospital Bremerton (NHB) Coalition of Sailors Against Destructive Decisions (CSADD) members raised awareness for NHB Sailors, staff, and visitors about the dangers of driving while texting as part of their month-long July driver safety campaign on July 17.

“We wanted to focus on what we call ‘Wait 2 Text’ which involved putting down the phone and not texting while driving,” said Hospital Corpsman Elizabeth George,
CSADD July motor vehicle safety campaign coordinator, of NHB’s Pediatric department.

“There are different organizations that have similar campaigns going on that are focused on teenagers.  CSADD is for everyone but specifically for Sailors 25 and younger. Our campaign is for those who might be the people most often guilty of texting and driving,” George said.

NHB CSADD members collected over 50 signatures during lunchtime from people pledging to keep from texting while driving.  Their table featured a static display with facts and statistics of fatalities resulting from texting and driving.  Those who made pledges signed a banner and were given a choice of different rings and bracelets with slogans such as “TXTING KILLS” and “DNT TXT.”

 “You’ve got a group of young Sailors in plain sight encouraging their peers to sign this document that they promise not to text and drive.  I think it’s a great idea,” said NHB Command Career Counselor Hospital Corpsman 1st Class (FMF) Jason Corless who signed the banner and received a ring emblazoned with “WAIT 2 TXT.”

“It’s pretty awesome that they’re taking ownership and accountability for everything themselves and their counterparts are doing in the hospital and in the region,” added Corless.

The July CSADD motor vehicle safety campaign is based around the acronym SAFETY to highlight the many dangers to Sailors.

“SAFETY stands for speeding, alcohol, fatigue, ejection (seatbelts), texting and you, and what you can do to prevent that,” said George.

After collecting signatures, CSADD members posted the banner below the CSADD display located at the hospital quarterdeck.  The tri-fold display explains the CSADD program, the CSADD Creed, and topics covered by CSADD.

Along with raising awareness, the NHB CSADD chapter is tentatively planning events such as paintball, MWR trips, and movie screenings to give NHB Sailors safe and fun activities to participate in.

“Our CSADD is doing a phenomenal job.  They’ve helped stand up other programs at the Naval Base Kitsap Bangor base and I hope they can be a good contender for chapter of the year,” said Corless.

The CSADD program was first implemented Navy-wide on June 18, 2010 by Chief of Naval Personnel Adm. Mark Ferguson.

NHB Volunteers help local church revitalized Pee Wee ballfield
By Douglas H Stutz, NHB Public Affairs -- By helping to build it, they will come. Naval Hospital Bremerton staff volunteered to help construct a foundation/retaining wall for a Pee Wee baseball field at Christ the King Lutheran Church and School in Silverdale on July 14.

NHB’s Chief Petty Officer Association, Team 365 and others formed the Saturday morning work party to bolster the area by placing and reinforcing block stones approximately four high around the backstop of the Church ball field.

“We had been trying to do this project for quite some time. We’re affiliated with the local Pee Wee Baseball Association and supporting them is something we shared with the community. We appreciate the help from Naval Hospital. It’s just awesome to get the extra support,” said Bruce Babler, Christ the King Lutheran Church and School principal.

By reinforcing the foundation and constructing the associated retaining wall, there is now available and sustainable space to add improvements to the field.

“The Church can now move onto phase three of their plan.  That phase is to build dugouts and bleachers for the ball field and players that use it.  This has been a plan in play for the last few years and the volunteers have made it possible,” said Stan Graham, NHB staff member and volunteer-organizer of the event.

Graham added that the entire project has resulted in many overlapping, positive contributions for everyone involved. The Church benefits, NHB staff (again) support a community project; the command is recognized as a leader in the community; the Navy is represented with the effort as a way to display a good image, and all those who volunteered have provided a needed service to the little league (from a safety and comfort perspective).

“Volunteering is what I do. I like getting plugged into the community and what better way to do that than by helping out? It’s also very rewarding in its own way by helping others out with a project. It really does show others that as representatives and ambassadors of the Navy, this is what we do. We help not only when deployed overseas, but also at home with our neighbors when needed, such as building this wall that is a lot larger than I thought,” commented Hospital Corpsman 1st Class Christopher Cornish.

HM1 Adam Cerullo showed up to volunteer after a long night of duty the day before. “But I made the commitment to be here. As long as I got the energy, I’m good to go.  Plus, this church is right in my area and is part of my community,” Cerullo said.

“On behalf of Christ the King Lutheran Church (CTK), I want to personally thank those in attendance this past Saturday for all your hard work in building and finishing the retaining wall at CTK!  Your efforts really made a huge difference,” Graham said.

“We really appreciate the help. Thanks very much to everyone for being here,” said Pastor Ted Lambert of Christ the King Lutheran Church

Puget Sound Family Medicine Residency honors Graduating Class of 2012
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton’s Puget Sound Medicine Residency held the annual Family Medicine Resident Graduation Ceremony on June 29.

Four of the Family Medicine third year residents ship out to other duty stations and six Family Medicine first year residents continue on their training at NHB along with six new interns.

“This ceremony celebrates the successful completion of one of the hospital’s mission, which is to train the world’s finest family physicians. Their maturity, intense personal drive, compassion and willingness to grow personally and professionally have been hallmarks of their academic achievement. I would put myself and my family under their care,” said Cmdr. Erik Schweitzer, NHB Family Medicine head.

The graduating class of Family Medicine Third Year Residents are; Lt. Arriel E. Atienza, Medical Corps, with next duty station with 2nd Marine Division, Fleet Marine Force, Camp Lejeune, N.C.; Lt. Cmdr. William A. Boller, III, Medical Corps, with next duty station at Branch Health Clinic Chinhae, Korea; Lt. Stephen A. Keck, Medical Corps, with next duty station at Naval Hospital Guantanamo Bay, Cuba; Lt. Daniel E. Warren, Medical Corps, with next duty station at Naval Hospital Oak Harbor, Wash.; and Lt. Ramil M. Francisco, Medical Corps.

The ceremony was highlighted by having two former commanding officers join in the event as guest speakers, along with the entire event being overseen by two bald eagles taking up residence in the trees along NHB’s shoreline.

“It is truly wonderful to be home, greet new family interns and meet with so many friends. The opportunity to be here is adding life to my years and years to my life being back in the Pacific Northwest. There is no place I’d rather be,” said Rear Admiral William Roberts, Fleet Surgeon, United States Fleet Forces Command and NHB commanding officer from 2003 to 2006.

“Nothing is achieved without enthusiasm, hard work and some doubt along the way. Make your place a better place by one or more thing you do. Smile. Have fun. Include your teammates, and remember to say thank you,” shared Roberts. “Congratulations to our graduating residents. You will be challenged as long as others seek freedom and come in harm’s way. I am humbled to be here.”

“We find our country at war and you knew that when you came here but still joined. You are to be commended for serving a cause greater than yourself. Your efforts and your dedication, discipline and focus have enabled you to achieve your goal. And with the added gift of leadership comes the gift of influence to inspire others,” Capt. Mark E. Brouker, Navy Medical Center San Diego Chief of Staff, guest speaker and former NHB commanding officer, 2008-2011.

Family Medicine First Year Residents continuing their residency programs are Lt. Amelia H. Buttolph, Lt. Casey E. McCann, Lt. John S. Roberts, Lt. Gordon P. Salgado, Lt. Adam D. Voelckers, and Lt. Amelia Wright.

The Residency graduation has also included several related events over a week-long period, starting off with the staff versus residents’ softball game, with the staff pounding out a 38-11 win. The week wraps up with the traditional Hail and Farewell ceremonial dinner.

The Family Medicine Residency program has long been unique in that the residents train to become family physicians in a community hospital setting such as NHB. In such an environment, family medicine residents become primary physicians for their patients on all inpatient and outpatient services. Residents also receive additional experience in the Intensive Care Unit and Neonatal ICU at Madigan Army Medical Center and on the Pediatric Wards and Emergency Room at Mary Bridge Children’s Hospital, both in Tacoma, Wash. PSFMR also partners with the University of Washington Family Medicine Network which has been consistently rated the top training program in the country. In addition, PSFMR was rated as the top rotation site by UW medical students.

Puget Sound Family Medicine Residency (PSFMR) has a total of 18 residents, usually averaging approximately six per year group. The Family Medicine staff at NHB have received additional training in Faculty Development, with two having completed the two-year (U.S. Army) Madigan Fellowship. PSFMR staff and residents have been recognized by the Uniformed Services Academy of Family Physicians for their research efforts, and they have been published in such noted medical journals as American Family Physician, The Journal of the American Board of Family Medicine, The Journal of Family Medicine and Military Medicine.

 “I would go in harm’s way and serve anywhere with any of you,” commented Capt. Christopher M. Culp, NHB Commanding Officer to the graduating class. “You will always be Bremerton family physicians. This is where you were trained.”

Newest Navy Doc from Bremerton completes dream at Naval Hospital Bremerton
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- For one graduate of Naval Hospital Bremerton’s Family Medicine Residency program on June 29, the journey to become a Navy family physician is completed a short distance from where it initially began 33 years ago.

When Lt. Ariel E. Atienza, Medical Corps, officially joins the ranks of NHB’s Puget Sound Family Medicine Residency (PSFMR) graduation class of 2012, he will have come full circle and then some.

Atienza was born and raised in Bremerton, Wash., completed Bremerton High School in 1996, and was active in Navy ROTC. After graduating from Cornell majoring in biology, the influence of a Navy town guided him. He served on several ships as a surface warfare officer before deciding to pursue his goal of becoming a physician.

“I knew early on I wanted to be a doctor, and I finally decided to do it in the Navy with the associated benefits and programs available. Being a Navy physician in family practice is what I want to do with myself,” said Atienza.

“Becoming a physician has been a goal of mine growing up and my parents have been proud supporters throughout,” said Atienza, whose parents, Rosie and Pedro have resided in East Bremerton for over 40 years.

“We’re very proud of him,” said Rosie.

“Now when someone asks me what my son does, I can say he’s a doctor,” added Pedro.

After completing medical school, Atienza then asked for and was selected for the Family Medicine Residency program at NHB, where he became immersed in the three-year program that provides graduate-level medical education for future Navy family physicians, and caring and training in improving the health of all eligible beneficiaries served through patient-centered care.

“Graduate-level medical education here is second to none and is the primary command objective for the Puget Sound Medicine Residency program. We also help continue to execute the demands of mission readiness along with daily general practice. Nowhere else could I have done as much learning and training,” said Atienza.

Like most residents, Atienza’s first year was training-centric and becoming immersed with basic medicine in a general practice setting. The first year students learned to become comfortable in dealing with patients on all levels, in-patient and out-patient management, and basic obstetrics and new born care.

“The first year curriculum is designed to prepare for any condition as a medical doctor who can then go into the fleet as a general entry level provider. There’s also more training added if someone is going to a sub-surface or aviation assignment,” Atienza said, adding that general practice medicine in a military setting means “being comfortable in seeing and treating a variety of diagnoses and injuries across a patient population of diverse ages and backgrounds. It’s also about knowing one’s own limitations and when to go for help.”

Atienza’s second and third years of residency built upon the foundation of his first. His focus on family medicine included becoming more knowledgeable on treatment concepts and procedures, as well as handling more advanced detailed management of medical diagnoses, processes and injuries.

“Our training is continually designed to make us competent with the ability to practice medicine wherever we go. We all went beyond our comfort level to finding out how to handle medical problems that initially we knew nothing about. We learned as much as we could and we were constantly challenged. It was always valuable to have clinical specialists and colleagues available and willing to talk over cases, procedures, diagnoses. We are expected to be proficient. Working, learning and teaching with others in the residency program has helped us all get comfortable with the full scope of family medicine,” Atienza said.

PSFMR program at NHB has long been unique in that the residents train to become family physicians in a community hospital setting where they help provide needed medical care to active duty personnel and family members, as well as retirees. In such an environment, family medicine residents become primary physicians for their patients on all inpatient and outpatient services. Residents also receive additional experience in the Intensive Care Unit and Neonatal ICU at Madigan Army Medical Center and on the Pediatric Wards and Emergency Room at Mary Bridge Children’s Hospital, both in Tacoma. PSFMR is also a partner with the University of Washington Family Medicine Network which has been consistently rated the top training program in the country. In addition, PSFMR was rated as the top rotation site by UW medical students.

“We have a renowned residency program. We have a nationally recognized program of excellence. We have a quality program with quality residents who depart with high marks and awards to prove it. The quality of interaction with the other residents and staff helps make this is a really good place. The Uniformed Services University of the Health Sciences (USU) has labeled NHB as the best family practice military training site,” explained Atienza.

The NHB Family Medicine staff has a combined total of over four decades of experience in medical education. Additionally, most of the faculty members have also received additional training in Faculty Development and that collective expertise has positively impacted Atienza and the other residents throughout their three years as residents.

“Our faculty doesn’t look at teaching as just a job. They think it’s a privilege. They always mentor a little extra, explain a little more and go out of their way to reinforce training on patient care. They have the drive and it rubs off on us,” explained Atienza.

Graduating from the residency program is very rewarding. Some say we’re like a tribe. We all have basically the same framework. We started as juniors and had fun and handled the work load.  Our focus on medicine also included family and camaraderie. As we continue to learn and progress, we also began to mentor and tutor as we were still being taught. Working with colleagues in this program is part of what makes it special,” Atienza said.

The past several months have been a whirlwind for Atienza and his family. In April he completed his Medical Board qualifications. In May he married Tina, his sweetheart. In June, he graduates, completing one full circle as he starts another. “We take off for 2nd Marine Division, Camp Lejeune, N.C. It will be new and exciting. One of the other reasons I joined the Navy is to see the world. I’ve seen about half, so might as well continue to try and see the other half.”

 BHC Everett Corpsman Making a Daily Difference on Down Range Deployment
By Douglas H Stutz, Naval Hospital Public Affairs –
When the weather warms during May to September in Afghanistan, the war also heats up. With the fighting season commenced in southern Afghanistan, a Branch Health Clinic Everett corpsman is right in the midst helping to care for wounded personnel.

Hospital Corpsman 3rd Class (Fleet Marine Force) Anthony M. Juarez is serving right in the midst providing direct medical support to help save the lives of those injured in combat.

Juarez is assigned to the Role 3 Multi-National medical facility at Kandahar Air Field, which has earned the title of the world’s busiest military trauma hospital. The 22-year old Bakersfield, Calif. native primary responsibility is to provide emergency care transportation to incoming casualties from the flight line to the Trauma Bay. He also assists with Emergent, Urgent, and Specialty care and works in the Referral Care Center (RCC)/ Emergency Vehicle Operation Casualty Care (EVOCC) section.

“I am part of a great team doing great things in a bad place,” said Juarez.

 An average day for Juarez has his 24-hour shift starting at dawn. It is at this time that the daily job assignments of shift corpsman in charge, flight line leader, primary and secondary driver are assigned. It takes several minutes for the shift to be changed over from the last crew to the next. Maintenance and restock checks are completed on equipment and supplies of the ambulances and Humvees. He then ensures that the consumable supplies on the Referral Care Center (RCC) crash cart are ready for any emergency situation that might arise. The RCC clinic then opens for business at 8 a.m. to process patient flow to the appropriate location and provider.

“Throughout the day we will get the call for an incoming patient(s) from the flight line anywhere from an estimated time of arrival (ETA) of 30 min to right now. In most cases, with only seconds to turn over a patient to a provider or nurse, my crew and I depart to our designated job assignment for the day,” explained Juarez.

“If I was (on) shift intensive care, my primary goal is to keep abreast with incoming patients,” continued Juarez. “Once a patient is confirmed inbound, shift I/C then coordinates with the flight line leader and trauma team leader for any possible medical support that will be needed such as providing a litter bearer team or ambulance. Overlapping coordination continues with the team briefed on the incoming patient(s) and the plan of action is generated.

Juarez notes that the flight line leader is then in charge once the team has left the hospital compound to await the incoming aircraft. “Even though a plan of action has been generated beforehand, our patients and the combat situations dictate quick and fast flexibility of orders for being directly responsible for ensuring patient and staff safety while providing our services on the flight line.”

The primary and secondary drivers ensure effective and safe patient movement from the flight line and provides litter bearing assistance. Juarez has held all of these titles on a frequent rotational basis. After 4 p.m., Juarez and the others in his section remain on call solely for the EVOCC patients that come to the hospital.

“But we help whenever and wherever we can. We (also) provide services to the Afghan National Army, Afghan National Police and local nationals who are casualties. We provide the same unbiased care to all who enter our doors,” Juarez added. 

 The escalation of fighting has sharply brought the most difficult aspect of deployment directly into focus for Juarez. According to hospital records for 2010, there were approximately 800 battlefield casualties treated at Kandahar Air Field’s Role 3 from May through September — the traditional fighting season in Afghanistan —More than half of the cases were U.S. or other NATO troops. The rest were Afghan soldiers and civilians too badly hurt to be cared for at nearby Afghan military or civilian hospitals. Compiled statistics also show that almost half of all battlefield injuries treated at Role 3 are caused by improvised explosive devices.

“I have experienced the loss of Marines, Sailors, and Soldiers. The hardest part professionally is accepting the results of the ultimate outcome no matter what and rationalizing in my head that I did everything I could for my patients, even though I may not feel that way personally,” he explained.

Memorial Day was a poignant time for Juarez who wrote in memory of fallen Marines and Sailors to commemorate that day.

"I will never know you for who you are, but only by who you were. I can't imagine how a parent's grief is generated but I can feel the effects from a distance.  I can only ask God in my own ignorance, for blessings on families; to mend them, build them, guide them and love them. Take them and keep them close. For you are our father and at your right hand may justice, peace, and comfort find them in their new beginning. Some gave little, some gave all! May God bless you on a job well done! I salute you!"

Juarez is the oldest of five children and was raised by his grandmother, a registered nurse who provided his introduction to medicine. His initial plans were to be a high school history teacher upon graduation from Highland High School, but in 2006 he entered the Navy. Fast forward six years later to a challenging deployment, which has become a maturation platform and notable experience to help him handle the continuous casualties and routine professional and personal needs.

“The most enjoyable aspect of this deployment has been the people I have met. The people that I have come to know on this deployment have really enriched my life beyond any measure I could have ever hoped for,” Juarez said, adding that he has gained added knowledge in himself as well as being a corpsman. “I have learned that no matter what I am faced with, I can overcome. The training and experience over the last few years have given me a great insight of what I am dealing with in my current situation.”

Nurse Corps Lt. recognized with Junior Nurse Corps Excellence Award after promotion
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs – A newly promoted Navy Nurse Corps lieutenant added to his career development by also being recognized with the inaugural command Junior Nurse Corps Excellence Award on June 21.

Lt. Anthony S. Hofer, assigned to Naval Hospital Bremerton’s Multi-Service Ward, began his day by being promoted by Rear Admiral Elizabeth S. Niemyer, Navy Nurse Corps Director and Wounded, Ill and Injured Deputy Chief in front of family and command staff members.

“This is a nice opportunity to promote someone during my visit. I’m impressed by Lt. Hofer’s career path which shows we can’t assume someone was a corpsman before. His expertise and leadership bodes well for Navy Nurse Corps,” said Niemyer.

Hofer’s first 10 years were spent as a fire controlman, serving aboard USS Mount Whitney (LCC/JCC 20) and USS Blue Ridge (LCC 19). He was commissioned on the 100th birthday of the Navy Nurse Corps (May 13, 2008).

“How to top his commissioning? By having the Navy Nurse Corps director being the reenlisting officer is how,” said Capt. Iris Boehnke, NHB Director of Nursing Services.

The Junior Nurse Corps Excellence Award managed to out-top the reenlistment. The initial recipient was selected by NHB’s Professional Council of Nursing.

“Lt. Hofer was picked due to his professionalism, clinical expertise and bedside clinical leadership,” explained Cmdr. Elizabeth Oakes, NHB Nursing Services Assistant Director.

The award citation read, “In recognition of your commitment to nursing excellence and to nursing as a unique discipline and art. Your demonstrated dedication, contribution to the nursing profession, and clinical expertise have made a positive difference in the quality of care provided to our patients and their families.”

“When I decided to make the Navy a career, I was told by a lieutenant that day that one day I would be in charge of people and I would have to decide if I wanted to be a manager who was hard to follow or a leader who people want to follow. I hope I continue to strive to be a leader,” said Hofer.

Hofer is part of the Navy Nurse Corps of over 4,000 members, with 2,911 active duty and 1,162 reservists. There are over 60 Navy Nurses stationed at NHB, with approximately a dozen of their members currently forward deployed.

Branch Health Clinic Bangor ribbon-cutting reopens renovated facility
By Douglas H Stutz, NHB Public Affairs -- Branch Health Clinic Bangor officially reopened on June 14 with a traditional ribbon-cutting ceremony after going through a major 17-month facility upgrade. The complete renovation has revamped and remodeled the facility.

“We made it! 17 months ago we broke ground before this day. There are two reasons to hold this ribbon cutting. One (reason) is to reflect on all we have gone through to reach this point, and it’s been a lot. There’s been noise, electrical outages, a number of moves, even emus to deal with. We did it with class, style, and professionalism. We have been flexible, dedicated and shown perseverance not only by our staff, but also by our patients. Through all the disruptions, our beneficiaries still think we’re the best,” said Cmdr. Christian Wallis, BHC Bangor Officer in Charge.

The clinic now has a well-organized 21st century layout with additional exams rooms, as well as associated medical and dental services in close proximity resulting in greatly improve patient flow. 

“The previous layout had become cumbersome as all of our medical and dental services have expanded over the years. Our new layout provides staff and patients with a better design that automatically improves patient flow throughout the clinic. We also have improved patient care and our clinic staff can now operate as efficiently and effectively as possible,” said Wallis. 

The new interior design is more than just cosmetically appealing with a consistent visual appearance throughout all spaces. The renovation conducted an architectural re-design of the entire health clinic based on the concepts of Medical Home to completely improve patient and provider flow while upgrading facility services. The recapitalized of 2.8 miles of square footage allowed an increase of clinical space including additional exam rooms, a second optometry eye lane and a four man audio booth. The redistribution of provider staff and reengineering of work flow processes to accommodate two-part physical exams reduced patient wait times by more than 50 percent while increasing patient throughput by 25 percent. 

The increase in clinical space has also allowed the implementation of a new Sports Medicine and Rehabilitation Team (SMART) clinic to provide
comprehensive treatment and management of musculoskeletal injuries within the family medicine clinic.

“This was an important project because it helps take care of our people; our Sailors on the waterfront and their family,” said Capt. Pat Rios, Navy Facilities Northwest Commanding Officer. “There is usually nothing worse to an engineer than an occupied renovation, especially a medical center. But this project worked out very well.”

According to Wallis, the clinic renovation was handled in four phases for a cost of $7.4 million and resulted in little or no degradation in services. Additionally, due to the detailed planning, coordinating and communication between three organizations working together on the projects, the renovation was completed three months ahead of schedule. The effective planning of the clinic helped maintain a 94 percent customer satisfaction rating and 99 percent access to care rating while being upgraded.

“Usually during a ground breaking ribbon cutting ceremony there are guest speakers, but we are all ‘guest-thankers’ today. What a remarkable achievement it was to continue through dealing with everything from jackhammers to emus during the renovation project to provide for our patients and keep morale high,” said Capt. Christopher Culp, Naval Hospital Bremerton Commanding Officer.

“We planned it to minimize as much as possible the impact on patient services. We had no impact on access to care for our enrolled population. Our beneficiaries still received the high quality, customer-friendly care that our clinic provides,” said Wallis.

 Wallis noted effective management ensured the clinic’s 11 Dentists, six Hygienists and three Specialists achieved a 98 percent Dental Readiness Index, 68 percent Dental Health Index and 99 percent access to care rate while exceeding BUMED production targets by 8 percent all during three moves during the renovation.

Effective space management has also factored in to allowing Submarine Group 9 Medical and Strategic Weapons Facility Pacific and Marine Corps Security Force Battalion medical personnel to comfortably co-exist within the clinic.

"This renovation was worth the minor inconveniences to our patients and staff. We've gained a first-class facility to deliver world-class patient-centered medical and dental care,” said Capt. Scott R. Peck, NHB Director for Primary Care and Branch Clinics

“The final reason we held this ribbon cutting is that it builds our future. The renovation is over and now behind us. Our next great thing, whatever it might be, is coming and we are well prepared for it,” Wallis said.

NHB Comptroller and Management Analyst Honored
By MC1 (SW) Charlemagne Obana, NHB Assistant PAO – Navy Medicine honored members of Naval Hospital Bremerton’s (NHB) Resource Management and Comptroller directorate with top honors on June 6.  

NHB Director of Resource Management/Comptroller Robert Tufts was awarded Bureau of Medicine (BUMED) Civilian Comptroller of the Year and NHB Management Analyst Sabrina Weber-Cornwell was awarded Data Quality Manager of the Year for Navy Medicine (NAVMED) West at the 2012 Navy Medicine Audit Readiness Training Symposium at the Nation Conference Center in Lansdowne, Va.

Vice Adm. Matthew Nathan, U.S. Navy Surgeon General, and Chief, U.S. Navy Bureau of Medicine and Surgery, presented them with their awards.

“The award is recognition of the hard work of my staff.   Any leader knows that you don’t achieve anything without your staff’s backing,” said Tufts.

 “I’m still in shock,” said Weber-Cornwell.  “It feels good to be recognized.”

Tufts expertly executed a $101 million budget and closed fiscal year 2011 at managing nearly 100 percent obligation of that budget, the highest rate in command history and second highest in Navy medicine according to the award nomination form.

 “We provide a fairly economical product.  Part of what we are doing is providing resources that our nurses, physicians, corpsmen are able to deploy into warzones without a hospital for the Navy to support our Marines and Sailors,” said Tufts.

NHB Resource Management and Comptroller directorate consists of approximately 25 staff members handling accounting, budgeting, travel, civilian payroll, civilian human resources, data quality, and uniform business office duties.

Tufts and his staff are responsible for overseeing an annual budget between $83-101 million excluding military compensation.

“We have the duty to advise the command leadership on proposed expenditures of funds and proposed contracts and whether we will be able to absorb those costs currently or in the future. We also advise on financial policies, regulations, and laws to make sure we don’t break any,” said Tufts.

In addition to the hospital, the directorate is responsible for maintaining the branch health clinics at Puget Sound Naval Shipyard (PSNS), Everett, and Bangor.

“$83 million dollars is the base we get every year.  The extra $17-18 million is for special projects like the renovation of the Bangor clinic or the renovation currently going on at the PSNS clinic, or when the elevators or boilers need replacing,” said Tufts.

Tufts attests that the staff works tirelessly to help keep the hospital running at its optimal efficiency with available resources to bring the best available care to beneficiaries.

“In addition to providing good, quality medical care, we are also taking care of the paperwork and trying to be good stewards of the taxpayer’s money,” said Tufts.  “We try not to waste funds and we do things responsibly.”

Weber-Cornwell plays a vital role in the process by ensuring data is correct, complete, and valid in making sure resources are being allocated where needed.

“I do data quality, MEPRS (Medical Expense Performance Reporting), and EAS (Expense Assignment System) processing.  What I deal with in my MEPRS/EAS role is the labor files, the financial files, and the workload files out of CHCS (Composite Health Care System),” said Weber-Cornwell.

Among her many noteworthy achievements according to her nomination form, Weber-Cornwell was recently hand-selected by the NAVMED West Data Quality Manager to assist in the testing and evaluation of several reporting methodologies to the Navy Medicine Data Quality Program.  Her assistance was key in the successful implementation of these reports which greatly enhanced Navy Medicine’s reporting capabilities.

“Changes happen so quickly. It seems like a moving target when you’re trying to find the right metric,” said Weber-Cornwell.  “I’ll continue doing what I do internal within the command or with external requests.  I’m always available to help and I like being the ‘go to’ person.”

One of the new changes facing the directorate will be an annual Department of Defense-wide financial audit by a Certified Public Accounting (CPA) firm for Generally Accepted Accounting Principles (GAAP) compliance.  The directorate is preparing for this evolution which tentatively takes effect fiscal year 2014, according to Tufts.

NHB Chiefs Welcome Home Wounded Warrior
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton’s Chief Mess gave a heartfelt reception to welcome back one of their own at Seattle Tacoma (SEATAC) International Airport on June 10.

Hospital Corpsman Chief Holly Crabtree, rehabilitating after being severely wounded by a enemy sniper while supporting operations in Iraq in April 2010, was greeted with a hero’s welcome.

The event was arranged by NHB Command Master Chief Frank Dominguez and Hospital Corpsman Master Chief Tom Countryman, and closely coordinated with Port of Seattle Aviation Security, Port of Seattle Police Department and the Transportation Security Administration.

“We’ve been looking forward for her arrival all week. It is just a honor to assist to welcome Chief Crabtree. We’re blessed to have her home. It’s hard not to be emotional about this, because usually when we render honors, it’s for those who have fallen,” said Port of Seattle Sgt. Doug Newman, Office of Professional Accountability, and the 2011 Navy Reserve Sailor of the Year of Navy Reserve National Security Forces, Naval Base Kitsap,Wash.

As the U.S. Airways flight was taxiing into place after landing, Port of Seattle Fire Department gave ceremonial twin water cannon shots across the plane brow. Once the plane door opened, Master Chiefs Dominguez and Countryman accompanied family of Crabtree onto the plane to greet her and escort her into the terminal. Once inside SEATAC, the NHB chief petty officers stood in formation and rendered salutes, followed by shared smiles and warm applause by Port of Seattle staff members and fellow passengers.

“This is completely unexpected and so awesome. What’s up my brothers and sisters!” acknowledged Crabtree to her Chief’s Mess.

“Holly will remember this event for the rest of her life and know that you all have her back here in the Pacific Northwest.  It was truly an honor welcoming one of our own home from the battle field.  I continue to be awed with the character of the mess and you all show its true strength every day. I will cherish today's moment for the rest of my life,” said Dominguez.

“We are so pleased and happy to be able to do this,” added Deborah Miller, Port of Seattle Aviation Security Supervisor.

Crabtree, a Port Angeles, Wash. native, was accompanied on the inbound flight from Florida with Leah, her daughter, and is transferring to NHB. She sustained injuries on patrol with Army Civil Affairs attached to Special Operations task Force West near Ar Ramadi in Iraq’s Anbar Province. Despite undergoing therapy during her lengthy rehabilitation process, it hasn’t held her back. Crabtree has participated in Wounded Warrior Games 2011, thrown out the first pitch at a University of South Florida baseball game, and shared greeting with members of the New Orleans Saints. 

There were also several former shipmates of Crabtree in attendance from her time on USS Abraham Lincoln (CVN 72) when homeported at Naval Station Everett. Along with Countryman were retired Hospital Corpsman Master Chief Bee Rose, and Lt. Jeremy Howell, acting Department of Administration head. “We were on a first name basis as young corpsmen from 2001 to 2004. Holly was a operating room technician and I was a general service corpsman. We also were at Independent Duty Corpsman school together, and I last saw her when I was commissioned in 2008. I’m very happy to be able to take part in welcoming her here,” Howell said.

“This has been without a doubt one of the coolest events I’ve ever been part of in all my time serving in the Navy. Like all of us, I’m glad and honored to be here to welcome one of our own home,” said HMC Michael Mussett, Leading Chief Petty Officer of Nursing Services.

NHB Operational Symposium shares Deployment Experiences
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton held an Operational Symposium on June 8, to share personal shipboard and shore-based deployment information, experiences and lessons.

The Operational forum has become a quarterly event originally created and coordinated by NHB Navy Nurse Corps staff to give recent returnees from deployment the opportunity to share their "story" in word and picture. Under the guidance and arrangement of Cmdr. Christine Ward, Pediatric Nurse Practitioner and clinic manager, and Operational Symposium coordinator, the program has expanded over the last 12 months to allow all staff members the ability to share their ship and shore experience.

“I wanted to give all staff members of our deploying platforms a chance to celebrate with others upon their return. I believe in the spirit of morale building, of esprit de corps, and inspiring enthusiasm for the duty that is before us,” said Ward.

The symposium is open to all staff members. According to Ward, every staff member can attend the event. Civilians can learn and support active duty staff, as well as add their insight or even share their own past experience(s). But the real hope is attracting busy active duty staff members to the event to pick up specific details and descriptive particulars from first-hand experiences from those returned on deployment.

“They will be better prepared when the baton is passed to them by learning about what works and what doesn’t, and all the good, bad and the ugly of deployments. These will be the main themes with each speaker giving it their own twist. Those attending will also find a ready personal reference and a point-of-contact to ask more questions,” said Ward.

The symposium presented two polar-opposite examples of a ship and a shore deployment. Hospital Corpsman Chief Shawn Kenney spoke on his Individual Augmentee assignment to Afghanistan and Lt. Cmdr. Kevin Gue, former NHB Multi-Service Ward and Intensive Care Unit head nurse and now Senior Nurse Officer assigned to USS John C. Stennis (CVN 74) shared his recent deployment to the Western Pacific, Indian Ocean and Arabian Gulf.

Gue focused his deployment talk as part of the Stennis Medical Department from July 25, 2011 to March 2, 2012. “We were gone for 221 days and the entire deployment was one of the best I’ve ever been on. We were really a small hospital on a small floating city,” said Gue, a 26-year Navy veteran.

Gue was part of a team of seven providers, one psychologist, one physical therapist, one radiological health officer, one anesthesiologist, and approximately 35-40 hospital corpsmen. Compiled statistics helped to tell a portion of Gue’s story – the Stennis Medical department, augmented by medical personnel from Carrier Air Wing Nine, treated 3,600 sick call patients and 2,745 acute care cases; handled 2,855 physical exams; conducted 410 surgeries, and coordinated 2,515 physical therapy appointments.

“Being a medical officer on a ship is career enhancing, not only because there are few billets. But also due to the amount of training we did, which was a lot with many different departments. I also worked with our preventive medicine team, medical readiness team, and our battle dressing stations and repair lockers for general quarters,” Gue said, noting that the long days on station supporting Operation Enduring Freedom also took them to great port calls like Singapore.

HMC Kenney’s deployment was well beyond the horizon from Gue’s in landlocked Afghanistan in 2011-12 with 3rd Battalion, 7th Marines, Kilo Company. Assigned to Forward Operating Base Inkerman in the volatile southern part of the country, Kenney provided medical support as the sole provider for approximately several hundred Marines, 50-100 Afghan National Army personnel and the local populace.

“Being an independent duty corpsman, I got orders to go as soon as I checked in to NHB,” Kenney related. “There was three months of training out of (Marine Air Ground Task Force Training Command) 29 Palms, including a month in the desert under actual conditions to simulate where we were going down range.”

Kenney ran Kilo Company’s Battalion Aid Station. He tailored the site to fit his ability and those of two additional corpsmen assigned. Besides the daily norm of sick calls and preventive medicine duties, he went along with vehicle and foot patrols outside the wire and dealt with a lot of trauma cases mostly for the locals and ANA. “There were such injuries as open fractures and chest wounds that I took care of. We did what we could and stabilized them to the best of our ability,” he said.

Kenney attests that the FOB was really just like camping out for seven straight months. But in a hostile environment. “Our Marines could go without water and food, but by God, we had a gym,” he noted, stressing that the weight lifting helped deal with the needs for carrying, at minimum, 40 pounds of gear when on foot patrols.

Kenney’s recollections of his time there include proud and sad memories. There was pride in seeing his corpsmen, HM3 Vincent Arreola and HN Garrett McDonald, attain their Fleet Marine Force qualifications, and there is solemn remembrance for two Marines that were killed in action, Cpl. Chris Singer, and Sgt. Joe D’Augustine.

The best day? When his relief, HMC Gil Garcia, also from NHB, showed up to relieve him. “When Gil arrived and I did the turn-over with him, that was the happiest day of my life,” Kenney said.

From the extremes associated with haze-gray underway to IA boots-on-the-ground, the symposium was deemed a success and continued on a NHB educational tradition.

“I attended last year and it was very good. It’s nice having a continuous educational event that brings together staff. During any deployment, there are always lessons learned. This symposium gave us a real opportunity to share the experiences of our current and former staff,” said Capt. Mark Turner, NHB Executive Officer.

 Naval Hospital Bremerton personnel depart for Pacific Partnership 2012
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs --
Throughout the week of April 16-20, approximately 40 staff members from Naval Hospital Bremerton have departed to report for Pacific Partnership 2012.

Pacific Partnership 2012 (PP12), the largest annual humanitarian and civic action (HCA) mission in the Asia-Pacific region, will begin May 1, and include engagements with the host nations of Indonesia, Philippines, Vietnam and Cambodia.

Hospital Corpsman 3rd Class Priscilla Sanchez of NHB’s Emergency Room is one of NHB’s doctors, nurses, hospital corpsmen and support staff augmenting the multi-specialized team of preventive medicine, veterinarians and medical, dental and engineering personnel embarking on board hospital ship USNS Mercy (T-AH 19) for the mission that is expected to last approximately four and a half months.

When Sanchez found out she was selected to go on Pacific Partnership 2012, she was more than ready. “I’m excited and ready for my first deployment. I volunteered for this mission and am happy to help and give back to others. We will see, meet and work with different cultures and different countries. Just being able to share in the diversity will be a great opportunity all its own,” Sanchez said, a San Antonio, Texas native, who besides providing her ER technician skill when needed also plans on getting as many at-sea qualifications as she can during the anticipated four-month journey.

As has been the case in the past, medical and dental projects in each country are tailored to the requests of the host nation based on needs in the areas of public health and preventive medicine, veterinary care, optometry and ophthalmology, dental, adult and pediatric medicine, immunizations, nutritional counseling, biomedical repair and medical environmental assessments. Medical subject matter expert exchanges are designed to build capacity for host and partner nation providers to better understand respective cultural and provider practices. In addition, Pacific Partnership deploys with an engineering team made up of members of the Naval Construction Force (Seabees) to construct and repair projects requested by the host nations.

“You will travel to countries you’ve never been, meet people you will never forget, and for years afterwards, you will have that feeling of satisfaction of doing why you chose to be part of Navy Medicine in the first place,” shared Capt. Christopher Culp, NHB Commanding Officer, leading the command to bid farewell to the departing staff members.

Mercy is slated to set sail in early May from San Diego for the annual HCA mission, which is sponsored by the U.S. Pacific Fleet and began in 2006 as a result of the 2004 Indonesian tsunami that ravaged the Banda Aceh area of Sumatra.

PP 2012 will also be the first deployment for Culinary Specialist 3rd Class Tyler Ney. “Everyone departing from here seems to be looking forward to it. Every single person I’ve talked to who has been on the deployment says it’s a great opportunity to visit places that most of us would never deploy to, let alone have a chance to go on any other kind of trip. I’ve got my camera packed, per family request. I’m ready to make the most of this, see as much as I can and lend a hand when needed,” said Ney.

At the invitation of the host nations, military and civilian professionals from Australia, Canada, Chile, Japan, Malaysia, Peru, Netherlands, New Zealand, Singapore, Republic of Korea, Thailand and the United States, along with non-government organizations (NGO) and international agencies, will partner to execute tailored HCA projects and subject matter expert exchanges. These HCA projects and events, coordinated at the request of each host nation, will employ the collaborative capabilities of all participants in medical, dental, veterinary, public health services, engineering and disaster response activities that will help to increase confidence, capability and preparedness of host and partner nations to respond to natural disasters and crisis.

Now in its seventh year, Pacific Partnership 2012 has collaborated with partner nations, NGOs and host nation counterparts to focus on sustainability projects on a range of topics from basic first aid, preventative health and hygiene, and women’s health; beach and seawall corrosion, and maintenance of fisheries; and combined animal and public health campaigns. Host nations that ensure they are equipped with sustainable programs that prepare for and support emergency relief efforts align with a broader goal for maintaining a stable and secure Pacific region.

For Leah, age 6, and Guyland, age 7, seeing their dad, Information Systems Technician 2nd Class Guyland Charles ready his seabag along with others, it became a lot clearer that their father was leaving on an extended business trip.

“I think my son is having a harder time in dealing with this than anyone else,” said Charles.

“We’ll miss him, but I like the fact that if I got to share him with others, he’s going on a humanitarian mission to help others,” said Mrs. Alicia Charles.

In addition to aiding the health, security, and improvement of disaster response capabilities of the host nations, the partnerships forged through Pacific Partnership missions help to ensure that the international community is better prepared to synchronize and function together as a coordinated force when disaster strikes.

NHB Main OR recognized for “Earth Day Every Day” efforts
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs --
Naval Hospital Bremerton’s Sustainability Team recognized Main Operating Room staff members on Earth Day, April 20,  for ensuring sustainable practices were continually performed throughout the first quarter of 2012. 

 The inaugural NHB Sustainability Award certificate was accepted by Cmdr. Fran Slonski, Main Operating Room (OR) Department Head along with Kevin Stevenson Main OR Nurse.

“Sustainability refers to "the ability to meet present needs without compromising the ability of future generations to meet their needs” and Stevenson has been the driving force of the Main OR team. He has helped to coordinate the overall environmental awareness efforts that has reduced the amount of solid waste leaving the Main OR, increased recycling outflow and advocated product substitution as a sound economic practice,” said Robert E. Mitchell, NHB Environmental Manager and Sustainability Program Manager.

According to complied figures by NHB’s Environmental department, Main OR surgical savings from recycling efforts for just three weeks in 2011 was $11,508. Projected 2012 savings for the entire year in the Main OR by recycling and usage of remanufactured items is estimated to be at $172,614.

“We really just started, but we’re going to save a ton of cash continuing to do what we do now.
We worked closely with our Environmental Department and brought in Stryker Sustainability Solutions to coordinate and accommodate the ambitious sustainability plans that was envisioned we could implement. Without them, this would not have happened. We wouldn’t be handling paper, plastic and any medical supplies as properly as we do now,” said Stevenson.

One such sustainability plan put into place by the Main OR staff involved medical supplies involved in laparoscopic usage during a procedure. Much is disposable and not reusable. But the instrumentation once used is recyclable. Plastic parts can be grinded and/or melted down; metal components of copper and steel can be separated, recovered and reused. “Due to our case load, we might use a dozen specific devices a day and instead of them now ending up in a landfill, each is recycled,” said Stevenson.

“It’s really all about changing habits. It is habit transfer and keeping people from falling back into former ways of handling waste product. Kevin is a champion of the cause because he has shared his awareness and discipline with those he works with. As former military, we know that service members tend to pick up on new instructions quickly and follow through. The efforts here at NHB are really great,” said Jayson Ayers, Stryker Sustainability Solutions representative.

The Main OR used to throw away three, 30-gallon bags of garbage per total joint surgery case. Now they recycle three, 30-gallon bags of plastic and have just one 15-gallon bag that is now thrown away.

“It’s a significant reduction in waste stream to the landfill. It’s really an incremental amount of waste product, and we’re staying on top of the process because it’s easy to take for granted. We even recycle the instrument wrappings to use again,” Stevenson said.

Compiled statistics at NHB show that the ongoing environmental awareness campaign of recycling is working. Recycled material (in tons) of paper and paperboard went from 52.25 in 2010 to 55 in 2011; plastic went from 15.53 in 2010 to 15.75; construction debris went from 2.55 in 2010 to 3.66 in 2011; metals and aluminum cans went from 1.90 in 2010 to 2.12 and batteries showed an increase from 0.43 in 2010 to 0.88 in 2011.

Concurrently, and as a direct result of the command’s overall recycle efforts, trash disposed (in tons) fell from 198.50 in 2010 to 190.19 in 2011. Overall, average solid waste disposed by hospital staff per day fell from 1.18 pound to 1.12 lb. per day.

“Our goal for 2012 solid waste disposal per person, per day, is one pound or under. We think that by continually being actively aware and getting as many people involved as we can, that we can achieve that,” said Ramon Calantas, NHB environmental technician.

“Earth Day is every day for us, but we also wanted to use this annual recognition of Earth Day as a perfect opportunity to educate our staff and beneficiaries on our sustainability programs in the hospital and how everyone can help. Our real mission is to shed some light on what goes on behind the scenes such as continuing to find ways to effectively reduce our bio waste outflow and soiled water reduction,” said Mitchell.

“We are recycling a lot more products now than ever before and the dividends to our local environment and savings in funding are getting better,” said Mitchell.

There were Earth Day displays showing other "green" processes at NHB, as the command has continually raised awareness through environmentally sound practices, energy progress and environmental stewardship. Success stories include: installing Big Belly Solar Trash Compactors, which use solar energy to compact refuse.  The containers hold up to five times normal capacity, saving on pickup and disposal costs, and reducing pollution produced during pickup and transport; implementing Daylight Harvesting in the Family Clinic, where refractive film bends light upward to reflect off of the ceiling into the room. Overhead lighting can be reduced or turned off on bright days; adding LED Parking Lot Lighting, resulting in improved visibility and security at night, as well as an expected savings of enough energy to light 17 homes.

NHB has also installed Restroom Occupancy Sensors Occupancy sensors in all NHB and Family Clinic restrooms for an expected energy savings of enough energy to light 4 homes. Time clock controls for lobby lighting have been installed in the hospital quarterdeck and Family Clinic lobbies, which automatically turn lights off during the day and on at nightfall.  The expected energy savings is enough electricity to light 10 homes. The installation of condensing boilers with 95.5 percent efficiency will replace the existing boilers with 80 percent efficiency and are expected to save enough energy to heat 16 homes.

Medical Laboratory Professionals to be recognized all week at Naval Hospital Bremerton
By Douglas H Stutz, NHB PAO
"Laboratory Professionals Get Results!" will be the theme at Naval Hospital Bremerton during April 22-28 to recognize and honor Laboratory Department staff members throughout National Medical Laboratory Professionals week.

“The focus is on allowing our staff to relax and celebrate the practice of their profession through fellowship,” said Lt. Cmdr. Todd. J. Tetreault, NHB Laboratory Manager.

Weeklong events include the traditional cake cutting with the Capt. Christopher Culp, NHB Commanding Officer on Monday, a special pizza luncheon on Tuesday, a Laboratory Scavenger Hunt on Wednesday; an ice cream social on Thursday, and a Lab Coat Design Contest on Friday.

“We do what we do as a great team not as a group of individuals. Using the entire week to recognize that is just a great way to say thank you to everyone,” said Hospital Corpsman 2nd Class Diana Rodriguez, Laboratory/Clinical Pathology technician.

“There really is a lot of planned activities week that’s all interactive. We got raffles, pot-lucks, even lab coat designing. It should be fun and a nice way to recognize everyone here for what we do on a regular, daily basis, which is help care for all of our patients,” said HM2 Melissa Couture, Laboratory/Clinical Pathology technician.

The behind the scenes responsibilities of the entire lab continually bring timely results that benefit and impact direct patient care. The approximately 25 active duty personnel and 12 civilians manning NHB’s Lab conducted more than 720,000 tests in the last 12 months, with another 250,000 processed for performance at military and civilian reference laboratories.

“The testing performed in the Laboratory forms the basis for more than 70 percent of patient diagnoses. As the world gets ever more complex, healthcare professionals need to work closely with the Laboratory that can deliver complex results that are unobtainable in most other clinical settings. The accuracy and quality of our labor directly affects the ability of the organization to provide effective and timely care to our patients,” said Tetreault.

There is never any real down time in the laboratory. Laboratory personnel continually work around the clock to support the Emergency Room and all inpatient clinics and departments. The Lab is open to beneficiaries for specimen collection and drop-off Monday through Friday from 7 a.m. to 8 p.m. and on Saturday from 8 to 12 a.m.

“Most of what we do is unseen by our patients, but it all helps provide the results they need when they come in for their appointment. We are a large part of patient care. I personally know the value of the lab because my mom in her battle against cancer always had to have a lot of lab testing done. I think that’s the main reason why I do what I do here. It’s because of what she went through. I know the importance ensuring lab tests are taken, handled and delivered in a correct and timely manner,” said Rodriguez.

Besides obtaining and receiving patient samples (everything from blood to tissue) and processing them, areas of specialty include; Phlebotomy (the act or practice of opening a vein by incision or puncture to remove blood as a therapeutic treatment); Chemistry (the study of the chemical processes in living organisms); Urinalysis (an examination of the urine to determine the general health of the body and, specifically, kidney function); Hematology (the study of the nature, function, and diseases of the blood and of blood-forming organs.); Microbiology (the branch of biology dealing with the structure, function, uses, and modes of existence of microscopic organisms); Serology (The science that deals with the properties and reactions of serums, especially blood serum); Histology (the branch of biology dealing with the study of tissues); Cytology (the study of the microscopic appearance of cells, esp. for the diagnosis of abnormalities and malignancies); Pathology (the science or the study of the origin, nature, and clinical course of diseases) and managing the Blood Bank (packed red blood cells or plasma is typed, processed, and stored for future use in transfusion).

Enlisted personnel assigned to the Lab are comprised of advanced medical laboratory technicians, histopathology technicians, and cytology technicians, throughout five locations. Besides the majority working in NHB's main lab, they are also at Branch Health Clinic Puget Sound Naval Shipyard, BHC Bangor, BHC Everett, and Madigan Army Medical Center Armed Services Blood Bank Center.

The list of all the specific jobs/duties/responsibilities handled by the Med Lab technicians includes; collecting blood or body fluids from patients; accessioning patient samples to allow automated equipment and Laboratory information systems to analyze, interpret, and result provider ordered testing; processing patient samples to allow ordered tests to occur; perform testing in Chemistry, Hematology, Urinalysis, Coagulation, Microbiology, Immunohematology (Blood Banking), Serology, Histology, and Cytology; Collating and verifying testing results; Certifying the authenticity of results and release them to the health care providers; Conducting Quality Control and Quality Assurance Initiatives to ensure the continued accuracy and precision of reported results; Maintaining equipment in every area listed above; and taking part in continuing education efforts to grow professionally.

Tetreault attests the Lab doesn’t provide a service to get results, but rather they provide a service as a result of a focused and directed need. “Knowing that the support we provide helps providers deliver quality care to our beneficiaries is gratifying,” he said.

NHB's Laboratory has also been fully accredited by the College of American Pathologists (CAP), American Society for Clinical Pathology (ASCP) and American Association of Blood Banks (AABB). It is also licensed and the Food and Drug Administration (FDA).

2012 Services to the Armed Forces Award presented to NHB ARC Chairperson
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton’s American Red Cross volunteer chairperson was presented the 2012 Services to the Armed Forces Award on April 18.  Joyce Berry was selected by the American Red Cross Volunteer Recognition Awards Committee and feted at the Burke Museum in Seattle, and a Volunteer Appreciation Event at the Bremerton West Sound Red Cross office that gave many NHB volunteers the opportunity to join in the recognition.

“I was completely overwhelmed. We don’t do what we do as volunteers for the recognition. We’re here to assist those in need. But it is nice to be acknowledged for all of the work we do here. I am really touched by all of this,” said Berry.

“Congratulations, Joyce! We appreciate you, and all you do for Red Cross and NHB.  Thank you for your service,” said Karen McKay Bevers, West Sound Director for American Red Cross Serving King and Kitsap Counties.

“We are all honored and pleased for her,” said Maria Landro, NHB volunteer Family Practice Nurse.

The Services to the Armed Forces Award recognizes an American Red Cross volunteer in a direct service, management, or leadership position who has made a measurable impact serving the American Red Cross, military customers and community by strengthening or improving services to the military and their family members.

“As an ambassador for the Red Cross, we all recognize your valuable and measurable contributions,” said Ivy Davis Zolle, American Red Cross Regional Director of Volunteer Services.

American Red Cross volunteers at NHB gave over 10,000 hours of service in 2011. The volunteers contribute time as doctors, nurses, outpatient and inpatient record assistants, patient advisors, customer service representatives, and have handled duties in such areas as Health Promotion, Dermatology, Mental Health, Pediatric, Orthopedic, OB/GYN, Labor/Delivery, Ophthalmology, Urology, Dental, Ambulatory Procedure, Pharmacy, Laboratory, Quality Management, Professional Affairs, Patient Services, Physical Therapy, Fitness Center, Staff Education and Training, Emergency Room, Family Medicine, Internal Medicine, Family Centered Care, and Referral Management.

“I am very fortunate to have such dedicated volunteers. I definitely could not function without them,” said Berry, noting that many volunteers go above and beyond to provide needed hours. “We appreciate everyone for their effort.”

NHB holds Holocaust Days of Remembrance ceremony
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs --
Naval Hospital Bremerton’s Diversity Council held a special recognition observance for Holocaust, Days of Remembrance on April 17.

The theme of this year’s event was “Choosing to Act: Stories of Rescue,” highlighted by a very personal narrative and historical retrospective shared by keynote speaker Mr. Sheldon Balberman, from the Washington State Holocaust Education Resource Center. Balberman is a second generation son of Polish survivors from the Nazi persecution during World War Two.

“The subject is a little bit difficult for me because it’s about my family and my emotions are real,” said Balberman, who addresses schools and specific groups five or six times a year educating audiences on the Holocaust.

With vivid details and visual aids, Balberman took assembled staff members 73 years back into the past, to Strykow, a tiny village in central Poland in 1939.  He told how his mother, Shaindel Kuttas, was then a young 21-year old who was herded away by the Nazis to varied ghettos, then to toil in fields until the day came when she joined 79 others in a cramped railway cattle-car to be taken to Majdanek concentration camp.

“There was death inside that car. Someone said to her to fight, so she clawed and fought her way to the top over others so she could breathe. Only three survived during that ride out more than 80,” related Balberman.

His mother’s personal odyssey continued on a harrowing journey. She ended up at the infamous Auschwitz-Birkenau and Ravensbrueck concentration camps before being finally liberated in Germany by the Russians while on a death march from Ravensbrueck back into Germany.

“The death march was in mid-January during winter. They had no shoes and were all exhausted and ill. If any stopped to rest they were shot down by the Nazi guards,” Balberman said.  

It was one horror after another. Auschwitz-Birkenau was where the notorious Joseph Mengele, dubbed the ‘angel of death,’ selected 400,000 persons for death and conducted grotesque experiments. “Every morning my mother and others had to parade before him and have him decide life or death. Dawn to dusk they had to work. Women were so desperate that some of them would prick their fingers to draw blood in order to rub color in their cheeks to try to make themselves more attractive to their tormentor,” said Balberman.

His mother faced death by execution on three different occasions. One time was due to being punished for stealing a piece of bread. She was made to knee forward, arms outstretched, holding a brick in each hand, with a rifle pointed at her head. If she dropped her arms, she would be shot. It was only because the guard took pity on her that she lived because he deemed that she was still strong enough to work.

The only link, the sole memoir that Balberman’s mother had of her family from that time was a yellowed photograph showing 48 relatives taken in 1934 that was then forwarded on to an uncle in Canada. Only five of that group survived the Holocaust.

“My mother always stressed the need to “never give up” and “never forget,” said Balberman, stressing that notion applies to anyone.

Balberman’s father Sender was also a victim of the time, with a tortuous trail similar in hardships but still different than his future wife. Following the Nazi blitzkrieg of Poland in 1939, Sender smuggled himself and his oldest brother (Moishe) across the border into Russia.  He was ultimately arrested for not having any identification and was sent to a Siberian labor camp.  There he spent three years working daily in sub-human conditions, often being forced to work outdoors as a lumberjack with minimum clothing in minus 50 degree weather.

“He was a guest under Joseph Stalin, then-leader of the Soviet Union. The difference between a Nazi concentration camp and a Soviet labor camp was that the Nazi camps were expressly built to kill people. The Soviets camps wanted to work them to death, in horrendous conditions,” Balberman explained.

 While many fellow prisoners died, Sender found a will to live and overcame horrendous conditions of disease, severe cold and grossly unsanitary conditions.  Sender was finally liberated from the labor camp when the Free Polish Army came searching for Polish citizens to fight the Nazis. He and his older brother were the only survivors of his family.

His parents met after the war’s end in 1948 in Munich. They knew each other from growing up in the same village but never had a romantic interest back then. But that was another lifetime long ago. They courted for several weeks. Then Balberman’s mother took the initiative. Shaindel proposed to Sender. She immigrated to Canada and he followed.

Historical evidence on the Holocaust shows that approximately six million European Jews that were persecuted and exterminated during the Nazi Germany reign of terror from 1933 to 1945 didn’t follow Balberman’s parents. Adolf Hitler, leader of the Nazi party, exploited anti-Semitic feelings during his rise to power and then ordered what he termed a “final solution to the Jewish question.” Most Jews in countries like Poland that were overrun by the Nazis became victims of the Holocaust. 

“The one who does not remember history is bound to live it through again,” said Balberman, quoting Spanish-born U.S. philosopher George Santayana. “It is up to us all that anytime we see anyone stereotyped we speak up because that’s a cause for concern. If it is not you today, it could be tomorrow.”

Medical and Dental Readiness more than just a weekend drill with OHSU NHB
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- As in weekends past and those to follow, Operational Health Support Unit (OHSU) Naval Hospital Bremerton (NHB) provided important medical and dental screening requirements for Navy Reservists on April 14-15.

The examinations are not only an annual responsibility to ensure all Navy Reservist personnel are fit for deployment, but the physical exams are potentially even more imperative due to the announced shift of manpower requirements for future Individual Augmentee (IA) responsibilities next year.

According to Adm. Mark Ferguson, vice Chief of Naval Operations, there will be a wholesale shift concerning IA manning needs. The recently-announced plan is to have Navy Reserves filling all billets in 2013, an estimated 3,800 number of ‘core mission only’ IA assignments (there are approximately 9,000 IA billets currently handled by Sailors, over half by active duty personnel).

“Our goal is to achieve and maintain our medical and dental readiness to a level at least 95 percent of our total Navy Reservist force. We serve a fairly large region in Reserve Component Command Northwest, with NHB as the hub. NHB is right in the middle of a large Pacific Northwest regional concentration of submarine, surface and air assets. All of us on the Navy Medicine Team, including nurses, hospital corpsmen and medical/dental providers have to help ensure all of our Navy Reservist assets are up to date and ready to deploy if and when called upon,” said Capt. Harry Ward, OHSU Bremerton Senior Medical Executive, and Physician Specialist/Professor of Medicine at the Geffen School of Medicine at UCLA.

“Taking care of our own is what we do. As such, we simply have to have medically and dentally ready forces. Our reserve detachments back up and support many of our local commands in this area, and we bring reservist medical providers in from all over the region. We want to reach out and touch everyone and not be constrained by geography in any way when asked to support.  One of the latest messages from Adm. Nathan, our Navy Surgeon General, said that to maintain our fighting forces, our Navy Reserves have to continue to be a critical part and continue to contribute a lot,”  said Ward, who has served in Navy Reserves for over 20 years, with three deployments. He has been in Operation Desert Storm in 1991, Operation Enduring Freedom in Afghanistan for 2006, as well as Landstuhl Regional Medical Center in Germany during 2009.

Ward’s experience in Desert Storm further solidifies his emphasis on having medical and dental readiness up to date.  According to Ward, during Desert Storm, nearly 40 percent of Navy Reservists were deemed not qualified for  active duty due to dental issues with periodontal disease.

Capt. William Creed, OHSU Reserve Liaison Officer (RLO) and head Dental Officer, also remembers well Desert Storm, as well as before.

“Historically, all of our efforts before that time were lax. We were recalling reservists who were not medically or dentally qualified. Now it’s much different. My main job is to coordinate the dental readiness for the whole region with all the Navy Operational Support Centers (NOSC) and Reserve Commands (REDCOMS),” said Creed, a Vancouver, Wash. resident.

Cmdr. Tim Labrosse, RLO and Reserve dentist, estimates that he and his dental team monthly provide an average of 70 to 80 screenings to Selected Reservists. 

“I can average eight to ten dental examinations an hour. Every Sailor I see is an important asset for us. My goal when they come in for the screening is to assess them for deployment and make sure they won’t have emergency dental needs, if and when they deploy. Nothing is more costly than sending a person in and out of an IA assignment for dental care. There’s lost manpower hours, logistical expenditures, and travel costs. It all adds up.  Before a Sailor departs from here, they will know what category they are concerning their dental readiness,” said Labrosse.

There are four classifications for Dental Readiness. Class 1. Patients not requiring dental treatment or reevaluation within 12 months. Class 2. Patients who have oral conditions that, if not treated or followed up, have the potential but are not expected to result in dental emergencies within 12 months. Class 3. Patients who have oral conditions that if not treated are expected to result in dental emergencies within 12 months. Patients should be placed in Class 3 when there are questions in determining classification between Class 2 and Class 3. Class 4. Patients who require dental examinations. This includes patients who require annual or other required dental examinations and patients whose dental classifications are unknown.

“Dental readiness is just an example of waking up to the need for healthy fighting forces ready to be part of the ‘edge of the sword.’ As part of those forces, we want to continue to contribute and maintain continuity and leadership with the large amount of Navy Reservists in the Pacific Northwest and throughout the western states,” Ward said. 

OHSU Bremerton is currently handling medical and dental readiness screenings for18 detachments with approximately 900 total personnel stationed in North Dakota, South Dakota, Colorado, Utah, Wyoming, Montana, Idaho, Oregon, Washington, and Alaska. There are Navy Reserve centers in such places as Sioux Falls S.D., Fargo, N.D., Fort Carson and Denver Colo., Cheyenne, Wyo., Billings and Helena, Mont., Pocatello, Idaho, Central Point, Ore. Tacoma, Bangor, and Everett, Wash. and Fort Richardson, Alaska. There are also corpsmen coming to NHB from farther afield out of Minnesota and Texas (Current compiled official Navy figures from April 2, 2012, list the total number of U.S. Navy Reserve component as 64,118).

One innovative means to handle medical and dental readiness in the vast, mostly rural area is by sending a traveling team of core Navy medical staff to specific Navy Operational Support Centers.

“Our training team is made up of physician/providers, nurse practitioners, and dental officers to go out and handle medical and dental needs all over the 15 state regional commands. Many of our Navy Reserve centers are scattered over large areas of geiography, so it’s value added to do all we can to keep that readiness up to date by going to the detachments, rather than having their personnel come to us,” said Ward.

“The work never stops.  It can take a lot of time to arrange logistics throughout our region to support Navy Medicine West, even as far away as Okinawa and Guam,” said Ward.

Another important part of OHSU’s overall mission is to backup and assist NHB and BUMED by providing doctors, nurses, hospital corpsmen and technician support.

“Whoever and whatever the CNO or Surgeon General needs, we will put out a message for support and operationally start looking at whom we have available,” Ward said.

“What we have now in Navy Medicine and the Navy, as a whole, is a truly integrated service. It used to be that reservists were just backfill for some positions, but we are now integrated across the board. Camaraderie has really greatly improved since the first Gulf War,” Ward said.

New and Innovative NHB Materials Exchange Site
By Douglas H Stutz, NHB Public Affairs -- Naval Hospital Bremerton’s innovative internal website for reusing, recycling and reducing waste of office supplies and furnishings has caught on over the first quarter of 2012.

“This is an original cost-savings 'green' concept that also encourages good stewardship of government resources by reusing, recycling, and reducing waste (cost) of office supplies and furnishings. The site was launched in December 2011 and we are already realizing savings and waste reduction for the command,” said Phyllis D. Slayton, Command Evaluation Officer and creator and designer of the new site.

 Instead of automatically purchasing new items, the new NHB Materials Exchange Site acts as a "Virtual Warehouse" that is available for all staff members. They can easily post or search for "available" items or list a "wanted" item. According to Slayton, approximately 50 staff members have utilized the site, and there has been several thousands of dollars saved. “It might not seem like much, but it’s a definite start,” she said.

“The office supply and furnishings re-use and recycle concept had been in the back of my mind for a long time.  We've never really had a method here at NHB to make those items easily accessible to staff. We would end up having used material either shipped off to DRMO (Defense Reutilization and Marketing Offices) or sent to the recycling bins. The site is for the benefit of the command and all staff members. This concept really is a unique cost-savings and waste reduction tool that can be easily reproduced at any MTF or other organization with available collaboration software like SharePoint,” Slayton explained.  

According to Slayton, the need for some way to reuse and recycle office supplies and furnishings became even more evident during last fall's Space Utilization moves. 

“Many people had to pack up their offices and downsize to move. Some staff members were even getting rid of good office items such as file folders, staplers, binders, and paper punches. I couldn't stand it!  Office furniture was being sent by the load to DRMO that could have been potentially been used by others. Being a good steward of government resources, coupled with budget constraints, it just seemed like an ineffective way to do business,” Slayton said.

Slayton then started looking for a possible physical location to store the excess items but it quickly became evident that space was at a premium.  It also became just as quickly apparent that no one was really interested in taking on the additional task of managing the materials.  “In the beginning it almost became a non-starter, but I don't give up easily,” said Slayton, labeled as tenacious by her father at age eight when determined to complete a specific task. This case was no different.

Without the feasible option of having enough storage space available, Slayton then hit upon the perfect alternative of using a centralized computer-based program to reach staff members. “It came to me; why not go "virtual warehouse" with a SharePoint site?  Our staff members are able to keep any item in their own area for a little longer and see if someone else wanted or needed it. The timing was right with our staff becoming more comfortable using and understanding the SharePoint computer program,” she said.

With some help from some savvy co-worker-friends, Slayton constructed the site and made it as user-friendly and easy to navigate as possible, along with a database to capture all transactions and estimated value of items.

The sites rules are basic; materials must be the property of the U.S. government. No personal items are allowed and any item listed is not for personal or home use. Any material to be posted must be handled appropriately beforehand with no authorized removal from walls, fixtures or other clinic and department areas without official consent. The material(s) to be posted must still be in good usable condition. No hazardous or damaged material will be accepted. For any computer equipment items, staff will need to coordinate with NHB’s Information Management Department. Each item listed on the site features detailed information on the condition, quality and quantity, along with contact information.

“If you build it, they will come.  And they did.  I've gotten many compliments on the site, with exclamations of "this is so cool," and "why didn't anyone think of this before?" and "what a great 'green' concept",” Slayton said, who was also invited to become a member of the new NHB Environmental Management System Green Team, which identifies opportunities to improve environmental stewardship and sustainable practices, help prioritize opportunities, and to promote and implement selected opportunities.

 NHB Medical Services continue during Force Protection Exercise on Mar 22/23
By Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton will continue with daily operations during Solid Curtain-Citadel Shield
2012, an annual Navy-wide Force Protection Exercise designed to enhance the training and readiness of security personnel to respond to threats to installations and units. 

NHB will participate in Solid Curtain-Citadel Shield 2012, commencing approximately 9 a.m. the morning of Thursday, March 22, and continuing through Saturday morning, March 24. Delays in accessing the bases are expected during this timeframe.

 While there will be no impact on Military Treatment Facility emergency and acute services at NHB, patients should anticipate potentially long wait time at the main gate. In the event of an actual emergency during the exercise when time is of the essence, patients should call 911 or go immediately to the nearest civilian medical facility for care. Emergency room visits are a TRICARE-covered benefit.  

Outpatient clinic schedules for March 22-23 have been revised to ensure patient access to emergent, urgent, and acute care. Inpatient, surgical and emergency services will not be interrupted.

There will be an Independent Duty Corpsman assigned to the NHB Main Gate area to assess those beneficiaries arriving for an appointment to timely facilitate their base access.

Access to Naval Branch Health Clinic Bangor will only be through Naval Base Kitsap Bangor Trident (main) Gate. Civilian beneficiaries who regularly utilize NBHC Bangor are recommended to seek treatment at NHB or the most conveniently located civilian medical facility.

All beneficiaries are strongly encouraged to utilize outpatient services such as the NHB Main Pharmacy and Drive-Through Pharmacy either before or after Exercise Solid Curtain-Citadel Shield.  

Exercise Solid Curtain-Citadel Shield is not in response to any specific threat, but is a regularly scheduled exercise designed to enhance the readiness of Naval Security Forces. 

NBHC Everett Medical Services during Solid Curtain-Citadel Shield 2012.
NBHC Everett will also be participating in Solid Curtain-Citadel Shield 2012 as a tenant command of Naval Station Everett. The clinic’s participation will commence at approximately 8:30 the morning of Thursday, March 22, continuing through Saturday morning.  Daily operations will continue on Thursday March 22, however, all clinic operations will be curtailed on Friday, March 23, due Naval Station Everett’s closure and the clinic’s participation in a mass casualty exercise.  All patients presenting to the clinic on Thursday, March 22, must enter the base through the North Gate and are strongly encouraged to get any prescription refills prior to Friday, March 23, since they will not have access to the base.

National Patient Safety Week kickoff highlights Safe Patient Care at NHB
By Douglas H Stutz, NHB PAO -- Naval Hospital Bremerton officially commenced National Patient Safety Week of Mar. 4-10 with a kickoff celebration on Mar. 5.

The annual week-long event focuses on enhancing, improving and increasing awareness on a wide range of patient-related safety topics for beneficiaries, staff and command visitors.

“By engaging our staff and engaging our patients with such tools as these at work and at home, we’ll make where we work and live that much safer. The more we know about our health and safety, the better off we will be. “Be aware for safe care” is our theme this year. We want to ensure that we have safe patient care every day,” said Cmdr. Sarah Butler, NHB Quality Management department head.

Butler shared that some things patients can do to “Be aware for safe care” include; seeking information and questions; keeping track of their family (medical) history; knowing and writing down personal health care history; exploring healthcare options and selecting a hospital, doctor and pharmacy that fit their needs; choosing a family or friend as a health care advocate; following up on test results; and evaluating their environment (at home, work, away) to assess (any) risk of falling.

The kickoff ceremony also included NHB’s Quality Management staff re-launching the Staff Safety Handbook campaign. “We’ve always meant to have this program in place and this kickoff gives us the perfect opportunity to pass on to everyone that this booklet is a great all-around training tool,” Butler said, noting that the basic safety tips in the pocket-sized books are also a convenient way to teach and share with others in the departments and clinics.

“We’ll put these handbooks to good use in ICU (Intensive Care Unit) to help increase our readiness in patient safety,” said Hospitalman Gregory Anderson, of NHB’s ICU/Critical Care.

The most visual and popular event throughout the week was the “Patient Safety Seek and Find” static and interactive display on the quarterdeck, where anyone could check their situational awareness (SA) for patient safety. The display featured a bed-ridden manikin patient, with associated medical and hospital props that may or may not be conducive to proper patient care. The goal was for each participant to try and find the 15 errors associated with the display.

“This display is for everyone, but especially our staff. We’re hoping to get as many staff members involved as we can throughout the week and increase their awareness. Our overall goal is for everyone to take a moment to try and see how many things they can find in the display that put the patient at risk,” said Mayda Schaefer, Patient Safety Analyst, adding that this is the eighth consecutive year NHB has highlighted National Patient Safety Week with a kickoff ceremony.

Butler stressed that patients and family are a key part of the healthcare team. “We want them to realize there are good questions for their good health that they should address and discuss with their doctor, nurse and pharmacist every time we see them during a visit. “What is my main problem?” “What do I need to do?” “Why is it important for me to do this?” All these are legitimate questions that are in their right to ask,” said Butler.

Butler also shared NHB’S usage of the Department of Defense Patient Safety Program theme of TEAM UP to actively promote getting patients involved as partners with their healthcare team.

“T is for ‘team together.’ E is for ‘educate yourself.’ A is for ‘ask questions.’ M is for ‘manage your medications.’ U is for understand changes in the game plan.’ P is for provide perspective,” Butler said.

According to Butler, the 2012 National Patient Safety Goals for hospital staff and leaders will focus improving identifying patients correctly such as using at least 2-ways to identifying the patient; improving staff communications by getting important test results to the right staff person on time; improving infection prevention with such measures as advocating hand-cleansing guidelines; using medication safely by labeling medicines and medication  containers not already labeled; and identifying patient safety risks correctly by identifying any patient who may be at risk for committing suicide.

There were also learning lads organized by NHB’s risk manager, patient safety expert and others.

“We’re highlighting one week for something we do year-round, but we feel the added emphasis is important not only for our patients, but also for our staff,” said Butler.

NHB Corpsman recognized at American Red Cross ‘Real Heroes’ event
By Douglas H Stutz, NHB Public Affairs – A hospital corpsman from Naval Hospital Bremerton was recognized by the American Red Cross serving King and Kitsap Counties as their recipient of the 2011 Military award on March 1. 

Hospital Corpsman 1st Class Marvin Belanio was honored for his life-saving efforts at rendering emergency first aid on an airline flight at the 13th Annual Real Heroes Breakfast that drew a packed-crowd of civic and community leaders.

“I’m surprised and humbled by being recognized for doing something that any corpsman would have done in such a situation,” said Belanio, Leading Petty Officer for NHB’s Bio Medical Repair division.

Belanio was returning last May to NHB from a fiscal logistics symposium in Maryland aboard a Delta Airlines flight.  Just as he put his headphones on and began to relax for the five hour flight, he heard a thump on the plane’s floor. Looking ahead a few rows, he spotted a gentleman lying on the floor.  The fellow passenger had collapsed, and just as Belanio started towards the man, the flight crew was calling for assistance from a doctor, or anybody with medical experience.  A quick look around confirmed to Belanio that he was the only one qualified to handle the situation. 

“I might have actually felt more than heard the thump of the passenger falling. The gentleman fell face first and obviously medical assistance was immediately needed. When I reached him, I noticed he had a pallid color and wasn’t breathing. There was commotion and flustered people around him. Some wanted to move him, but I quickly took charge. The last thing we wanted to do in such a situation is move anyone in such a condition because there could be some type of spine injury. Especially with the kind of force he had to incur landing the way he did.”

"I didn’t see the passenger go down but I did notice that HM1 Belanio jumped out of his seat right away to render assistance. It was ‘Corpsman Up!’ and there he was. While everyone else was looking around for someone to step up, that’s exactly what he did. He told the flight attendants, "I'm a Navy Corpsman and I can help him," said Lt. j. g. Rachel Smith, NHB Assistant Department Head for Materiel Management, who was also on the flight and sitting three rows behind Belanio.

Once Belanio had maneuvered into position to reach and handle the downed patient, he swiftly carried out a rapid assessment and administered cardiopulmonary resuscitation (CPR) that resuscitated the passenger. “I did the ‘look-listen-feel’ and received no response. I started the CPR which got his breathing back,” Belanio said.

For the remainder of the flight, Belanio continued to assess and monitor the passenger.

Upon arriving in Seattle, Belanio briefed the emergency responders waiting to take over, was personally thanked by the flight crew and passengers, and was later awarded a free flight and bottle of champagne from Delta Airlines.

“HM1 Belanio has experience in combat caring for Marines and Sailors. He’s a stand-up guy who always does the right thing. He has earned the right to be called ‘doc’ by his Marines, which is the highest honor for a hospital corpsman. What he did on that flight to help just showed why he is a ‘doc’, said Smith.

“I really don’t consider myself a hero, but my wife Michelle does tell our two-year old that ‘daddy is a hero,’ and it is pleasing that she thinks that. My parents are also very happy and proud,” said Belanio, a Wash. native and 13-year Navy veteran, with a background in emergency care. Belanio has served two tours in Iraq with Marine units as well as taught trauma support courses such as Tactical Combat Casualty Care (TCCC) training.

“Basic life support is something all corpsmen know. It’s what we do. I think that all of us in uniform who are making such sacrifices to care for others are the real heroes. A hero is just someone at the right place at the right time to make an effort to help when needed,” said Belanio.

The American Red Cross Real Heroes Breakfast celebrates extraordinary acts of courage and compassion by Kitsap County and North Mason County heroes, with those honored being chosen from hundreds of applications by a selection committee. Each Real Hero from the greater Kitsap Peninsula had a special tribute for their respective acts of heroism which included such as areas as; Good Samaritan, Animal Rescue, Call to Action, Law Enforcement, Fire Rescue, Good Neighbor, Medical, Preparedness, Water Rescue and Military.

NHB Celebrates Black History Month
By MC1(SW) Charlemagne Obana, NHB Assistant PAO --  Naval Hospital Bremerton (NHB) Diversity Council celebrated Black History month on the quarterdeck with staff and patients Feb. 29. NHB Commanding Officer Capt. Christopher Culp helped kick off the ceremony by recounting how he was personally motivated by Master Chief Boatswain’s Mate Carl Brashear, (the first African-American to qualify and serve as a master diver in the Navy) who was his patient for 10 years in Naval Medical Center Portsmouth.

“We are collectively better for the contributions of every person present,” said Culp.  “That means the more diverse we are, the more diverse our experiences, the more contributions we’ll have going forward.  Today, we recognize and pay tribute to the contributions of African-Americans of the nation and the Navy.”

The celebration continued with a recital of Maya Angelou’s poem, ‘Still I Rise’ by X-Ray Technician Hospital Corpsman 2nd Class (SW/AW) Rosalyn Dupree, and the reading by diversity council members of an article highlighting the myriad inventions and innovations developed by African-Americans.

Next, the Naval Branch Health Clinic (NBHC) Bangor Diversity Dance Group led by Hospital Corpsman 2nd Class (SW) Jason Span excited the crowd with an energetic modern dance recital.

NHB Chaplain Lt. Martie Johnson followed up by honoring the first African-American Navy Officers known as the Golden 13.

“They were trained as officers at Great Lakes and this was done before civil rights which was [a] huge [accomplishment].  This was 1944, not 1964,” said Johnson.  “In the Navy, before WWII, the only rates you were eligible for if you were black were CS (culinary specialist) or SH (ship’s serviceman).  Back then, they were called messmen and steward.”

Assistant Department Head for Labor and Delivery Lt. Jenique Keys recounted her experiences as an African-American female naval officer and discussed the history of pioneering African-American female naval officers.

“My parents paved the way for my journey.  They both served with an accumulated service of almost 45 years on active duty between the two of them.  I look to them as my heroes,” said Keys. 

“Their path was paved by other people especially my mother.  She served 20 years as an active duty enlisted African-American woman in the Navy…and I’m sure she still gives thanks to those who came before her.”

The ceremony closed with a benediction by NHB Chaplain LCDR Timothy May and a cake cutting ceremony. Immediately after the ceremony, diversity council members served the audience in attendance plates of traditional African-American foods.

NHB Promotes Children’s Dental Health Month
By MC1 (SW) Charlemagne Obana, NHB Assistant PAO -- Naval Hospital Bremerton (NHB) oral surgery technicians visited nearby Jackson Park Elementary to promote Children’s Dental Health Month on Feb. 28.

“It was good to see the kids enjoying our presentation.  They were raising their hands and asking questions which means that they had an interest in learning more and telling us their own stories about their experiences with the dentist or brushing and flossing,” said Oral Surgery Leading Petty Officer Hospital Corpsman 2nd Class (SW) Jeremiah Hays.

The NHB staff members taught a classroom full of first graders the importance of brushing all surfaces of their teeth and flossing properly with visual aides and props.In addition, the surgical technicians shared with the children the consequences of poor dental health.

“Dental health is extremely important to children because it's as kids that we tend to form our habits,” said Surgical Technologist Hospital Corpsman 3rd Class Dustin Ragsdale.  “It’s a lot easier to form good habits when you’re learning everything than try to undo bad habits.”

“As someone who has worked in dental, I’ve seen people who have not had the best dental care before their time in the Navy.  They come in and need fillings or teeth removed not necessarily because of neglect on their part, but they weren’t taught good habits early on,” said Hays.

According to the oral surgery staff members, one of the easiest things a parent can do to improve their child’s oral health is to be good example by letting their children watch them brush and floss regularly.  Also, parents should supervise their children directly as they brush and floss to make sure their child’s technique is correct.

Each student received an oral care package consisting of items such as toothbrushes, toothpaste, dental floss, and stickers.  NHB oral surgery department is also tentatively planning to celebrate the Children’s Dental Health Month in March with informative static displays on the quarterdeck.

TRICARE SERVICE CENTER RELOCATED
Naval Hospital Bremerton’s TRICARE Service Center has relocated from the main hospital’s Family Practice wing to nearby Building 14.
The move is designed to improve internal communications between TRICARE and NHB’s Referral Management Center and Enrollment specialists by combining all services in one location.

“This will primarily be a seamless move and there should be no impact on our customers,” said Renee Proctor-Brown, RN, BSN, Clinical Liaison Nurse and TRICARE Manager.

Building 14 is located in Mt. Adams Parking Lot, across the foot bridge from the Third Floor of the main hospital. NHB’s TRICARE Service Center offers walk-in service to provide assistance to service members, retirees and family members on enrollment with Naval Hospital Bremerton, authorizations and referrals in the community; claim issues; and benefit information.  Walk-ins are seen from 7:30 a.m. to 4:30 p.m.

According to Proctor-Brown, the five staff members of NHB TRICARE Service Center help approximately 50 to 60 walk-ins per day.

“This move will be great for all of us. By being co-located, it will make both of our jobs much easier,” said Diane Polizzi, Referral Management department head.

Polizzi notes that the move will positively impact patients by improving the timeliness of services. “This will certainly speed up handling consults and getting the proper authorization for our patients,” she said.

Along with the walk-in service available at NHB, beneficiaries can contact the TRICARE Regional Appointment Center (TRAC) 1-800-404-4506 and TriWest Healthcare Alliance Beneficiary Services at 1-888-874-9378.

From Kitsap to Kabul – NHB Physician handling role of CMO for ISAF
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- The program director for NHB’s Puget Sound Family Medicine Residency has taken his expertise from Kitsap to Kabul.

Cmdr. David Congdon departed in September when the tasking order came for a senior family physician to deploy to Afghanistan.  He is currently Chief Medical Officer for the headquarters of International Security Assistance Force (ISAF) in Kabul.  Congdon is filling a NATO billet with a small team of one physician assistant, a Navy chief petty officer, one hospital corpsman and two U.S. Army medics.

“My team provides basic routine care, emergent care and trauma stabilization and I advise the base commanding officer on all things medical. I (also) do preventive medicine assessment for the camp and track epidemiology for the camp,” said Congdon.

Congdon, an Oak Harbor, Wash. native with 24 years of active duty service is the only physician at ISAF and thus handles every illness and trauma. “We’ve had several emergency situations requiring quick stabilization and transport to higher echelons of care,” he said.

Although most of his responsibility is to ISAF personnel, Congdon has also ventured into Kabul to render assistance when needed. “We recently traveled to a local orphanage and delivered school supplies, toys and clothing. The kids were great. They were super polite and knew a little English. Like all kids, they laugh at the same silly stuff that our kids laugh at.”

The Kabul-based ISAF Headquarters serves as the operational command for the NATO-led mission. It interacts with the Afghan government, as well as with governmental and non-governmental organizations present in the country to assist with reconstruction, and supports the work of United Nations Assistance Mission in Afghanistan (UNAMA). ISAF Headquarters are also distinct from the Headquarters for the Regional Command Capital (RCC), also located in the Afghan capital.  At the ISAF Headquarters level, there are approximately 50 contributing nations with more than 2,200 service members to make up the headquarters and its support personnel.

“The NATO environment is quite different. There are so many different countries represented on the base, and I’m speaking a little Italian and French every chance I get,” said Congdon.

The shape and size of ISAF Headquarters has continued to evolve as the mission progresses, with the size of each nation’s contribution to the Headquarters changing over time. Congdon’s main responsibility from a medical perspective is to provide care and ensure the camp continues to operate. To that ongoing goal, engaging in preventive medicine duties helps keep the focus on the prevention of disease that is intricate in maintaining force readiness for ISAF personnel throughout the camp.

“I have done a fair amount of preventive medicine such as inspections of dining facilities and providing education on how to limit the spread of viruses. We have so many different nations represented here at headquarters, and getting everyone to the same level of hygiene awareness is a challenge. Poor hygiene is a major threat to military operations and is the single most important duty we do. Some of the specific things I have worked on include proper hand-washing, limiting virus spread and even how to cough correctly,” Congdon said.

Congdon’s medical clinic is also his bunk-room, living area, classroom, and impromptu dining facility. “Our small medical team and I all live together in the same place we work. We basically live, work, and eat 24 hours, seven days a week together. There are no days off, no weekends, no holidays and no escape,” he said. “But I am able to hit the gym regularly which is very good fo r the morale.”

Deployment conditions notwithstanding, Congdon and his team also are carrying out their duties in the midst of a typical harsh Afghan winter.

“The weather is super cold. The temperature gets down to zero and night and in the mid-20s during the day. It’s currently snowing and this is our fifth snowstorm of the winter,” said Congdon.

Congdon notes that his expertise goes beyond handling duties as the primary and only provider. As the resident medical expert for headquarters, his insightful recommendations are also heeded in the ongoing decision making process in ISAF’s daily mission. “The overall leadership atmosphere here is excellent and my boss, Col. Curtis Winstead, U.S. Air Force, is superb. I’ve met a lot of great people over here. There are plenty of foreign military and civilians all here attempting to assist Afghanistan in becoming a more self-reliant country. I am certainly proud that I am able to be in a supportive role in all of this and will not soon forget this experience.”

Before Congdon headed down range, his leadership propelled NHB’s graduate medical education (GME) residency program to continue to set lofty standards. The GME residency program received the singular honor of being granted five year accreditation instead of the traditional three by the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee (RRC) for Family Medicine.

“I couldn't be more proud of the residency and our hospital! This was a major victory for the command and great recognition for the high quality of education here throughout the hospital,” said Congdon.

Congdon noted that one of ACGME’s main concerns before granting the five year accreditation was how NHB’s internal process would ensure that the necessary teaching/tutoring and mentoring would being consistently accomplished during a time with so many staff members heading on extended deployments. “We made sure our residents aren’t abandoned if anyone heads down range,” explained Congdon, who was confident that the program would continue on during his deployment.  “Our permanent civilian faculty members are fully vested to provide top-notch training and teaching in addition to our active duty faculty.”

As has been the case with others before him, once Congdon returns from Afghanistan, he can share his experience and insight with residents and physicians alike, thus continuing his role in advising and assessing.

NHB support for Great American Spit Out Campaign Exposes Smokeless Tobacco Dangers
By Douglas H Stutz, NHB PAO – The Great American Spit Out (GASpO) campaign was recognized Navy-wide on February 23, but is always year-round at Naval Hospital Bremerton (NHB).  The Department of Defense event is part of
‘Quit Tobacco—Make Everyone Proud,’ an on-going educational campaign tailored specifically for the U.S. military to give up tobacco products.

“Smokeless tobacco is dangerous and has definite health risks
,” said Patrick W. Graves, Naval Hospital Bremerton Tobacco Cessation Facilitator. “Any time any person puts any kind of smokeless tobacco into their mouth, they become exposed to such health threats as oral cancer, pancreatic cancer, esophagus cancer, stomach cancer and colon cancer. We encourage anyone who uses smokeless tobacco to just give it up for the day.”

“It’s time for me to quit. I have finally realized that I don’t need it. This is the right choice for my overall health,” said Logistics Specialist Senior Chief Edward Lange, Medical Services Leading Chief Petty Officer.

Lange counts himself as one of many who has attempted to quit, only to restart and then try again.  “It’s only been nine days for me this time. I’ve tried before, so maybe the third time is a charm,” said Lange.

Graves notes that smokeless tobacco has 28 cancer-causing carcinogens. The dip is a super concentrated form of nicotine, equal to 3.5 packs of cigarettes. “That makes it all the more addictive,” he said

DoD data shows that smokeless tobacco is used by 19 percent of 18- to 24-year-old military males, which is approximately twice the national average. “But it's seems so much harder to quit in our older populations,” Graves said.

“Just like alcohol used to be, no one thinks it's cool to be a quitter.  But once you quit you're really glad because you get rid of the baggage that went along with something that is self-destructive,” Graves said.

Graves acknowledges that there are success stories. He estimates that almost 50 percent of serious quitters, people who make the commitment and take the necessary steps, do quit the habit. “But for those who give a half-effort and expect and hope just a pill or some patches will do all the work, the odds are less than 25 percent,” he said.

“Having the guts to start is important. Having more guts to succeed is also needed,” Lange said.

Naval Hospital Bremerton hosts Commander Navy Medicine West
By Douglas H Stutz, NHB PAO -- Rear Admiral C. Forrest Faison III, Commander Navy Medicine West and Naval Medical Center San Diego visited Naval Hospital Bremerton and Branch Health Clinics at Naval Base Kitsap, Puget Sound Naval Shipyard and Naval Station Everett, February 14 and 15. Faison also called upon Naval Hospital Oak Harbor.

Faison used his time to meet and greet many staff members throughout his visit as well as hold discussions with command leadership. During several Admirals’ Calls, Faison shared the guidance of Navy Surgeon General Vice Adm. Matt Nathan along with his observations of leading approximately 13,000 civilian and military staff members scattered across 15 time zones from Arizona in the American Southwest to the island of Diego Garcia in the Indian Ocean.

“If you don’t remember anything about this admiral’s call, remember these two words; thank You. Thank you so much for the difference you make. You are there to answer the call and carry on the tradition of care and compassion that dates back to the founding of our nation,” said Faison.

Faison noted that by every conceivable measure that is looked at, NHB staff is helping to lead the way in such areas as training, patient care, and optimizing resources.  “NHB is making a real difference in time of need with efficient and effective practices across the board. Quality care has never been better,” he said.

Echoing the recent guidance by the Navy’s Surgeon General, Faison reinforced the three guiding principles – Ship, Shipmate and Self - of leadership expectations to all staff members.

“The Ship is our mission, which is taking care of people. We have been at war for 10 years and Navy Medicine has been in the middle. How we move forward after these 10 years of war to continue our mission is a challenge. Keeping our skills refreshed and our training updated is important. Our mission will continue and we will continue to do the best we can. But we have had a very high operational tempo and that has created some shortages in some clinics in our hospitals. It has been a balancing act taking care of patients when deployed and at home. By continuing to train at home, we continue to be well-prepared to serve when deployed,” said Faison.

Faison noted that one vital aspect of medical training for both Navy Nurses and Hospital Corpsmen is that they need to continue to treat and care for patients at home before they are sent down-range. Taking care of patients here is important not only to help them out, but it give our corpsmen the skills and expertise to be well-prepared to deploy. Same for our nurses. He or she shouldn’t need to be learning fluid management and ventilating care on the fly working on a critical patient in a tent in Afghanistan. That is not what we do. Our people are first responders. There are no runny noses and ear aches in Kandahar. We’re there to care for the sick and injured and save lives. That’s what we do, and we do it well.”

Addressing the topic of Shipmates, Faison stressed the importance of watching out for one another. “During this time of war, the longest our nation has been through, we have had staff members see horrific and gruesome stuff when deployed. What keeps me up at night is worrying about a corpsman who hasn’t asked for help because they don’t want to be seen going to Mental Health. Be attuned. Look out for each other. Our ability to help each other is as critical as taking care of our patients,” he said.

Lastly, Faison touched on Self. “We also need to look at ourselves and ensure we are taking care of ourselves. We need to have a balanced approach to our lives and we have the resources to help anyone anyway we can with career, skill enhancement and training. Taking care of Self also means advancing in rate, something that NHB has done a great job with, by helping their Sailors pass their advancement exams. Self also refers to not becoming a Physical Fitness Assessment casualty. PFA is 100 percent avoidable.”

Faison wrapped up his two-way admiral call and discussion with staff members by sharing his sincere thanks for all they do. “We are unlike any healthcare organization in the world for one simple reason; everyone we care for is someone who has volunteered and sacrificed to serve our country and defend our freedom. With great challenges comes great opportunity. I have no doubt we are up to the challenge. By providing guidance, initiative, and support to our staff, we can meet those challenges. Thank you on behalf of all that you care for. You make me so proud.”

Gone but Never Forgotten – NBHC Everett Remembers Clinic Namesake
By Douglas H Stutz, NHB PAO -- Naval Branch Health Clinic Everett formally recognized the Medal of Honor recipient and namesake of their clinic on Feb. 15.  Hospital Corpsman 2nd Class David R. Ray, who would have turned 67 on Feb 14, was remembered with a birthday celebration attended by all hands as well as several distinguished guests. The event also included staff members sharing comments from Ray’s family and another hospital corpsman who served alongside Ray during the Vietnam War.

Ray was awarded the Congressional Medal of Honor (posthumously) for his actions during the Vietnam War at Phu Loc 6 near An Hoa in Quang Nam Province, Republic of Vietnam, on March 19, 1969. NBHC Everett, commissioned in 2002, is located within the David R. Ray Health Center.

“We really decided to do this ceremony for several reasons but primarily because it’s the right thing to do. Sharing what Ray did is something that a number of our more seasoned petty officers can relate to. They have deployed like Ray did and have been in the action. But we also have younger corpsmen that have yet to deploy and this clinic is their initial command experience. They need to know and understand that Ray’s legacy defines who we are,” said Cmdr. Doug Stephens, NBHC Everett Officer in Charge.

Rear Admiral C. Forrest Faison III, Commander Navy Medicine West and Naval Medical Center San Diego, addressed the assembled staff of NBHC Everett during part of his tour of Pacific Northwest Navy hospitals and clinics and stressed that by their actions they were continuing to follow in Ray’s footsteps.

“We do stand on the shoulders of giants, much like Petty Officer Ray. All of you are following with that tradition,” said Faison.

NBHC Everett Command Master Chief Martin Aquino read heartfelt correspondence from Ray’s sister, Mary Don Bixby, Friends of Fondren Library Executive Director at Rice University

“I wish that I could be with you today. One of my fondest memories is attending the opening ceremony for the Health Center. We were treated with such respect and warmth during our visit, and we returned home with the knowledge that my brother had been honored by an exceptional group of U. S. Navy personnel who had chosen to name the Health Center for him. His love of his country and his dedication to his work as a corpsman led him to give his life to save the lives of others. Every day I am in awe of his heroism. It is hard to believe that Bobby, as we called him, would have turned 67 on Feb. 14. Thank you for honoring my brother in this special way. Even though we've never met, you can be assured that you are often in my thoughts,” wrote Bixby.

Hospital Corpsman 2nd Class Krystal Wasson also shared a personal letter, one penned 43 years ago in Quang Nam Province by Ray’s friend Hospital Corpsman Tommy Vickers to his family.  The letter was received by Mr. and Mrs. Tom Vickers from their son the day before the Rays were notified on their son being killed in action. It read, in part, “I guess you know by now that Bob Ray got killed last night. They (Vietcong) ran over An Hoa. This is the story I got from a Marine he (Ray) patched up.  “They started when one got through the wire and pulled a satchel charge under a hutch. When it went off everyone ran outside. They started mowing them down as they ran out. Bob got hit, but was still treating wounded when he was hit the second time. I hope this isn’t true, but this Marine said he and Bob were real close. After his mother has calmed down, tell her this little Marine said Bob knew his job and was doing it. He fixed my arm. Then he stated to cry. He said that the enemy was all over them, plus rockets and mortars as thick as flies.”  

Vickers worked late in the night and well into the next day helping to treat and care for mass casualties. By 6:30 a.m. (on Mar. 20), six more choppers from An Hoa landed. Vickers still could not locate his friend and began asking Marines from Ray’s outfit if they knew his status.

“Everyone said he had been hit, but no one knew how bad. Then this one kid told me what happened. I couldn’t work. All I could do was sit and stare,” wrote Vickers.

In addition to Ray, 10 Marines died in the battle.

“This ceremony is a poignant and powerful reminder of who we are,” said Capt. Christopher Culp, Naval Hospital Bremerton Commanding Officer.

"For conspicuous gallantry and intrepidity at the risk of his life above and beyond the call of duty while serving as a HM2 with Battery D, 2d Battalion, at Phu Loc 6, near An Hoa. During the early morning hours, an estimated battalion-sized enemy force launched a determined assault against the battery's position, and succeeded in effecting a penetration of the barbed-wire perimeter. The initial burst of enemy fire caused numerous casualties among the marines who had immediately manned their howitzers during the rocket and mortar attack. Undaunted by the intense hostile fire, HM2 Ray moved from parapet to parapet, rendering emergency medical treatment to the wounded. Although seriously wounded himself while administering first aid to a marine casualty, he refused medical aid and continued his lifesaving efforts. While he was bandaging and attempting to comfort another wounded marine, HM2 Ray was forced to battle two enemy soldiers who attacked his position, personally killing one and wounding the other. Rapidly losing his strength as a result of his severe wounds, he nonetheless managed to move through the hail of enemy fire to other casualties. Once again, he was faced with the intense fire of oncoming enemy troops and, despite the grave personal danger and insurmountable odds, succeeded in treating the wounded and holding off the enemy until he ran out of ammunition, at which time he sustained fatal wounds. HM2 Ray's final act of heroism was to protect the patient he was treating. He threw himself upon the wounded marine, thus saving the man's life when an enemy grenade exploded nearby. By his determined and persevering actions, courageous spirit, and selfless devotion to the welfare of his marine comrades, HM2 Ray served to inspire the men of Battery D to heroic efforts in defeating the enemy. His conduct throughout was in keeping with the finest traditions of the U.S. Naval Service."

NHB ACLS Program Trains To Save Lives
By MC1(SW) Charlemagne Obana, NHB Assistant PAO --  Naval Hospital Bremerton (NHB) staff education and training department (SETD) conducted Advanced Cardiac Life Support (ACLS) at Naval Base Kitsap (NBK) Bangor Behavior Health and Education Center (BHEC) Feb. 16-17.

“ACLS is a requirement for me as an independent duty corpsmen (IDC) and I’ve been qualified since 2006 when I went to IDC school,” said Emergency Department Leading Chief Petty Officer Chief Hospital Corpsman (SS/SW/AW) Allen Truhn.  “The way everything was run here, it was a relaxing setting with great instructors.  The facilities at the BHEC also made it very easy to learn in.”

“The training is required for the majority of nurses and doctors at NHB.  It isn’t required for most hospital corpsmen, but it sets them a step above the rest of their peers,” said ACLS Program Manager Hospital Corpsman 2nd Class (SW) Timothy Poole.

“They’ll know exactly what to do in case of a code even if doctors or nurses aren’t there.  Since they’ve been trained, they can lead the scenario.”

“A code is a cardiac-related emergency.  Anything ranging from a patient coming in with chest pain, where we assume it is cardiac-related until proven otherwise, to cardiac arrest or a stroke,” said Truhn.

“This training is mission critical so I just want to thank everyone that is a part of the team at NHB because they’re the reason why this program is so successful,” said ACLS Program Director Cmdr Fran Slonski.  “Also, we are lucky we have the BHEC because it allows people to get away from their jobs so they can concentrate on their training.”

The curriculum consists of classroom training in basic life support (BLS), respiratory emergencies, stroke, and cardiac emergencies which is taught by video, instructors, and scenarios.  The instructors are primarily hospital corpsmen, nurses and doctors from NHB.

“I really liked the practice sessions to do the hands-on since it got to mix the students together.  In my group there were students with experience levels from a hospital corpsman taking the class for the very first time to a civilian anesthesiologist who was actually a retired Navy who has been doing ACLS probably since the early 1980’s,” said Truhn.

The final tests include a written exam with 50 questions which requires a minimum score of 84 percent to pass and a mega-code scenario usually consisting of a group of six students evaluated by an instructor.

ACLS is usually held quarterly unless there is a situation that requires additional classes according to Poole.  One of the additional classes is held in June when the new family medicine interns arrive at NHB.

Most incoming medical professionals arriving at NHB are already certified in ACLS which requires renewal every two years.

“If their certification has lapsed, they need to recertify because technically they cannot practice medicine without it.  That’s why when the new intern college doctors get here, we hold class for them so they can re-qualify as part of their check-in,” said Poole.

The curriculum, guidelines, and testing material are supplied by the Military Training Network (MTN) which is standard for all branches.

Changes to the guidelines are made every five years, and NHB changed over to the 2010 guidelines on Sept. 2011.

“For corpsmen taking the course for the first time, I strongly encourage them to take the EKG course and the pre-ACLS course.  That will get them the base knowledge they need in order to go in to get the ACLS qualification,” said Truhn.  “There is a lot of new information and there is an assumption of knowledge prior to coming to the [ACLS] course.”

For enrollment into the ACLS course, contact HM2 Poole at NHB SETD (360)475-4146.

Preventative Medical Screenings at NHB a complete team effort
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Naval Hospital Bremerton continued to improve upon patient centered care by holding the 2nd Captain’s Cup HEDIS Challenge for clinical quality based on Healthcare Effectiveness Data and Information Set (HEDIS) metrics. NHB Medical Home Port teams used HEDIS metrics to inform, coordinate and schedule preventative breast, cervical, and colorectal cancer screenings and diabetes maintenance and management for beneficiaries. 

According to Dr. Dan Frederick, NHB Population Health Officer, the goal of the challenge was to motivate all the staff members of Medical Home Port teams to engage their patients in the preventive medical screenings process. By educating and reminding patients about annual screenings and checkups, Medical Home Port teams have the ability to diagnose and treat any potential health issue early rather than later.

“We thought that by borrowing the term ‘Captain’s Cup’ from our Navy sports colleagues we could capture the competitive spirit of involvement and increase health screenings which benefits our patients in the long run. We have been very pleased with the improvement in our command’s overall HEDIS metrics as result of the response by our staff,” said Frederick. “Everyone who put forth the effort has worked hard to improve the overall care of their patients. Point of care intervention, which occurs while our patients are here for any reason, is a critical pathway of involving our staff with the arranging preventive screenings.”

“HEDIS metrics is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of health care and medical service,” said Aimee Aldendorf, Health Educator.

The competition lasted eight weeks with honors going to the top Medical Home Port team for compiling the highest composite score of patient screenings. Team Two, lead by LCDR Gray Dawson, Family Medicine physician and Maria Millsap, Primary Care nurse, claimed the top composite score and received their award from the Commanding Officer, CAPT Christopher Culp. Recognition also went to the team that demonstrated the greatest improvement from the inaugural challenge held last year. Team Four showed the greatest improvement, with honorable mention to Team Three. “Everything  done help to make a positive difference in caring for our patients. Thanks to everyone for their contributions,” said Culp.

“This is definitely a team award. Everyone has worked together to make this happen and to change our processes for the better,” said Dawson.

Aldendorf noted that NHB had all primary care providers and support staff use Carepoint, the Military Health System (MHS) population health tool, which provides a listing of patients in need of preventive screening.  “The health care providers then encourage their support staff to assist in calling patients and arranging necessary studies for each beneficiary,” Aldendorf said.

“We not only inform a patient of their need to come in for a screening, but we can also identify those who are in for a appointment to use that opportunity to get whatever screening or additional checkup is overdue,” added Aldendorf.

“It really is our patients who benefit from having our Medical Home Port teams contact them to come in for the screenings. It certainly helps us treat any disease by catching it early,” said CDR Cynthia Kuehner, Family Medicine Department Head.

Five Medical Home Port teams at NHB, along with one at Naval Branch Health Clinic Bangor and NBHC Everett participated in this event. Each healthcare team is made up of approximately 25 staff members of primary care managers (PCM), registered nurses (RN), and hospital corpsmen and/or medical assistants. Additional physicians/providers are also part of the team to fill in during absences.

NHB’s primary care services transitioned last year from an individual patient/provider model to a standardized primary care team model that provides better access, continuity, wellness, and disease management for patients. The HEDIS metrics helps with standardizing primary care services, enhancing access and continuity between the patient, his/her primary care provider and their primary care team. Even the patient’s family is added as part of the overall team.

The partnership between NHB staff and an individual patient enrolled to a Medical Home Port team completely focuses on sustaining and enhancing wellness, along with delivery of comprehensive health care services, based on the patient needs before they visit the hospital, during their time at NHB, and afterwards during recovery.

“Bottom line, their work really makes our jobs much easier,” added CAPT David Murphy, Director for Medical Services.

 NHB support an ongoing legacy for Operation Iraqi Freedom and Operation New Dawn
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- With 2011 wrapped up, so has the deployment of Naval Hospital Bremerton personnel to Iraq. From the onset of Operation Iraqi Freedom in 2003 to the final days of Operation New Dawn in 2011, Naval Hospital Bremerton staff members continually deployed for medical support inside and out of Iraq.

From the cities along the Euphrates River in rural Anbar Province to Basra on the Al Faw Peninsula, from the northern urban enclave of Mosul to Baghdad’s Green Zone and Sadr City and many places in between, NHB doctors, nurses, hospital corpsmen, and support staff were there.

They embedded with various units that included 1st Medical Battalion, Special Warfare Group Iraq, 20th Seabee Readiness Group, Civil Affairs, Warrior Transition Team, 1st Marine Expeditionary Forces, 3d Marine Air Wing, 1st Marine Logistic Group and 1st Force Service Support Group.

NHB sent nearly 300 staff members to augment Fleet Hospital Eight at Naval Base Rota Spain in early 2003 to gear up for Operation Iraqi Freedom, and also deployed approximately 200 additional staff members to help run Expeditionary Medical Facility Kuwait that rendered support to the ground mission just north of the Kuwaiti border inside Iraq through 2011.

NHB staff members were directly involved in assisting with caring for the almost 4,500 American troop fatalities and the approximately 32,000 service men and women wounded throughout OIF and OND.

Yet the nine years for many NHB staff members, some who did multiple deployments, produced more than simple statistics and accumulated data. The time spent brought many to the forefront of their chosen Navy Medicine profession, in ways that forever remain etched in their professional bearing and personal mindset.

At the Beginning -

“I don’t recall exactly when I knew that Fleet Hospital Eight would play a major role, but soon after 9/11, we knew something was ramping up,” recalled retired Hospital Corpsman Chief Steven C. Jackson, who deployed from March to September 2003 as leading chief petty officer for Fleet Hospital Eight Surgical Services. “We were materially ready thanks to good preparation and training, but we had no idea what to expect or how it would affect our own lives.”

Naval Hospital Bremerton received orders February 2003 to staff, ready and deploy personnel to stand up and support a 116–bed Expeditionary Medical Facility (EMF) to Rota, Spain, in support of Operations Enduring/Iraqi Freedom (OEF/OIF) and possible future contingencies.  The Operational Readiness Department coordinated all logistics to marshal, ready and deploy 274-personnel from NHB as well as from nine other gaining commands around the country to form Fleet Hospital Eight. 

“Our first group set up the EMF on a vacant lot next to the flight line and by mid-deployment we had built the 250-bed fleet hospital in tent city,” said retired Hospital Corpsman Senior Chief Timothy D. Stewart, who was assigned to Inpatient Services as the ward leading chief petty officer. “It seems like so long ago, and we probably weren’t prepared for what was to be done. My fellow corpsmen drove stakes and erected a quality structure and cared for our wounded warriors to the best of their abilities. It was a pleasure to serve with them as they did all the hard stuff.”

Stewart noted that they treated almost 1,700 patients with 78 hospital corpsmen running seven wards and worked port to starboard (12 hours on, 12 hours off) shifts nearly the entire time deployed in 2003. “I was extremely proud of how well my corpsmen completed their duties. We received accolades from the Soldiers and Marines we were treating,” he said.

Jackson attests to the mettle and resolve of the fleet hospital staff to deal with the influx of incoming injured from the battlefield.

“I cannot recall a time in my life when I’ve been more proud of the Navy and being a corpsman. Having such an outstanding team to work with inspired me beyond words. Watching my corpsmen perform flawlessly and without complaint, often working long hours without a break, sometimes with no end in sight, literally brought a tear to my eye,” said Jackson.

Jackson also came away with high regard for the rest of the medical team at the fleet hospital. “Seeing some of the ‘miracles’ performed by our surgeons and nurses was truly memorable. They handled facial reconstructions, avulsed limbs, severe eye injuries and more. And watching our junior corpsmen step up to effectively and efficiently handle the support challenge turned them quickly into seasoned professionals,” Jackson said.

In-Country Iraq -


When Lt. Roger Williams arrived in Baghdad’s Green Zone in 2007, his initial thoughts of being in a safe and secure area were quickly tested. “I was actually doing the tourist thing, thinking I was completely safe. I was swimming with my Army counterpart in what had been renamed ‘Liberty Pool,’ one of Saddam’s former personal-use only pools, when my buddy said that it had been a while since any rocket or mortar attack had happened. I thought he was kidding and not five minutes later, we heard incoming rounds landing all over the place. That was really my ‘welcome to Baghdad’ moment,” said Williams, working at NHB’s Operating Room.

The occasional shelling actually never abated when Williams was there, and it became part of the almost unreal aspect of deployment. “The attacks added to the surreal aspect of being there. Some would hunker down and others would go about their business as best and safely as they could and just dealt with it,” he said.

Williams worked as a perioperative nurse attached to Forward Surgical Team assisting with the 28th Combat Support Hospital in the Green Zone, helping care for troops, contractors, and Iraqi's. “We operated on all who needed us,” he said.  

The surreal gave way to heartrending - There were two vivid and equally tragic reminders of the war at hand.

Army Capt. Maria Ines Ortiz was killed on July 10 during a mortar attack on the Green Zone. She was the first Army nurse killed by hostile fire since the Vietnam War. The attack also killed two other people and wounded 18 more. “It was very sad. I had met her. I knew her. She was on the way from the Emergency Room to the Operating Room when we lost her,” said Williams, who also deployed with Fleet Hospital Eight four years earlier. “We were all devastated. Lt. Cmdr. Amy White, our current Emergency Medicine division officer, worked with her in the Intensive Care Unit.”

Ortiz was one of many that Williams and others worked to save. Most of those wounded in Iraq did make it out for further treatment. Advances in training, experience, equipment and technology has brought the survival rate of battlefield casualties up dramatically – some estimates as high as 98 percent - compared to former wars.

Another colleague drove up one day in a Humvee filled with casualties from a sniper attack. A local Iraqi mother was wailing in shock over her two young daughters who both had been shot and in immediate need of medical care. “We could see that one of the daughters was already dead. I couldn’t even begin to imagine the grief the mom was experiencing. That tragic incident really stood out about the horrors of war,” said Williams, a father with daughters and one son of his own.

“I had two tours in Iraq,” remembered Hospital Corpsman Chief Nathan W. Sims, former Leading Chief Petty Officer for Operational Readiness Department.  “The first time I was with 1st Battalion 5th Marines at Ar Ramadi in al-Anbar province, from February to August 2005. Things were pretty bad at the time. We took mortars and rockets almost daily. We had several large Vehicle Born Improvised Explosive Devices and lots of contact with the enemy. We were busy doing all we could. We lost 15 Marines and one great corpsman, HM2 Cesar “Cid” Baez. Cid was an inspiration to everyone that he served with.”  Baez, from Pomona, Calif., died as a result of enemy small arms fire while conducting combat operations.

As was the case in wars past, medical advances were made under battlefield conditions that have enabled Navy hospital corpsmen like Sims to deal with the wounded as never before. Compiled BUMED statistics show that casualties today have a 90 percent and higher chance of surviving, a quantum leap even from the first Gulf War over a dozen years earlier.

One medical advancement carried out during OIF was improving upon the personal protective body armor. “I saw up close body armor saving a life,” Sims said. “We had one round stopped by it.  The bullet almost went all the way through a protective plate on one of our Marine. It didn’t enter his body, but he did end up getting a huge bruise. We’ll take that any day over the alternative.”

Self-applied Combat Application Tourniquets to stem blood loss were implemented during urban warfare and roadside bombing attacks.  “The CAT tourniquets are a good fallback to help stop bleeding, especially for all Marines on patrol,” said Sims, noting that there was also medical care advances made using new technology in surgery that help to prevent infection.

Sims deployed again in 2008 to Al Asad with Naval Mobile Construction Battalion (NMCB) 17 and noticed improvement with treating the wounded and getting them out of harm’s way. “We used to have undersized vehicles that a litter wouldn’t fit into,” said Sims. “When we got the Mine Resistant Ambush Protected (MRAP) armored vehicle, it was a vast improvement. A litter could fit inside with stable protection when transporting injured personnel.”

“Even with all the advanced technology that has been added, the number one asset we had in Iraq to save lives was our hospital corpsmen,” Sims stressed. “It’s the training that every corpsman goes through and knowing the basic ABCs (airway, breathing, circulation) for saving lives out there on patrol.”

Training and experience trumps all in caring for troops, yet the ability to provide medical assistance to Iraqi civilians was also vital to the success for many missions, commented HMC Emiliano Rabor. Rabor served as part of the Al Anbar Provincial Military Transition Team 2007-2008. “There were times we provided more medical care when on patrol than anything else. Medical care was considered a blessing where we were. We treated so many civilian cases. Showing compassion and care to the medical needs of local Iraqis allowed us to gain some mutual respect and cultural understanding,” said Rabor.

“When I went back for the second time, there really was an improvement in the climate and the lives of the Iraqi people,” recalled Sims, noting the difference between his initial and following tour. “It was a whole different world the second time around.  I believe that the sacrifices made by all who have served in Iraq have meaning. We have all helped the Iraqi people by improving their quality of life and making sure that they don’t live in a constant state of fear.”

Towards the End -

Hospital Corpsman Master Chief Tom Countryman’s one-year deployment from 2010 through 2011 as command master chief at Expeditionary Medical Facility Kuwait covered a time when the drawdown of troops in Iraq went from 90,000 to 50,000. The war-time violence abated some but didn’t completely diminish.

“It didn’t mean that our work load got any easier, and it didn’t mean we just stopped doing what needed to be done. We continued to provide urgent and emergent expeditionary medicine and primary care, as well as combat force health sustainment. Those were our main missions,” Countryman explained. 

EMF Kuwait served as a Level III hospital with top-notch resources for emergency room needs, surgery requirements, Intensive Care calls, clinical providers on call, and vital laboratory and blood bank concerns.

 “One of the goals I reminded our Sailors was to continue to get better than they were when they came here. My primary personal goal was the same as any other CMC that has ever been on deployment, and that was to take care of our troops and get every one of them home safely. That goes double for our patients,” Countryman said.

Currently –

Hospital Corpsman 2nd Class (Fleet Marine Force) Andrew L. Chase brought back his experience to handle NHB’s Tactical Combat Casualty Care (TCCC) training as program manager and lead instructor.
“TCCC is the course that will help save lives on the battlefield. It’s our duty to take what we know and share with our units in the field,” said Chase

Chase modified and enhanced the course to ensure than once hospital corpsmen are deployed with a Marine Corps unit, they are ready to handle first responder care for wounded on the field of battle and prevent loss of life. TCCC is now required within 90 days of members deploying. “The bottom line is that you fight like you train,” Chase flatly stated. “Our training will have our deployers confidently and aggressively assess and treat our wounded brothers and sisters in Afghanistan and the world over.”

Chase brings knowledge gained the hard way – from the battlefields in Western Iraq to urban warfare in Baghdad. He deployed with Regimental Combat Team 1, 1st Marine Division from Dec. 2007 to Jan. 2009. He went originally to Fallujah, Iraq, but then found himself relocating from one hot spot to another. Along with running daily convoy ops with the Regimental Combat Team and working the Rear Area Security, he was a combat replacement for multiple Marine battalions carrying out standard operations that included mounted/dismounted patrols, and sweeping for Improvised Explosive Devices and weapon caches. He also got in a mission with a Navy SEAL team and spent a few months embedded with a Military Transition Team training the fledgling Iraqi Army. His duties included the battle of Sadr City to helping track High Value Targets in Diyalah. He also trained several Iraqi doctors on treating combat trauma and the necessary clinical care afterwards, as well as six Iraqi Army medics. He finished up his time in Iraq working out of Ramadi.

 The support missions for OIF and OND are completed, but as is the case with the rest of BUMED, Naval Hospital Bremerton continues to support ongoing contingency operations. A total of 63 staff members have deployed in 2011, with approximately 25 currently serving in Afghanistan.

NHB Runners leg out year with 'Yukon Do It' Marathon 
By Douglas H Stutz, NHB Public Affairs -- There were approximately 120 full marathoners and 300 half marathoners who ran the second annual Yukon Do It Marathon and Half Marathon on Dec 31. Along with 80-plus additional 5K runners, the 500 participants used the last day of 2011to close out the year with a picturesque run along a sizable stretch of Port Orchard’s waterfront.

“This is a fast and scenic course and is quickly becoming known for both in the running community,” said Tony Seabolt, race director of Narrows Bridge Running Club/Route 16 Running and Walking, Gig Harbor.

Organizers billed the run ‘as a perfect opportunity to join other crazy runners for one last hoorah before the year ends.’ Ninety percent of the race course afforded continuous views of the Olympic Mountains, Puget Sound Naval Shipyard, Seattle, and occasional glimpses through the clouds of Mount Rainier and the Cascades.  

Seabolt noted that the half marathon offered a personal record-type course with a negative elevation gain and almost all of it relatively flat. The course started at South Kitsap High School, wound down onto Beach Drive and continued on along the waterfront to Manchester State Park and back. Those who ran the full marathon continued on to Yukon Bay before retracing back.

“Manchester State Park could not house any more than about 200 runners so we came to downtown (high school) due to parking.  But also the course is a double out and back for the marathon because the Southworth bridge is under construction,” explained Seabolt.

As runners mingled and meandered before the start, one question that was posed and commented on was, “which came first, the full or half marathon?” Certainly the historical relevance of the initial marathon that has expanded from being highlighted and commemorated in the modern Olympic Games to year-round weekend offerings lends credence to the notion that the marathon came first. But even back at the beginning, didn’t the runner have to complete a half before finishing the full to deliver his message?

The 26.2 mile marathon legend can be traced back to 490 BC to Marathon, the famous plain about 25 miles northeast of Athens, Greece. It was there that an Athenian force of about 11,000 under Miltiades prevailed in victory over 20,000 Persians. Miltiades then dispatched the runner Pheidippides to reach Athens as quickly as possible to report their victory in case Athens might surrender prematurely to the Persian fleet assuming their land army had already lost. On reaching Athens, Pheidippides delivered the message, collapsed and died.

The current acceptable distance of the marathon waffled back and forth between the first Olympic games of Athens in 1896 of 24.85 miles and 26.56 in the Antwerp games of 1920, finally deciding on 26.2 from the London 1908 games.

As much as the full marathon presents a challenging athletic event, so does undertaking the completion of the half marathon. The half doesn’t have quite the mystical allure of the full, but Runner’s World magazine attests that the half has grown in popularity so much that it has been the fastest growing race distance since 2003 in the U.S.

According to Running USA, U.S. half-marathons have continued to increase in popularity, increasing from 1.1 million finishers in 2009 to nearly 1.4 million finishers in 2010, a record 24 percent annual increase. Complied statistics also show that there are more half marathons, such as the second running this year of the Poulsbo full and half and the Yukon Do it, being added to run calendars every year. This year’s recently held popular Seattle Marathon had 2,600 for the full and almost 7,500 for the half.
 
The mileage distance of the half is a demanding length for many. But for the uninitiated, 13.1 isn’t some numerical answer to a statistical problem, although it sometimes seems like it past the 10K almost half-way point on a hilly course (see Seattle Marathon); and 13.1 isn’t an alliteration to some religious scripture tract, although it can certainly feel like it during specific portions of a challenging course (see Poulsbo Marathon); and 13.1 isn’t some obscure radio station fading in and out on some remote FM frequency, although that fading in and out bit is relative to some (see Tacoma City Marathon).

“Watching people finish and the satisfaction on their faces at their accomplishment is gratifying,” said Seabolt, who also coordinated donations from participants for Backpacks for Kids in Port Orchard.

The coordination and organization of all needed logistics, communications, and course details can if not overly difficult, at least time-consuming. “When you love running and the community, it's easy.  There are a lot of details to cover to manage 500 runners, and hopefully next year, we double that,” Seabolt said. “We're really hoping to make the Yukon Do It a marquee event for the city of Port Orchard and the community.  Hopefully this will become a great event and raise a lot of awareness and money for local charities for years to come.”

TCCC prepares NHB Corpsmen for Combat Environment
By MC1(SW) Charlemagne Obana, NHB Assistant PAO --  Naval Hospital Bremerton (NHB) Staff Education and Training Department Sailors conducted a highly refined and improved Tactical Combat Casualty Care (TCCC) Nov. 14-18 at Naval Base Kitsap (NBK) Bangor Behavior Health and Education Center (BHEC).

“We’re giving deploying corpsmen training in treating traumatic injuries in a combat environment,” said TCCC Instructor Hospital Corpsman 3rd Class (FMF) Bryan Thude.  “They’re being given tools to keep themselves and their patients safer.”

The TCCC instructors added elements of realism by attending a course in fabricating simulated improvised explosive devices (IED) at Joint Base Fort Lewis-McCord.

“We went down to Fort Lewis for a day class in order to learn how to effectively and safely put together IED simulators,” said Thude.  “I think it adds to the realism and opens up the students eyes more.”

The weeklong training culminated in the 25 students running through a final course simulation that reflected a scenario which might play out in the battle space.

“Now, we incorporate tactical maneuvers and IED simulators.  We have new staff members who have returned from battle in Afghanistan who are instructing students on applying techniques learned doing the job while being forward deployed,” said Hospital Corpsman 2nd Class (FMF) Andy Chase, TCCC lead instructor.

“The instructors themselves have gone through more training.  We’ve completed the Operational Expeditionary Medical Skills (OEMS) course.  In addition, we implemented physical training throughout the course because as a corpsman, you have to be stronger than the ones you have to provide care for.”

“It’s one of the best TCCC courses I’ve been to,” said Hospital Corpsman 3rd Class (FMF) Brian Brock.  “This was more hands-on so you get idea about what you’re doing instead of it being verbalized.”

During the final scenario, the TCCC instructors emphasized the importance of situational awareness in the battle space and the significance of maintaining communications with those around them.

“We’re really trying to teach the students to not only be tenacious but to understand that they have to endure all endeavors to keep that patient alive,” said Chase.

“I’ve never seen explosions at TCCC before which is good since they can really throw you off your game in combat. It’s good for people who haven’t been over there to get the idea.  It was a good experience,” said Brock.

“Our goal with this training is to send our deploying corpsmen over into the battle space well prepared and confident in their skills,” said Chase.

By that measure, the NHB’s TCCC instructors have been highly successful judging from the positive reactions of the students after completing the final simulation.

“It’s a very good course with seasoned instructors who know what they’re talking about.  I’m really impressed with how they put it together,” said Chief Hospital Corpsman (SW) Gil Garcia who is anticipating his first deployment to Afghanistan with 1st Marine Division in early 2012.

“This training will no doubt come into play with where I’m going and hopefully help me save lives.”

 Great American Smokeout at NHB
By MC1(SW) Charlemagne Obana, NHB Assistant PAO --  Naval Hospital Bremerton (NHB) Health Promotions staff and Substance Abuse Rehabilitation Program (SARP) team members joined forces to educate and encourage Sailors and civilians to quit smoking during the Great American Smokeout Nov. 17.

“The theme this year is ‘Walk Away For A Day’ to try to spur people to just try it for a day to see that for 24 hours you can have success,” said Patrick Graves, NHB’s tobacco cessation facilitator.  “How challenging would it be to quit for a lifetime?”

The day started off with a celebration breakfast with recent inductees to the nicotine-free life dining and sharing their stories of dependence and their affirmations to quit.

“I smoked my last cigarette on Apr. 2 and it put me on my knees,” said Curt Jones, a retired Army sergeant 1st class who stopped smoking after 52 years with assistance from NHB’s smoking cessation program.  “I’ve felt better [since I quit].  I cough very seldom, my wheezing is pretty much gone, my tongue is no longer coated, but because I have emphysema, I’m still terribly short of breath.”

Following the breakfast, Graves met with a classroom of Outpatient Crisis Intervention Program (OCIP) students to educate them about the smoking cessation program at the hospital.

Recently, SARP moved from Naval Base Kitsap (NBK) Bangor Behavior Health and Education Center (BHEC) to NHB’s 7th floor which has given Graves more opportunities to educate Sailors about the tobacco cessation assistance provided by the hospital.

“We’ve started to approach at each point we can intervene and educate people to let them know that tobacco addiction is something we want them to think about,” said Graves. 

“They need to be deliberate and intentional with their actions and choices that they make.  Smoking is an unhealthy decision that may not affect them right now, but it will in the future.  There is an addiction going on here and we can help you break that cycle.”

The team took to the halls of the hospital with a cart brimming with promotional items and rewards for health providers to share in the message of the healthy tobacco-free life. 

NHB Health Promotion Coordinator Janet Mano dressed as a six-foot tall cigarette butt and followed Graves around to family medicine, pediatrics, and OB/GYN to engage the hospital staff, patients, and visitors to encourage them to stop and to let the friends and family members they know who smoke to quit.

“If you tried to quit smoking and you didn’t have success, try again,” said Graves.  “Be honest with yourself about why you failed in the past and this time be more deliberate, intentional, and mindful in your approach to quitting.  You will have a higher success rate.  I beat this drum day in and day out.”

“I hope I never smoke again,” said Jones.  “I’m 62 now, and I want to live as long as I can.  I’d like to live to see my grand children grow up.”

City of Port Orchard Police Dept. reaches out to one of their own with NHB’s help
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- When the City of Port Orchard Police Department needed quick help to find out how to contact one of their officers wounded from an Improvised Explosive Device in Afghanistan, they knew Naval Hospital Bremerton was the place to call.

Staff Sergeant Robert McFann of the City of Port Orchard Police Department, and former Navy master-at-arms first class petty officer, sustained injuries at the end of October while supporting contingency operations on deployment in Afghanistan.

“As soon as we found out he’s been injured, we immediately set out to contact and let him know that we’re here for him and that he has people caring. We’re family,” said Bill Schaibly, Community Police Officer and retired Navy master chief, who directly contacted NHB’s Hospital Corpsman Master Chief Tom Countryman for assistance and guidance on how to locate and contact McFann.

As soon as Countryman got the request, he passed it on to NHB’s Patient Administration.  Hospital Corpsman 1st Class Dana Jones, HM3 Angel Gilbert and Michael Hall used their knowledge to collectively provide the timely linkup to enable the department to get in touch with one of their own. Jones used her considerable knowhow as NHB’s Fleet Liaison as well as a recent medical evacuation coordinator in Afghanistan to commence the tracking requirements. Jones knew to begin via Landstuhl Regional Medical Center in Germany, the conduit for all injured coming out of Afghanistan.

“I know how the patient services there works and enough about the ins and outs of the command,” explained Jones, who ended up contacting outpatient services at LRMC and then finally locating the correct barracks where McFann was. “It’s what we do. It really didn’t seem like a difficult task for us because we know what to do. But it can be hard for those who don’t really know where to start or who to contact.”

“That’s why Jones and the rest are here. I just asked for their support and then stepped out the way to let them work their magic to help those in need,” said Countryman.

The injured officer was flown out of Afghanistan to Germany on Nov. 2, and the call from home was established a day later. “Try to put yourself in his place. Wounded, away from his shipmates, and in a hospital setting a long ways from home. It’s nice to receive a long-distance call from home. We let him know we’re tracking and he’s on our radar,” Schaibly said.

 “We sincerely appreciate all the help to help us track the movement in-theater of our officer, The staff at Naval Hospital Bremerton was extremely helpful,” City of Port Orchard Chief of Police Alan L. Townsend said. 

NHB CPOA recognized for Volunteer Work
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Certificates of Appreciation were presented to nine members of Naval Hospital Bremerton Chief Petty Officer Association (CPOA) on Nov. 8 for their volunteer support of the recently held Veterans Stand down on Sept. 13.

Kitsap County Commissioner Charlotte Garrido and Kitsap Veterans Assistance Program coordinator Leif Bentson presented the Certificates of Appreciation to Hospital Corpsman Senior Chief Michael Hess, Hospital Corpsman Chief Christopher Newcomber, HMC Ernesto Oliveros, HMC Neilrose Gervacio, HMC Julie Sanchez, HMC Gilbert Garcia, HMC Keith Davis, Information Systems Technician Jennifer Clem and Personnel Specialist Chief James McCormack.

“One of my favorite words is ‘volunteer.’ We wanted to come to Naval Hospital Bremerton to thank those who helped out,” Garrido said. “Our community wouldn’t be anything without the commitment of such volunteers as we’re recognizing here. Volunteers go above and beyond their regular work by donating time, service and heart to help out and make a difference. What they did was really invaluable to us here in Kitsap County.”

“Getting members of Chief Petty Officer Association involved is a sure way that any project will get done. That’s what Navy Chiefs do; they get it done,” commented Capt. Christopher Culp, Naval Hospital Bremerton Commanding Officer.

The Fall 2011 Veterans Stand down was held at the Kitsap County Fairgrounds and provided several hundred veterans and family members a range of services and information, including free haircuts and groceries, clothes, financial help, housing, foreclosure information, Veterans Affairs health care enrollment, legal counseling, and lunch.

NHB’s chiefs primarily took part in the preparation, setup, serving of the food service for the event. “This was a great opportunity for us to help support of local veterans. We did the prep work, feeding and tear down for lunch,” said Davis.

“I saw younger veterans and family members and veterans from the Vietnam era. I also got to meet with one of our World War II veterans who was at the battle for Okinawa. Getting to talk with him was the highlight of my time,” Davis said.

“Volunteering to help is just the right thing to do. We’re a service organization. It’s our duty to help others. The veterans there are who we’re going to be. It’s up to us to help take care of them,” explained Newcomer.

“We are proud of the many veterans we have in our county and we also know that all of them do not have an easy life. The stand-down gave those in need the access to many helpful services,” said Garrido.

Kitsap County Commissioner Charlotte Garrido is the chair of the Kitsap Board of County Commissioners, where she and the two other commissioners oversee several county departments and the county’s $300 million dollar budget.  Leif Bentsen is the coordinator for Kitsap County Veterans Assistance Program. Leif is also a veteran, having served in the Army from 1965 through 1968, including 13 months in-country in Vietnam.

A Veterans Day Legacy – Gone but Never Forgotten
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs -- Veterans Day this year falls on a unique numerical twist of time in our history; 11-11-11. That’s an aggregate trio, hat trick, and three-pointer all of the same.

Unfortunately, one of our local veterans, William Frampton Ballinger, didn’t make it to 11-11-11. It wasn’t without trying, as he did in most things. Ballinger is one of many American veterans who made 11-11-11 the symbolic date what it is – a date set aside to honor and remember those who gave their all, and then some, for their country in time or war.

Ballinger was 85 when he passed away. I didn’t really know him, but I knew of him and others like him; men (and women) who had fought and survived through the Second World War, the Korean War and the Vietnam War. Those three wars gave Ballinger his own trio, hat trick, and three-pointer of a sort that is a woven part of our nation’s military history during those trying times.  

His obituary reads like a primer of our country’s involvement in deadly engagements scattered across the globe. Ballinger participated in five beachhead landings in 1944 onto the Philippine Archipelago during the Pacific Campaign of WWII. He helped liberate those islands, charged with carrying out forward observer duties for artillery.

When the Korean War broke out in 1950, Ballinger was back. He took part in the Inchon Landing, evaded capture by Chinese Communist forces and even found himself swept away down the freezing waters of the Yalu River, all while serving again as a forward observer.

The 1960s took him from the frozen Korean Peninsula to Can Tho, in South Vietnam’s Mekong Delta. He was again back in the thick of it, operating a communications center with the Signal Corps during the Tet Offensive of 1968.

Ballinger wore the cloth of our nation in a career that spanned four decades. Those of us following stand on his shoulders, as well as those of the many other veterans living in Kitsap-area communities. Like a number of others, Ballinger chose to reside and retire in one of those communities. Yet there were many who didn’t return. According to the National Archive, 38 Kitsap residents died during the Vietnam War, 15 were lost in the Korean War, and WWII took the lives of 218 residents.

During his final week, surrounded by family and attentive staff of the Naval Hospital Bremerton’s Intensive Care Unit, he even found time to meet and greet a visiting group of Seattle Seahawk Sea Gals. He and his family had been following the team’s fortunes since 1979. If anything, the cheerleaders came away from the impromptu meeting more moved than Ballinger, who was visibly touched by their surprise showing. Being able to spend some time, share a smile, and take images with the ailing combat veteran made their collective day.

“The caring, compassion and dignity by all the entire staff at Naval Hospital to Bill was very special to us,” said Alvina, married to Bill for approximately 58 years.

In 1918, on the eleventh hour of the eleventh day in the eleventh month, America joined in with other countries to celebrate the signing of an armistice to end of the First World War. That date a year later became Armistice Day in the U.S. to remember those who fought and sacrificed during the four long years of WWI. In 1954 the day became formally known as Veterans Day, the annual remembrance for America to honor approximately 25 million citizen-Soldier, Sailor, Airmen and Marine.

Ballinger was born on Feb. 17, 1926 and died on Oct. 30, 2011. Up until the end, his honor, courage and commitment continued to be evident to all, traits that are really the epitome of 11-11-11. Which is why we remember.

National Healthcare Quality Week showcases NHB efforts
By Douglas H Stutz, NHB Public Affairs --
Naval Hospital Bremerton hosted National Healthcare Quality Week, October 16-22.  The weeklong event provided the opportunity for the command’s clinics and departments to showcase their best health care performance improvement projects that have contributed to the quality, education and safety of patients and staff.

All submitted projects focused on enhancing patient safety, improving patient care and strengthening knowledge, performance and attitudes among staff members.

“Quality Healthcare is all about dong the ‘right thing at the right time for the right reason for the right patient,’ with timeliness, effectiveness and efficiency,” said Carol M. Butcher, MSN, CPHQ, CPUR, Joint Commission / Process Improvement Coordinator, Quality Management Department.

According to Cmdr. Sally Butler, Quality Management department head, Quality Healthcare is “the extent to which patients get the care they need in a manner that most effectively protects or restores their health. This means having timely access to care, getting treatment that medical evidence has found to be effective, and getting appropriate preventive care.”

This entire week has been devoted to promoting our quality care improvements to patients and staff. Even having a simple process like having the poster presentation contest lets us all reflect and see what’s going on throughout the command.  Others can share in those ideas and hopefully spark some of their own,” said Butler.

The highlight of the week was the Performance Improvement Poster Competition, with over 25 posters displayed on the Quarterdeck throughout the week. Poster topics ranged from Infection Prevention with the new automated hand-washer and sanitizer to Emergency Department Patient Care Testing.

“Congratulations to all of our PI Poster participants from NHB and our Branch Clinics that showcased their incredible PI projects on the Quarterdeck this Week. We appreciate your dedication at all levels of our organization to continuously improve the healthcare of those entrusted to our care and the vital services necessary to support those efforts,” said Butler.

There were five specific categories in the poster competition. The winners, as selected by the NHB Executive Board, were for “Best Aligned to Command Vision” that went to Naval Branch Health Clinic Everett with their "Mobile Dental Unit Initiative.  "The Best Collaborative Improvement” award went to Quality Management for "Scanning Technology Efficiency." For the “Most in Supporting Family-Centered Care" award was received by Population Health with their "Improve HEDIS Metrics." The “Most Innovative” award went to Staff Education Training Department, with "Electronic Tracking for Training." The “Most Focused on Patient Safety” award went to Nursing Services, Professional Development Council for their "Medication Safety Initiative." In the Best Overall Category, first place was awarded to Patient Administration with their "Outpatient Records Release of Information." Second place went to Population Health with  "Improve HEDIS," and third place went to Emergency Department with "Waive Testing at the Bedside - POC Testing." Honorable Mention was given for the efforts of NBHC Everett for the number of projects submitted and the effort to bring to them to the main facility for inclusion, and also to Directorate of Administration and Directorate of Nursing Service for 100 percent participation from all of their departments.

Other weeklong activities included a Halloween-themed open house at Quality Management and Staff Education Training Department on Oct 18, with the Simulated Lab open to share ‘lessons learned.’ An updated patient safety handbook campaign was re-launched to encourage staff members to get even more involved and focused on safety. “Our goal is to get everyone continually aware and accountable in aiding in our culture of continuous readiness and patient safety,” said Butler, also noting that staff members are now given the pocket-sized booklets during their check-in indoctrination and orientation period.

NHB has received quality recognition over the past year to validate that the command awareness of Quality Healthcare principles, such as NHB’s Graduate Medical Education (GME) Residency Program received the singular honor of being granted five year accreditation instead of The usual three by the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee (RRC) for Family Medicine; Joint Commission accreditation for three years. The purpose of the JC survey and inspection was to evaluate the compliance of NHB and branch clinics with nationally established Joint Commission and Navy standards. By continuing to be an accredited organization, NHB enhances community confidence, stimulates the organization’s quality improvement efforts, aids in professional staff recruitment, provides a report card for the public, offers an objective evaluation of the organization’s performance, and provides a staff education tool; NHB was also recognized as the winner of the 2010 Department of Defense Patient Safety Award in the category of Identification and Mitigation of Risks and Hazards for an in-patient facility. The DoD Patient Safety Award acknowledged efforts designed to improve the care delivered within the Military Healthcare System and NHB’s submission was “Improving the High Level Disinfection Process of Vaginal Ultrasound Probes; and The Navy Surgeon General's Health Promotion and Wellness Medical Command award, The Blue H for Command Excellence in Health Promotion, was presented to Naval Hospital Bremerton for the 12th time. Health and Wellness is defined by Navy and Marine Corps Public Health Center as “ensuring healthy living through various sources and education by providing tools to assist individuals in gathering helpful information. The mission is to provide quality Health Promotion products and services with a vision of producing a healthy and fit force. Health promotion and wellness, along with healthy living, continues to address prevention, community health promotion and general wellness”

Staff and visitors are continually encouraged to share their ideas. Because there are some things we can change for the better, and we do,” said Butler.

NHB recognized with LIMDU CPM Award
By Douglas H Stutz, NHB Public Affairs --
NHB has been awarded the Outstanding Certified Pipeline Movers (CPM) Award by Naval Personnel Command's Transient Monitoring Unit (TMU) in a recognition ceremony October 14. The results are from a Bureau of Navy Personnel audit on the handling of Limited Duty personnel at Naval Hospital Bremerton.

The TMU conducted the on-site audit of NHB's Patient Administration Department to ensure the proper monitoring and movement of personnel through the Limited Duty (LIMDU) Pipeline.  NHB was selected for the award for its outstanding documentation, efficiency, and dedication to managing Limited Duty service members. The award demonstrates NHB's ability to communicate between providers, patients and their families, meeting the command's mission of patient and family-centered care. Last year NHB completed and tracked over 600 LIMDU boards from the entire Northwest Region and are on pace to surpass that number this year.

“Very few naval hospitals receive the Certified Pipeline Movers award. It's the culmination of a lot of hard work, foot work and attention to detail that makes NHB stand out in the LIMDU field. This award has many components and has required ongoing help from many different departments.  The fleet liaisons, nurse case managers, clinic medical staffs and the physicians make this a true team affair.  The great cooperation is truly unique in Navy medicine. It's pretty telling when Captain Christopher Culp, our new commanding officer, made the comment to some of our Patient Admin staff at a recent meeting that NHB is known to all in Navy Medicine for it's great staff and work ethic,” said Lt. Tamara Sorensen, NHB Patient Administration department head. 

NHB’s program has been in place for approximately 17 years when then retired Personnelman Master Chief Norm Sanders took over the program and set it up as it still runs today.   “Norm won the CPM a total of 14 times before he retired. He passed his knowledge on to Jan Poore who then passed it on to the current Regional LIMDU coordinator Ms. April Dinucci.  Both Jan and April benefitted from learning the process from Norm first hand when both were on active duty and worked in the Patient Administration dept,” Sorensen said.

“I had the privilege of learning from the best serving with Jan and Norm. I replaced Jan in this position 3 years ago and she was (also) an excellent mentor,” said Dinucci.

Even though the entire process might not seem overly difficult, it can be time-consuming and daunting to some, which is why NHB’s CPM process exists. The LIMDU paperwork must be completed and signed by the appointed Convening Authorities at NHB in five working days.  This process requires that a total of three medical officers sign the LIMDU board form before it becomes official. The Convening Authority is appointed by NHB’s Commanding Officer and must be a senior medical officer.

 The LIMDU board form is used by physicians to place a Navy or Marine Corps member on a six month period of limited duty.  The form contains personal data and also the dates the limited duty encompasses, the member’s diagnosis, treatment plan, and limitations their medical conditions restricts them from participating in.

Dinucci’s specific role in the pipeline is hands-on contact and training with the physicians and face-to-face counseling with the service member during every process when they are placed in a limited duty status. 

“Limited duty can be a scary transition for a Sailor who hopes to serve his country until retirement. It is always gratifying to assuage any fears they may have in the early stages of the process. We have great resources and opportunities to share with Sailors who may eventually transition to civilian life due to a disability or suitability issue,” Dinucci said.

“Our most prominent success is being diligent in tracking medical boards processing times and not allowing them to sit.  The pipeline award is all about timeliness and accuracy.  Through our training and hands on approach with both the service member and the physicians we were able to reach this success.  NHB is a wonderful team atmosphere and our success comes from the positive working relationship we have with our docs and clinical staff.” 

NHB currently has the best Integrated Disability Evaluation System (IDES) in Navy medicine specifically in meeting or exceeding timeline requirements in support of the Medical Board Review Process.

“NHB staff skillfully merged the DoD Medical Evaluation Board and the Veterans Administration (VA) compensation processes together. This impressive achievement afforded a seamless transition for those military members separating from military service. Expeditiously, yet with compassion, NHB staff has successfully transitioned 311 patients from numerous area shore and fleet commands through this process, surpassing established standards,” said Sorensen, noting that NHB was one of two sites visited by staff from the Senate Committee for Veterans Affairs due to overall timeliness and efficiency and the Congressional Staff Delegation verbally expressed how pleased the panel of patients was with the care provided by NHB.

NHB has also been chosen as a pilot site for the Joint Executive Committee Separation Health Assessment Project in recognition of outstanding Medical Board Separation Processing achievements. This U.S. Senate initiated-project will evaluate the feasibility of processing all military separation physicals through the VA, drastically reducing duplication of separation exams. 

Deployers Dental Readiness enhanced by Everett and San Diego dental staffs
By Douglas H Stutz, Naval Hospital Bremerton Public Affairs - Dental Health Clinics at Branch Health Clinic Everett and Naval Station San Diego combined to use creativity and flexibility to improve upon Operational Dental Readiness for deploying ships in the month of September.

USS Ingraham (FFG 61) departed on deployment in mid-September with 100 percent dental readiness, and USS Momsen (DDG 92) finalizing pre-deployment workups, has already achieved 95 percent dental readiness. Both high marks are a direct result of extra efforts by Everett and San Diego dental staff to ensure both commands, home ported at Naval Station Everett, were as ready as possible to deploy.

“Sending a ship to sea at 100 percent dental readiness is an extremely rewarding experience for every single person in the dental department, as each staff member clearly understands the importance of what they do and the direct role they play in mission accomplishment and national defense.  This was obvious in the individual and collective pride shared as USS Ingraham departed Naval Station Everett for an extended deployment at 100 percent Operational Dental Readiness,” said Capt. Mark V. Colaianni, Naval Branch Health Clinic Everett Dental Department Head.

Momsen’s high operational tempo and extensive sea time proved to be a logistical challenge for dental readiness.  Colaianni, Capt. William R. Davidson, Director of Dental Services, San Diego, and Capt. Robert J. Peters, Force Dental Officer, Commander Naval Surface Force, U. S. Pacific Fleet, Commander Naval Air Force, United States Pacific Fleet originated a viable game plan to handle the ship’s needs.

“Because access to patients can be a challenge, and time away from the job to visit the dental clinic can hinder work completion on the Sailor's part, we have utilized portable dental gear onboard ships to conduct required exams in anticipation of an extended deployment.  More than 200 exams were completed recently in such a fashion over a seven-day period for the USS Momsen,” said Colaianni.

NBHC Everett Dental Health Clinic arranged to handle a lot of Momsen’s dentistry before the ship got underway for routine operations off the Southern Californian coastline. Colaianni and Peters then coordinated for additional Momsen dental care needs with Naval Station San Diego Dental Health Clinic. During a three day window following Labor Day while the Momsen was moored at Naval Base San Diego (NBSD), a total of 73 patients were seen, with 46 ‘Class 3’ (not dental ready) conversions to Class 2 (dental ready), resulting in the Momsen achieving 95 percent Operational Dental Readiness.

“This extraordinary proactive stance is what defines us as Dental Corps Officer and support staff which further underscores our value in Navy Medicine.   Please extend my personal thanks to each and every person who contributed to this effort to include the dental technicians and front desk personnel that made this coordination so successful.  We are all so blessed to be part of this "machine" and the all the superb professionals that keep us focused. Thank you all again for your leadership as without you and all your dedication, we would not be the Corps we are all so proud to be today,” Capt. Robert M. Taft, Bureau of Medicine and Surgery Deputy Chief, Dental Corps, acknowledged via email.

There are four specific dental classifications for patients: Class 1 is Dental Ready and indicates good Dental Health with no treatment required or recommended; Class 2 is also Dental Ready, but with minor dental care recommended such as cleanings and small fillings needed; Class 3 is Not Dental Ready, with dental requirements, that if not treated, could result in a dental emergency in the next year, such as moderate to large cavities and possible root canal needs; and Class 4 is Not Dental Ready, with a patient’s dental condition unknown, usually due to no annual dental exam, also known as a T-2.  If the T-2 is not done, then that Sailor automatically converts to Class 4 status. 

“When ships deploy we need to provide exams to all those who are due or will become due during the period of deployment to prevent conversion to a non dental ready status while they are away,” explained Colaianni.

According to Colaianni, the importance in a 100 percent dental ready crew is directly related to success in mission accomplishment for deployed ships.  A crew member with a dental emergency may not be able to properly carry out his or her duties.  As a result, the mission suffers. 

“The ships that we serve in Naval Station Everett do not carry a dentist onboard, and although the independent duty corpsmen are very skilled in treating emergencies and getting patients out of pain temporarily, they are limited in ability to provide definitive dental care.  As a result, a deployed ship might find it has to transport a crew member off the ship in a foreign port to get the dental condition resolved.  Prevention of dental emergencies is therefore mission essential.  A ship's Operational Dental Readiness of 100 percent means that all crew members have been screened and that none are expected to have dental complications for the duration of the deployment period,” said Colaianni.

Colaianni attests that the biggest issue to reaching 100 percent dental readiness with any Command is access to the patients.  This can be because of rigorous training schedules including periods away from homeport, stand downs where members are away on leave, holidays, avoidance of dental by the member for various reasons, fear being one of them.  “There are also periods of provider shortages, or ships returning from deployments where Sailors have spent the last six months bathing their teeth is acidic sugar soft drinks and now require extensive restorative work to deal with all of the tooth decay,” he said.

 “We are very proud of the effort given by the crew of 32nd Street Dental (Naval Base San Diego), especially our Fleet Liaison Department who coordinated the entire evolution,” Davidson wrote in an email.

“A great collaborative effort between Everett Dental and Naval Base San Diego Dental Clinic to take care of USS Momsen Sailors!  Everybody went above and beyond on this!  Just a great effort!” stated Capt. Jim Martin, Naval Hospital Bremerton Director for Dental Services.

“Old Ironsides” on Display at NHB
By Douglas H Stutz, NHB Public Affairs PAO --
“Old Ironsides” was open for public viewing at Naval Hospital Bremerton on Sept. 30, albeit on a slightly smaller scale than the original USS Constitution.  For those who have never had the opportunity to visit or see up close the world’s oldest commissioned warship afloat, retired Electronics Technician Chief Gary DeWitt provided the opportunity. He has loaned NHB an exact wooden replica model to display for all to enjoy.

“Old Ironsides has always been one of my favorites. It’s so rich in history. Because of my love of our Navy, I decided to loan it at NHB to put on long term display for the Sailors and families to also share and enjoy,” said Dewitt.

The construction of the Constitution took DeWitt approximately 520 hours, stretching from early April to late October 2010, averaging 15-20 hours per week. The final product measures 43.5 inches length by 30 in. high by 15 in. width.

“This is a work of amazing craftsmanship, attention to detail and incredible dedication,” said Capt. Christopher Culp, NHB commanding officer, who officially accepted the loaned wooden replica.

According to DeWitt, the wooden replica represents a natural progression in his model-building hobby.

“Constructing plastic models lost their challenge. I love the results switching to wood,” said DeWitt, who learned a lot of working in such detail with wood. “There is a lot more involved than most think. Wood is in a class all of its own. The biggest part was learning how to curve and bend the wood using heat to fit it in for the precise configurations of the ship.”
 
Even though he started the construction project from scratch, he did have a kit, complete with instruction booklet. He started on the bulkheads, then the false keel, and then adding the hull, which required heat-bending work on the wood to fit properly. He then added the deck planks. The step by step process was a labor of love. With patience and an eye for detail, he then added nets, stanchions, walling, block and tackle, 52 brass cannon (the original Constitution had 44 guns) and even miniature crew members to provide a depth of scale. Then there was tying knots with tweezers. The rigging was perhaps the most challenging. He had to painstakingly assemble the standing rigging before threading the running rigging through the standing.

 “I build model for others to enjoy. That’s the main reason why I loaned the Constitution to our hospital. It is helps to bring a visual reminder of America’s naval history.” said DeWitt, who had the Constitution also honored in August by taking Best in Show in hobbies at the Kitsap County Fair.

 Before he commenced working on his labor of love, he had to locate it. The model kit idea originated with Gary’s wife Terry, who decided to present it as a Christmas gift, but with a definite twist. He had to negotiate a challenging treasure hunt and decipher clues leading to the Christmas gift. “He really didn’t appreciate the treasure hunt idea that even had a plastic model that was a red herring. I wanted it to be a complete surprise for him and it was,” said Terry.

The end result of that initial surprise and long hours of work now has a new home. NHB also plans to add a log book, for those who have actually visited the USS Constitution can affix their signature and date of visit to further connect the replica with the real.

“Chief DeWitt, we are honored and privileged. We will enclose in a suitable glass case to prominently display so others can enjoy the fruits of your passion and labor,” said Culp.

 There is also historical relevance with USS Constitution, as 2012 marks the bicentennial of the War of 1812 with England, a two-and-a-half year period of land and sea battles that has been referred to as “Second War of Independence.”

USS Constitution was developed and built in response to the threat of Barbary corsairs, which threatened American merchant shipping off northern coast of Africa. Following the American Revolution, the United States' Continental Navy disbanded, leaving the new nation without a credible seapower to defend its interests abroad. Signed into law on March 27, 1794 by President George Washington, the Naval Armament Act called for the construction of six frigates, to be built at shipyards along the eastern seaboard. The 44-gun ship was built in Boston, launched on Oct. 21, 1797 and defended the sea lanes against threat up to 1855, much like the mission of today's Navy.

USS Constitution, located in the Charlestown Navy Yard of Boston Harbor, offers community outreach and education about the ship's history to more than 500,000 visitors per year. NHB’s Constitution might not get that many visitors, but the outreach and educational mission will be the same as its namesake. Just on a slightly smaller scale.

Hispanic Heritage celebrated at Naval Hospital Bremerton
By Douglas H Stutz, NHB Public Affairs -- Naval Hospital Bremerton celebrated Hispanic American Heritage Month with cultural presentations, vibrant dance demonstrations and static displays for staff members and family, beneficiaries and visitors on Sept. 29. The event highlights the command’s observation of Hispanic Heritage Month from Sept. 15 to Oct. 15.

“This is part of our month long tribute. With a theme of ‘many backgrounds, many stories…one American spirit,’ we celebrate the experiences and diversity of our nation’s Hispanic Americans,” said Lt. Cmdr. Jimmy Trujillo, during her opening remarks.

Trujillo noted that there are approximately 70,000 Hispanic Sailors, officers and DoN civilians serving today, including three Hispanic flag officers, 158 Hispanic master chief petty officers and five Hispanic members on the Senior Executive Service.

“Hispanic Americans have served at sea in every war of our nation's history. They have not stood on the fringes of service, but rather at its center as makers of American naval history,” Trujillo said.

Hispanic Heritage Month was originally observed in 1968, when then-President Lyndon B. Johnson proclaimed a National Hispanic Heritage week, to coincide with the independence anniversaries for Chile, Costa Rica, El Salvador, Guatemala, Honduras, Mexico and Nicaragua. That week expanded in 1988 to encompass a month-long celebration of the histories, cultures and contributions of Americans who trace their roots to Spain, Mexico, the Caribbean and Central and South America.

“I thought the entire event was great. Everyone was really into it,” said Ms. Esperanza Baux, of NHB Pediatrics department and the initial organizer of the commands first-ever Hispanic Heritage celebration. What started as an impromptu potluck get together is now a command-backed, Diversity Council-organized, hugely popular event.

“When we first did this, I went from clinic to clinic and got people involved. Over time, our command leadership came onboard and look where we are today! As before, we have people who want to be involved, and it’s really great to see our young Sailors interested and taking part. Sharing between young and old the common cultural heritage with others is what an event like this is all about,” Baux said.

Presentations included “El Jarabe Tapatio,” a traditional courtship dance performed by Master at Arms 2nd Class Eleazar Valdivia and the visiting Nobleza Folklorica dance group; “Dia de los Muertos” presented by Lt. Jo Ann Martinez, explaining the historical relevant of Mexico’s ‘Day of the Dead,’ a national holiday that honors the memories of those departed.  “Dia de los Muertos” tradition dates back 3,000 years and has been fused with influence from Spain and is rich in symbolisn and cultural roots,” explained Martinez.

Hospital Corpsman 1st Class Jason Corless performed ‘E; Cancion del Mariachi’ with solo guitar and accompanying vocals. “I didn’t like Mariachi music at first, but was inspired by the movie, ‘Desperados,’” said Corless, whose playing drew appreciative applause from the assembled crowd.

The show ended with MA2 Valdivia and the Nobleza Folklorica dance group rendering a rousing dance rendition of ‘Los Machetes,’ a traditional expressive dance on celebrating the end of the harvest.

“Many thanks to everyone involved for their time and energy. And food,” said Trujillo in her closing remarks, as everyone in attendance lined up to sample a variety of entrées and side dishes from numerous Hispanic cultures.

Today, Hispanic Sailors, officers and civilians continue to distinguish and represent the long legacy of service by Hispanic Americans. Notable examples, past and present, include LT Lisseth Calvio of U.S. Naval Hospital Yokosuka, Japan, recipient of a LatinaStyle 2011 Distinguished Military Service, and Hospital Corpsman Luis E. Fonseca, Jr., who was awarded the Navy Cross for saving the lives of several wounded Marines during the 2003 battle of An Nasiriyah, Iraq.

According to 2010 statistics from the U.S. Census Bureau, Hispanics comprise 16.3 percent of the total United States population, or 50.5 million people, forming America’s largest racial or ethnic minority.

NHB Emergency Manager receives CEM credential
By Douglas H Stutz, NHB PAO -- Naval Hospital Bremerton’s Medical Treatment Facility Emergency Manager (MEM) was among 38 candidates this year approved by the International Association of Emergency Managers (IAEM) to receive the Certified Emergency Manager (CEM) credential.  NHB leadership received notification that Terry Lerma received the CEM credential on Sept. 24.

“Being certified by such a highly accredited world-wide organization as the IAEM really brings a sizable degree of credibility to what we do here at NHB. The current BUMED EM program guide stresses to try to get the certification. Now that we have, it validates our EM program. Overall, our command is doing the right thing in regards to EM training, preparation and exercising,” said Terry Lerma.

Terry Lerma joined Cedric Corpuz, Navy Medical West Regional Emergency Management program manager, as the only certified EMs in the BUMED area. In his capacity, Lerma independently manages the entire emergency management efforts and requirements for the approximately 1,400 military and civilian personnel at NHB.

“The CEM provides an internationally recognized professional measure and benchmark in the emergency management field. It's a significant accomplishment because of the increased credibility of the MTF Emergency Manager and ensures they have met multiple stringent industry standards of competence to perform their work for the command,” said Corpuz.

Lerma’s main emphasis is on organization, planning, facilities and training readiness, along with working closely with members of the Naval Base Kitsap Emergency Operations Center Operations Center (NBK EOC), Navy Region Northwest Regional Operations Center (NRNW ROC) and with emergency managers of civilian regional Public Health agencies and Kitsap County Department of Emergency Management in coordinating training and planning for real world contingencies.  In addition, Lerma maintains liaison with Madigan Army Medical Center emergency management officer. 

According to the IAEM, Lerma’s CEM designation is the highest honor of professional achievement made available for them in emergency management and disaster preparedness.

“It goes without saying; preparedness in anything will increase chances for success. Emergency preparedness is no different and is obviously more relevant.  A command with a viable emergency management program will be able to meet four critical phases of emergency management:  mitigation, preparedness, response, and recovery for all risks.  Additionally to ensure compliance readiness, Joint Commission (JC) and the Medical Inspector General (MEDIG) have benchmarks and standards to ensure commands are working towards a solid emergency management program,” said Corpuz.

IAEM boasts a membership of approximately 4,500 emergency managers from local, state, and federal government entities, as well as private industry and military branches.

As an applicant, Lerma compiled and completed an extensive credentials package that included experience as an EM, personal and professional references, education, training, and multiple contributions to the profession outside of his normal duties, along with a management essay and written exam. The essay required him to describe a scenario he might encounter as an EM. “We’ve done pandemic flu, earthquake and mass casualty drills to name a few, so I knew I had ample background and training to be able to handle that responsibility,” Lerma said. “Even the background and actual work on our two previously held shot exercises are both prime examples of how emergency management has worked with other offices, departments, and groups to effectively accomplish the mission.”

Lerma’s background and passion for his vocation in EM stretches past his past 4 and half years at NHB starting when he contributed to the EM plans while employed at Bremerton’s Harrison Hospital for seven years. He has also been a volunteer firefighter with South Kitsap Fire and Rescue since 1995, a member of the Kitsap County Explorer Search and Rescue since 2002, and a certified K9 handler with All Breed Canine Search and Rescue since 2006.

But Lerma attests that the success of NHB program relies largely upon the command leadership. “The true value of our EM program is a result of the commitment by the front office on down. We have the right focus, we have plans in place, and we practice what we preach in continuing to improve our skills in handling a variety of potential emergencies,” Lerma said.

For the uninitiated, being a CEM lends a certain credence that those in the EM profession immediately recognize. Lerma compares receiving the CEM designation to a shipboard Sailor earning their enlisted warfare designation. Everyone on board that command knows what it takes to get the warfare device. Same principle holds for emergency managers. “It tells others that the extra effort was put in to achieve the certification. That extra effort would not have been possible without the support of our command, which is why we have such a good program,” said Lerma.

Lerma’s myriad and overlapping responsibilities as NHB’s MEM has him carrying out such duties as advisor to the commanding officer, director for administration and Navy Medicine West CEM on all issues of vulnerability involving natural and man-made disasters, as they affect the environment of care at the command; ensuring Emergency Preparedness program meets BUMED and Joint Commission requirements; coordinating the disaster supply/re-supply system to ensure adequate supplies are available to support emergency response operations; ensuring operability of the Command’s Hospital Command Center (HCC) and monitor readiness of all equipment including communications equipment, publications, and operational guides; providing briefs, lesson plans, and training on ICC/emergency response procedures to command staff, watch-standers, and Regional partners; maintain proficiency in Incident Command System (ICS), Hospital Incident Command System (HICS) and National Incident Management System (NIMS) procedures. Lerma is also the primary action officer for emergency management matters, coordinating directly with city, county and state emergency management agencies.

 For others seeking CEM credential, Corpuz recommends seeking a mentor in the field vice simply going to a website and independently working towards certification. "It's not enough... There are best practices and pitfalls a senior mentor in the field can provide to mitigate unnecessary delays and heartache in attaining certification.  Secondly, always continue to seek education in the field, whether independent FEMA courses or a degree in the field. Emergency management has grown exponentially and education and overall opportunities have never been better,” he said.

NHB recognizes Surgical Techs all week for patient care work
By Douglas H Stutz, NHB PAO - The 30 surgical technologists on Naval Hospital Bremerton staff were recognized during National Surgical Technologist Week September 18-24, 2011. Along with handling duties and responsibilities in NHB's Main Operating Room, hospital corpsmen with the surgical tech specialty rating also staff clinics such as Ears Nose (and) Throat (ENT), Dentistry, Ophthalmology and Urology. There are also two techs currently deployed to Afghanistan.

 “Our surgical techs are vital! Their service to the surgeon is so important that if they were not there the surgery would not happen in some cases and/or at least be extremely difficult to perform,” said Cmdr. Fran Slonski, Main Operating Room (OR) head.

Although the Main OR became the focal point for Surgical Technologist Week, the informal and festive cake cutting and catered-pot luck breakfast offerings were put on hold on the morning of Sept. 22, due to a sudden call to duty for OR members. There was an emergency appendectomy needed before normal scheduled surgery hours. The OR surgical techs immediately commenced setting up and readying for the procedure.

“This is what we do. As a surgical tech, it’s my duty to make sure everything we need for any type of procedure is sterilized, setup and in place, and is in good working condition,” said Hospital Corpsman 2nd Class Juniffer Jose, activated Reservist from San Diego fulfilling a 90-day duty assignment at NHB.

 Lt Cmdr. Frederick French, general surgeon, stated that good surgical techs not only know the upcoming procedures going to be performed, but also know the doctor’s preferences, patient positions, and necessary tools and instruments to be used and the order thereof.  “Surgical techs are a tremendous asset. They make our surgery cases proceed as professionally as possible. Their ability to assist during the operation and their ability to anticipate what’s needed during the operation are main reasons for providing the best care for our patients as we can,” French said.

“They are the surgeon’s right hand. We have a really good team that is a mix of knowledgeable, experienced corpsmen who know how to handle all the instruments and even anticipate what a surgeon needs next, and we also have young techs recently assigned here from school who are all eager, open and quick to learn,” said Lt Cmdr. May Ton, OR perioperative nurse.

According to compiled data, there are approximately 1,000 surgical techs in the Navy and nearly 59,000 in the U.S. “But our Navy surgical techs are more knowledgeable and able to assist more than their civilian counterparts,” said French.

Navy surgical techs serve on all types of platforms, in various duty stations and on a number of assignments. They can be found from shock trauma teams near a combat zone to fleet surgical teams helping with humanitarian assistance missions to a military treatment facility (MTF) like NHB.  

“The more experienced techs bring so much knowledge that the younger surgeons rely on them for their expertise,” said Slonski, noting that in the Vietnam era some units only had hospital corpsman/surgical techs that did perform life-saving surgeries and were their only Doc. “I can only speak to my experience as a OR nurse. For me it is extremely gratifying to be able to learn, lead and work besides these outstanding young men and women. I have been a OR nurse for 17 years and I feel that a lot of my expertise and experience is because of the opportunity to work alongside these amazing hospital corpsman,” Slonski said.

When deployed, surgical techs are dealing with the wounds of war as up-close as anyone can get. Their world, much like those they care for, can become completely chaotic on the battlefield. But not so in an MTF setting. The world of surgical techs in an OR is orderly and sterilized. They are taught those principles during their 6-month schooling, which is then honed and defined as they move into actual real-life clinics and ORs to practice their skills. “Our job is all about making sure all the instruments are ready, the surgical field is sanitized, and our patient’s safety is being cared for. We help make our surgical cases go smoothly,” said Hospitalman Nathan Nicholson.

A typical day for surgical techs in the OR has them scrubbing up to prepare for an average of two to five surgical cases. “Every time it’s gratifying to know we’re doing our part to provide patient care and assist in improving someone’s health and well-being,” said Jose.

Especially if it’s during a sudden call to duty for a OR emergency. The surgical techs will be among the first on the scene.

NHB hosts Electronic Health Record road show
By Douglas H Stutz, NHB Public Affairs -- The Defense Health Information Management System (DHIMS), Electronic Health Record (EHR) Road Show was showcased with demonstrations, one-on-one training, education and awareness at Naval Hospital Bremerton on Sept 20.

“This event allowed our command’s leadership and providers to know and see firsthand that AHLTA is continually evolving and we need regular training to keep updated,” said Pat Flaherty, NHB Information Management Department head, explaining that AHLTA is the universal, accepted shortened version of Armed Forces Health Longitudinal Technology, the military’s electronic medical record system.