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Wednesday , November 14 2018
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New Audiology Booth Supports East Bliss Readiness

“Say again… Over.” “Say again… Over.” Radio static may be the culprit for some miscommunication, but at times hearing loss may be to blame.

As part of the U.S. Army Hearing Program, Soldiers are required to take a hearing test, attend a hearing conservation briefing, and get fitted for hearing protection annually. To increase Soldier readiness on Fort Bliss, William Beaumont Army Medical Center’s East Bliss Health and Dental Clinic is slated to debut a new eight-station hearing booth, October 1.

The hearing booth will allow Soldiers assigned to the clinic, approximately 5,700, to conduct hearing exams near their Area of Operations while relieving congestion at other clinics through the Fort Bliss footprint.

“The brigade here was going to (Spc. Hugo V. Mendoza Soldier Family Care Center), this will alleviate the strain of trying to get everybody into that one clinic,” said Capt. Lydia Malloy, an audiologist and chief of the Fort Bliss Army Hearing Program. “Access to care is going to be better, hearing readiness is going to be better, all around a good thing.”

According to the Army Public Health Command, Soldiers may be subject to impact noise topping decibel (dB) levels at 175 – 180 dB, a range well above the safe limits of 85 dB for continuous noise and 140 dB for impact noise.

“The reason for the Army hearing program is to prevent noise-induced hearing loss, if we can identify shifts (in hearing capability) early then we can change the behavior to keep it from becoming a problem,” said Malloy. “Eventually that problem may affect someone’s career when you hit a certain point.”

The East Bliss Clinic offer a full spectrum of services from dental to behavioral health but has lacked audiology services since opening its doors six years ago.

“(The addition of the booth) will allow Soldiers to complete their physicals, enhance medical deployability while facilitating a much needed service within walking distance and in their medical home,” said Jackie Beard, clinical nursing officer in charge, East Bliss Health and Dental Clinic. “The booth will also alleviate some of the demands on the other test sites and meet missions.”

The eight-station booth joins two other hearing conservation booths already in use in other primary care clinics throughout Fort Bliss.

The Army Hearing Program consists of four components: hearing readiness, operational hearing services, clinical hearing services, and hearing conservation.

According to Malloy, survivability and lethality also drive hearing conservation amongst Soldiers, to maximize human potential during stressful situations such as combat.

In addition to safeguarding Soldier’s hearing, the new addition to the clinic also improves unit readiness by reserving more time for mission requirements in lieu of medical examinations.

“This booth will have a positive effect on Soldiers’ clinical needs, the installation and overall missions,” said Beard. “We are always forward thinking with new innovative ways to deliver excellent clinical care to our soldiers.”

Author: Marcy SanchezWilliam Beaumont Army Medical Center Public Affairs Office

WBAMC Soldier Aims to Improve Readiness of Fellow Soldiers

Marksmanship qualification courses are rare opportunities at Army Medical Centers where 24/7 operations essential to the health, and at times lives, of service members, their families and retirees, take top priority.

At William Beaumont Army Medical Center, a Military Treatment Facility which treats nearly 100,000 beneficiaries to include civilian traumas, a patient-filled schedule is an unacceptable excuse for disregarding Soldier duties.

To help Soldiers qualify on “the range,” one Soldier is increasing Soldier readiness at WBAMC through Primary Marksman Instruction (PMI), aimed at improving overall weapons proficiency and range scores in the Army’s Weapons Qualification Course.

“As soon as I showed up here (Troop Command, command sergeant major) tasked me (to provide marksmanship instruction),” said Staff Sgt. Stephen Van Eps, noncommissioned officer in charge, Urology Clinic, WBAMC. “He knows I’m a weapons guy, a gunsmith and he lives right by me.”

In his seven months assigned to the hospital, Van Eps has assisted in coaching dozens of Soldiers. Over his military career, Van Eps estimates he has coached over 100 qualification courses and oversaw at least 50 of them as the noncommissioned officer in charge.

The Master Marksmanship Training Course, a pilot program for marksmanship instructors in the Army, was recently launched. However, Van Eps, who hasn’t attended the course, credits his service as an infantryman in the Marine Corps for four years with launching his knack for shooting iron.

“To me (marksmanship instruction is simple), it’s just the standard,” said Van Eps, a graduate of the Marine Corps’ Primary Marksmanship Instructor (PMI) school, which develops marksmanship coaches to assist and instruct in small-arms fire. “I don’t do anything different, I just do what I do when it comes to any type of training.”

Recently, Van Eps was presented a token of appreciation from the German Air Force Air Defense School at Fort Bliss, Texas, for providing instruction on the M16 rifle and M9 pistol qualification courses to several German Air Force members, resulting in all 10 shooters placing in the sharpshooter or expert levels on the M16 and 70 percent of shooters qualifying with the M9 pistol.

“(Being recognized) was a huge honor, I was shocked to hear about it,” said Van Eps, a native of Morris, Minnesota. “There’s not that many opportunities for them to qualify on these weapons, so we taught one on one and small group instruction helping them identify deficiencies.”

While Van Eps, who holds an associate of science in firearm technology, has brought a wealth of marksmanship knowledge to WBAMC Soldiers, he credits other Soldiers for the increase in proficiency.

“I started recruiting within the hospital for coaches immediately after the first range,” said Van Eps. “I assessed who knew what they were doing, how they were shooting, and put together a comprehensive training plan to build safety and coaching mentalities in these coaches.”

According to Van Eps, a combat veteran with multiple deployments as a flight paramedic, marksmanship training at Military Treatment Facilities (MTFs) is unique because of the emphasis on patient care. While some Soldiers are assigned to front-line units throughout their careers, others may not be afforded the opportunity, possibly compromising basic Soldier skills, such as marksmanship.

“If you don’t have (marksmanship) knowledge like this (qualifying) becomes complex,” said Van Eps. “(Noncommissioned officers at WBAMC) are trying to develop those skills in young Soldiers, across the board, not only in marksmanship. We’ve seen results the last few ranges with more than 95 percent qualifying, something unheard of in the medical community.”

A husband and father of three, the firearm enthusiast has extended his training to family members and enjoys watching them progress with different weapons systems.

“I’m an avid hunters, and have gone through several types of weapons courses,” said Van Eps.

Van Eps has qualified on weapons courses as an expert multiple times and hopes to one day qualify for the President’s Hundred Tab, a badge awarded to the top 100 civilian and military shooters in prestigious shooting competitions.

“I’m not an expert coach, I’m not an expert in marksmanship, but I am an expert in the basics,” said Van Eps, humbly. “As long as you master the basics you can do anything.”

Story by Marcy Sanchez – William Beaumont Army Medical Center Public Affairs Office

WBAMC’s Addiction Medicine Intensive Outpatient Program Shifting Culture, Stigma at Fort Bliss

From tanks and fighter jets to grenades and cadence, the public’s perception of the military as an institution and the culture varies.

Perceptions within the ranks also extend to service members who fear reprisal if asking for help, a stigma the staff at Fort Bliss’ Addiction Medicine Intensive Outpatient Program (AMIOP) are working to end.

Since opening doors to Fort Bliss service members just over a year ago, over 150 service members have completed a six-week program at the AMIOP to sober up and break free from addiction. But, according to the experts, the AMIOP is only the beginning of recovery.

“Initially (service members) start at (Substance Use Disorder Clinic Care, or SUDCC) for most cases,” said Gisela Carter, program director, AMIOP / Partial Hospitalization Program (PHP). “A lot of times they get sent fairly quickly to us if they have higher needs.”

The AMIOP, the only one of its kind at Fort Bliss, offers intermediary rehabilitation for service members and provides a level 2.5 level of care based on the American Society of Addiction Medicine’s (ASAM) continuum of care which describes treatment as a continuum marked by four broad levels of service and an early intervention level. The lowest level of care, according to ASAM, is at level 0.5, early intervention, with the highest being at level 4, medically managed intensive inpatient services. The six-week-long program differs from SUDCC by approaching addiction with a full schedule of therapy modalities designed to keep patients engaged and practicing methods toward rehabilitation.

“We provide the tools during that six-week program and collaborate with patients (after completing the program) to see how they are using the tools,” said Maj. Marlene Arias-Reynoso, AMIOP medication provider/ SUDCC consultant and chief of 1st Brigade Combat Team, 1st Armored Division Embedded Behavioral Health. “The earliest they come and get help, the more effective the treatment will be. If they don’t come until a DUI later, there’s already things in place. Although the Soldier may want to recover, their career may likely be over.”

For one Soldier, a self-referral helped set up the Soldier to continue in the Army before the addiction took over.

“I had personal issues that escalated and I started going to Embedded Behavioral Health to get help then I was introduced to the program,” said the Soldier. “I was off-track very badly, everybody saw a change in me, even (senior leaders) before going through AMIOP.”

The Soldier, who wishes to remain anonymous, initiated his recovery at SUDCC and eventually found himself at the AMIOP for elevated care.

“For the first two weeks, like most people, I thought this was a bunch of BS. We’re going to come in here and sing Kumbaya, a lot of people are just going to say, ‘this is what you should do…’ but after we got past that particular phase, I had a few emotional days. They started to peel the layers off the onion to figure out what makes us turn to using substances,” said the Soldier. “It provided an open forum, where you can actually speak to others going through the same thing, because back in the unit you can’t speak to others freely. The group is where everybody opened up, in that forum, with a bunch of strangers and I put my business out there, but to this day we still have that group that we had.”

The Soldier’s perception of stigma surrounding Soldiers who ask for help is one the AMIOP staff is working to transform.

“There’s still a huge stigma about people who are recovering. There are still negative connotations with it,” said Carter. “Sometimes the value of the Soldier decreases and becomes negative because of the stigma, people refer to them as ‘bad for the unit’.”

In 2016, the Army Public Health Command’s Health of the Force report, a force-wide annual report discussing factors impacting Soldier readiness, lists five percent of active-duty Soldiers across the Army as being diagnosed with substance use disorder. The report consolidates the misuse and abuse of alcohol with prescription medication and other drugs.

“The longer you keep struggling with whatever substance, the worst the outcome is going to be. Habits are hard to break, so addicts may go back to (abusive) behaviors,” said Arias-Reynoso. “This is only six weeks, after that are the challenging times. The certificate (for completing the AMIOP program) is not the end, it’s the beginning.”

According to the Soldier, one activity at the AMIOP helped him realize the importance of scheduling and keeping him active to deter him from negative behaviors.

“I’m back to the (Soldier) who (other Soldiers) knew. I had stopped going to the gym, I loved being outdoors and I had gotten away from all of that because of depression, anxiety, and crazy thoughts going through my head,” said the Soldier. “I needed to eliminate the drinking, because at first I just wanted to minimize. But, (at the AMIOP) you have breathalyzers, urinalysis, AA meetings, which are eye-openers, just to see the long-term effects of what alcohol was doing.”

By starting treatment, the Soldier was also able to reconnect with a daughter who was beginning to notice the changes.

“I have no problem talking, but I wasn’t reaching out to my family as much (when the Soldier started drinking heavily). Once I opened up to family, it became easier to speak more about (addiction). Now our conversations are back to normal,” said the Soldier.

“When we have graduation in six weeks, I always tell (patients), this is genesis, this is the beginning, this is the initial start of the recovery,” said Carter. “There’s after-care at the SUDCC, in addition they come back to us on Fridays for several weeks to see how they are doing. It is like a recovery group for patients that have attended the AMIOP, and on the outside they continue that external support system like Alcoholic Anonymous or Narcotics Anonymous.”

According to AMIOP staff, continuity of treatment is essential in recovery and staying sober, with many programs designed to continue care three to six months after completing the program, to include family counseling.

“The program definitely gave us different tools to deal with the triggers, I don’t even go out to clubs anymore, I go do my activity and back to the house,” said the Soldier. “It’s helping me deal with everyday life and motivate me not to drink. As long as you have like-minded people and someone who has been through a similar experience, then you can relate. And that’s one of the best things about the program.”

Two cohorts of eight service members occupy the program year round, with each cohort’s participants starting at the same level of recovery.

“Recovery is not just something that happens, it’s a process and people have to continue to work on it,” said Carter. “Sometimes we have patients here until the day they walk out the gate (are out of the military), if a patient is willing to stay and work with us then we’re willing to admit them.”

“The tools that they learn here, even as civilians they can potentially apply them to their lives,” said Arias-Reynoso. “Being sober is not recovery. Have you changed your lifestyle? Not just stop your substance.”

Each September is Recovery Month, a Substance Abuse and Mental Health Services Administration-sponsored observance to increase awareness and understanding of mental and substance use disorders and celebrate those who recover. This year’s theme is: Join the Voices for Recovery: Invest in Health, Home, Purpose, and Community.

In efforts to increase awareness of addiction symptoms, the AMIOP recently provided training to primary care providers at Fort Bliss to help identify addictive behaviors, during regular exams to help service members before it becomes a habitual juggernaut.

“Anybody that actually needs help, no matter what your rank, don’t be afraid to stand up and say something,” said the Soldier. “Just speak up, don’t try to handle all issues by yourself. I always thought I was one of those people where it won’t happen to me and I had my stuff together but I didn’t… and it all came crumbling down.”

Today, the Soldier is back at his unit and working toward bettering himself while continuing counseling during recovery.

Multiple referral options exists for service members seeking treatment including self, physician and command referred. All patients are required to enroll in SUDCC prior to seeking higher levels of care.

Author: Marcy Sanchez William Beaumont Army Medical Center Public Affairs Office

El Paso-Based Reserve Unit Boosts Medical Readiness at Fort Bliss

Approximately 30 Soldiers with the 7248th Medical Support Unit (MSU), based out of El Paso, conducted an Annual Training event at William Beaumont Army Medical Center, providing additional healthcare support to Soldiers, retirees, families and other beneficiaries in the area.

The unit, which falls under the 7454th Medical Backfill Battalion out of San Antonio, is comprised of different medical professionals from patient administration specialists and combat medics to nurse practitioners and physician’s assistants.

“Our mission was to support the hospital in various departments,” said Maj. John Buen, a Certified Registered Nurse Anesthetist and officer in charge of the detachment. “We had Soldiers supporting (laboratory services, labor & delivery, and medical, surgical and behavioral health inpatient wards) for two weeks. The training helped supplement our own training to keep (reserve-component Soldiers) competent in their skills.”

The locally-based MSU provides medical support to Military Treatment Facilities throughout the Army through personnel backfills to sustain uninterrupted medical operations. Because the unit is mostly comprised of medical professionals, Soldiers are spread throughout WBAMC to provide premium training opportunities related to their Military Occupational Specialty (MOS) and provide a real-world experience.

“It was a good learning experience,” said Spc. Levi Raygoza, patient administration specialist, 7248th MSU. “I learned more (at WBAMC) than I did at (during initial MOS training).”

This is the first annual training Raygoza, an El Paso native, has been assigned for. A college student while out of uniform, Raygoza, who enlisted in the Army two years ago, said he believes the two-week exercise will prepare him for potential assignments in the future.

“(The staff) covered pretty much everything of what our job entails,” said Raygoza. “By the fourth day I was already on my own. With a little more training I would (feel comfortable) being activated.”

For several Soldiers, like Buen, the mission is an extension of their civilian occupations, providing added training for their civilian occupations and adding diverse work experience at WBAMC work areas.

“If we can provide manpower to help the hospital and promote (Soldier) skillsets at the same time,” said Buen, who also works as a civilian CRNA in the El Paso Community. “It’s a win-win for both institutions.”

The annual training event was held from July 8-20.

Col. Shawna Scully (left), deputy commander for medical services, William Beaumont Army Medical Center, and Sgt. Maj. Dina Pang, chief clinical noncommissioned officer, present reserve-component Soldiers with the 7248th Medical Support Unit commander’s coins for their service during an annual training event at WBAMC, July 20. |
Photo by Marcy Sanchez

Story: Marcy Sanchez – William Beaumont Army Medical Center Public Affairs Office

WBAMC ‘Mystery Shopper’ Aims to Gauge Patient Experience

William Beaumont Army Medical Center’s Patient Assistance Office recently kicked off a program to measure quality of outpatient encounters and provide immediate feedback to providers, clinics and other hospital staff.

The program, similar to retail-industry mystery shopper programs, entails patient advocates randomly questioning consenting patients who have recently completed a medical appointment at any of WBAMC’s primary care or specialty care clinics.

“The intent is to give patients the opportunity to give us (immediate) feedback of their experience, positive or negative,” said Thomas O’Dea, patient advocate, WBAMC. “From the beginning of their appointment to the end, we want to know what they thought.”

Patients have always had an opportunity to provide feedback concerning their experiences through traditional means such as Interactive Customer Evaluations (ICE) comments and the Military Health System’s recently launched Joint Outpatient Experience Survey (JOES). Outpatients can expect a JOES survey a few days after appointments and may return the survey via mail or electronically.

In addition to allowing patients to provide instant feedback, the mystery shopper program allows for WBAMC patient advocates to correct or address concerns on the spot.

“We want (patient’s) information, their name, phone number, so that if we do get a negative feedback we can address the situation and that’s where we want to go with it, we want to be able to reach back to (the patient),” said O’Dea. “It’s to add that personal factor to (patient’s experience), and the survey can provide us with a lot of good information, such as: are we doing the right thing, are we becoming complacent, that feedback is valuable overall for the organization as it carries over to JOES.”

The Military Health System’s patient satisfaction survey, JOES, assesses outpatient beneficiary experiences at Military Treatment Facilities (MTFs) allowing the MHS to compare results to the civilian benchmarks. Patient advocates plan to launch a similar mystery shopper program directed at inpatient experiences to supplement the TRICARE Inpatient Satisfaction Survey (TRISS), aimed at gauging inpatient experiences.

Providing high-satisfaction rated feedback on surveys like JOES and TRISS also impact medical operations directly through monetary incentives for increased medical resources such as staff and equipment as well as patient amenities such as recent mobile device charging stations available in select wait rooms.

For patients such as Sgt. Emmanuel Rivera, customer service is essential to meeting objectives.

“It’s not about doing the job faster but improving customer service,” said Rivera, a culinary specialist with 1st Battalion, 36th Infantry Regiment, 1st Stryker Brigade Combat Team, 1st Armored Division. “Good customer service helps keep customers.”

As an employee in the food service industry, guest relations are essential to daily operations for Rivera, who says he’d prefer to give instant feedback on his experience over waiting for a survey.

According to O’Dea, patients can provide feedback on any part of their WBAMC experience, from the first interaction while making an appointment to picking up any prescribed medications at pharmacies.

“It begins with first interaction with our facility which could be the appointment line, whether patients couldn’t get through (to schedule an appointment) or if there’s a certain number that is not working. We’ll alert those who can fix it,” said O’Dea. “It’s the whole experience, until they finish. We’re excited about it. We care about your experience and we care about our facility.”

Primary care clinics throughout the WBAMC footprint will also participate in mystery shopper surveys. For more information, contact WBAMC the Patient Assistance Office at 915-742-2692.

Author: Marcy Sanchez –  William Beaumont Army Medical Center Public Affairs Office 

WBAMC’s Child, Adolescent and Family Behavioral Health Service Hosts ‘Camp Wonder’

William Beaumont Army Medical Center’s Child, Adolescent and Family Behavioral Health Services welcomed 17 school-age children to a week-long camp designed to discuss experiences in a safe and supportive environment at Fort Bliss.

The summer camp, dubbed “Camp Wonder,” included four half-day sessions comprised of three counselor-led sessions targeting self-esteem, empowerment, depression, anxiety, behaviors, coping skills and social skills. Children completing kindergarten through fifth grades from Milam, Bliss and Colin L Powell Elementary Schools, were divided into age-appropriate groups to encourage interaction and uniform progression with peers.

“This is a great program for my son to participate in dealing with emotional and socioemotional feelings,” said Ebonie Sanchez, a military spouse at Fort Bliss and mother of three. “I thought it would be really good for him because he is young, so any aspect that can help him with his maturity level and growth, I’m all about it.”

In collaboration with Army Community Services, the camp also engaged parents with workshops addressing behavioral reward systems, medication management, family strengthening, and special education services available at Fort Bliss schools. During the camp, children were introduced to a reward system, earning small prizes for accomplishing daily goals. Parents were encouraged to continue the reward system at home, utilizing leisure activities such as video games and cell phone usage as rewards.

“Since he first found out he was going to the camp he asked question after question,” said Sanchez. “After coming home that first day he was ecstatic, he had so much fun he showed me a reward system they implemented and that gave him motivation to do more positive things to gain rewards.”

“Because school behavioral health is embedded within schools, during the summer they don’t have any children (assigned to programs) so they host camps and groups,” said Lashonda Bogan, outreach coordinator, Child, Adolescent and Family Behavioral Health Services, Department of Behavioral Health, WBAMC. “(The workshops) incorporate parenting classes into what the kids are learning, so (parents could continue to engage at home).”

According to Bogan, the short groups and camps offered during the summer allow eligible children to participate in programs before committing to services during the school year. Programs are aimed at increasing understanding and awareness of special-needs children to better prepare military families for challenges such as deployment of service-members, adding to unit readiness.

The program introduced Sanchez’ six-year-old son, DeAaron, to social settings outside of school while also addressing feelings, bullying and respecting others and themselves.

“It might be their first time being around other kids they could identify with,” said Bogan. “Knowing everyone in the camp (is unique), made campers more comfortable being themselves.”

“(DeAaron) has (Attention-deficit/hyperactivity disorder) so sometimes sitting down and calming down to get all the instructions (at school) is difficult for him,” said Sanchez. “He is learning about being courteous and those life skills parents want them to have to be successful.”

The camp wrapped up with a closed performance for parents featuring children singing as a choir about bullying and respect and swimming at the Fort Bliss Aquatics Training Center.

When asked what he enjoyed about the camp, DeAaron answered “the song,” while also adding he had fun during the camp.

“I’ve seen changes,” said Ebonie Sanchez. “I’m very involved in every aspect of his life, as much as I can be. (Camp coordinators) did have a mandatory meeting for the parents where bullying and coping with certain emotions were discussed, which I felt was a really great aspect of the camp.”

For the soon-to-be first grader, DeAaron says he’ll take what he learned and apply it to school, a goal Sanchez yearns.

“I feel like this was a positive camp that allowed children to work in an environment they felt was fun but also gained the skills of cooperating with others, showing respect and learning about bullying,” said Sanchez. “I look forward to him continuing using the skills he learned here and help him be successful in the next grade level.”

“All of us have our own things that make us different, but we shouldn’t treat anyone differently,” said Bogan.

The summer camp was held June 18 through 22.

Author:  Marcy Sanchez  – William Beaumont Army Medical Center Public Affairs Office

WBAMC Doctor Transplants Ear “Grown” on Soldier’s Forearm

Plastic surgeons at William Beaumont Army Medical Center successfully transplanted a new ear on a Soldier who lost her left ear due to a single-vehicle accident.

The total ear reconstruction, the first of its kind in the Army, involved harvesting cartilage from the Soldier’s ribs to carve a new ear out of the cartilage, which was then placed under the skin of the forearm to allow the ear to grow.

“The whole goal is by the time she’s done with all this, it looks good, it’s sensate, and in five years if somebody doesn’t know her they won’t notice,” said Lt. Col. Owen Johnson III, chief, Plastic and Reconstructive Surgery, WBAMC. “As a young active-duty Soldier, they deserve the best reconstruction they can get.”

The revolutionary surgery has been over a year in the making for Clarksdale, Mississippi native, Pvt. Shamika Burrage, a supply clerk with 1st Battalion, 35th Armored Regiment, 2nd Brigade Combat Team, 1st Armored Division.

In 2016, while returning to Fort Bliss, Texas, after visiting family in Mississippi, a tire blowout changed Burrage’s life in an instant.

“I was coming back from leave and we were around Odessa, Texas,” said Burrage, who was travelling with her cousin. “We were driving and my front tire blew, which sent the car off road and I hit the brake. I remember looking at my cousin who was in the passenger seat, I looked back at the road as I hit the brakes. I just remember the first flip and that was it.”

The vehicle skidded for 700 feet before flipping several times and ejecting the Soldier. Burrage’s cousin, who was eight-months pregnant at the time, managed to only suffer minor injuries while Burrage herself suffered head injuries, compression fractures in the spine, road rash and the total loss of her left ear.

“I was on the ground, I just looked up and (her cousin) was right there. Then I remember people walking up to us, asking if we were okay and then I blacked out,” said Burrage, whose next memory was waking up in a hospital.

She was later told by doctors if she would not have received medical attention for 30 more minutes, she would have bled to death. After several months of rehabilitation, Burrage began to seek counseling due to emotions caused by the accident and its effects on her appearance.

“I didn’t feel comfortable with the way I looked so the provider referred me to plastic surgery,” said Burrage.

“She was 19 and healthy and had her whole life ahead of her,” said Johnson. “Why should she have to deal with having an artificial ear for the rest of her life?”

When explained her options for reconstruction, Burrage was shocked and initially resistant to go through with the total ear reconstruction.

“I didn’t want to do (the reconstruction) but gave it some thought and came to the conclusion that it could be a good thing. I was going to go with the prosthetic, to avoid more scarring but I wanted a real ear,” said Burrage, who is now 21. “I was just scared at first but wanted to see what he could do.”

In order to avoid any more visible scarring, Johnson selected prelaminated forearm free flap, which involved placing the autologous cartilage into the patient’s forearm to allow for neovascularization, or the formation of new blood vessels. This technique will allow Burrage to have feeling in her ear once the rehabilitation process is complete.

“(The ear) will have fresh arteries fresh veins and even a fresh nerve so she’ll be able to feel it,” said Johnson.

In addition to the transplant, epidermis from the forearm, while attached to the ear, will cover up scar tissue in the area immediately around Burrage’s left jawline.

“I didn’t lose any hearing and (Johnson) opened the canal back up,” said Burrage, whose left ear canal had closed up due to the severity of the trauma.
“The whole field of plastic surgery has its roots in battlefield trauma,” said Johnson. “Every major advance in plastic surgery has happened with war. This was trauma related.”

With only two more surgeries left, Burrage states she is feeling more optimistic and excited to finish the reconstruction.

“It’s been a long process for everything, but I’m back,” said Burrage.

Author: Marcy Sanchez – WBAMC/US Army

New Simulator Preps WBAMC Staff for OB Emergencies

A new simulation system at William Beaumont Army Medical Center’s Labor & Delivery Department aims to improve patient care and safety through advanced training simulations.

The state-of-the-art simulator provides WBAMC staff up to various cutting-edge training scenarios which are documented and transmitted to allow for instant feedback on the exercise, increase communication during emergencies, and improve interdisciplinary and clinical performance.

“We have been doing monthly simulation training for years. However, the (new simulation system) is a more advance simulator that will provide feedback to the team regarding their performance” said Maj. Laquincyia Key, clinical nurse specialist, Maternal-Child Health Services (MCHS), WBAMC. ”

The new simulator follows standardized guidelines from the American College of Obstetricians & Gynecologists, which not only provides health care staff with instant feedback from the exercise according to their performance, but also collects and transmits the data to the Defense Health Agency to advance and standardize training platforms. According to Key, the new simulator also meets required DHS’s biennial training mandates.

“The (previous simulation system) needed updating and wasn’t able to collect training data and track clinical outcomes,” said Key. “The (new simulation system) has pre-programmed scenarios with Internet curricula available.

Because most patients at WBAMC’s L&D are low risk, the simulator helps train and prepare staff for emergency cases. Scenarios such as postpartum hemorrhage, umbilical cord prolapse, shoulder dystocia, eclampsia, breech vaginal delivery and operative vaginal delivery are feasible with the simulator to provide staff opportunities to improve obstetric emergency skills.

“Communication and organizational culture are the root causes of most cases of perinatal death and injury,” said Key. “Simulation-based training allows the team to practice high-risk, low-volume obstetric emergencies in preparation for when these events actually occur. They are able to identify areas of improvement and evaluate their team’s performance with non-judgmental debriefing.”

Scenarios also supports WBAMC Simulation Center’s continuing mission to produce measureable outcomes from scenario-based training.

Added features include a medical manikin capable of birthing an infant manikin which allows staff to conduct neonatal resuscitation training. Over 100 newborns are delivered each month at WBAMC.

Author: Marcy Sanchez – U.S. Army/WBAMC

Revamped Curricula at WBAMC’s Sim Center Aims to Increase Safety, Readiness

William Beaumont Army Medical Center’s Simulation Center kicked off the first of a series of revamped medical programs for medical students, staff, nurses and physicians at the hospital as part of the recently provisionally accredited center’s goal to achieve outcomes in medical simulation processes implemented at the center.

The center introduced a newly-revised curriculum for suturing and wound closures to students of the hospital’s Interservice Physician Assistant Program (IPAP), one of six Graduate Medical Education programs at WBAMC, during a scenario-based training, March 9.

“A credentialing body wants to see what the credentialing is for. So the more complete the course we can show them is, the better,” said Thomas Soto, simulation technician, WBAMC. “They don’t want to come in and credential random training.”

The step toward standardizing processes in the new curriculum will evaluate students based off scenario-based training, with students required to accomplish objectives during evaluation.

“(Faculty and students) have been (engaged in didactics) but they weren’t covering (scenarios) in detail and putting it into application,” said Joe Lloyd, interim nurse educator, Simulation Center. “Basically this is our (new) policy and we present scenarios and (situations to medical staff and students) where they have to act on the situation.”

The Simulation Center recently presented scenario-based training during an Emergencies in Clinical Obstetrics course aimed at providing OB-GYN staff training on situations from shoulder dystocia, hemorrhage to breech deliveries.

According to Soto, this type of training will not only prepare healthcare professionals for different patient situations but also increase patient safety.

“Whatever (students) end up doing (at the simulation center), when they actually go see the patient they’ll be more prepared for it because they’ve came in here and have done the repetitions,” said Soto.

Aside from increasing patient safety and staff readiness, the center’s upgraded curricula will also minimize the need for training outside of WBAMC. The center expects to recapture training currently performed at other health centers in the region, due to the increased trauma cases at the community hospitals.

“(Medical education programs at the hospital) have to get so many students to perform certain medical procedures, and there isn’t enough patients (requiring those procedures), so they have to do simulation,” said Lloyd. “We have all these different (medical education) programs that want to practice so to give exposure to everyone we have to simulate the environment.”

Future revamped training curriculum is anticipated to continue engaging staff and students throughout all of the medical education programs at the hospital. The center also hopes to incorporate role players in future simulations to educate and evaluate patient engagement and communications.

“(Students) will have to talk to a patient, do their assessment as part of their procedure, and perform that wound closure on a (mock) patient and a simulation model,” said Soto, discussing the IPAP suture/ wound closure scenario in particular. “(The scenario-based training) will improve patient care and make our simulation center premier.”

Author: Marcy Sanchez – WBAMC

WBAMC’s Sim Center Receives Prestigious Recognition

William Beaumont Army Medical Center’s Central Simulation Committee Medical Simulation Center recently gained provisional accreditation from the Society for Simulation in Healthcare, an international organization promoting improvements in simulation technology, educational methods, and patient safety.

The Simulation Center at WBAMC supports Continuing Medical Education and Graduate Medical Education (CME/GME) to increase patient safety and practitioner competence. The center provides healthcare professionals with lifelike scenarios aimed at developing and shaping teamwork, communications and critical thinking skills to enhance outcomes.

“(Full accreditation means) we’ll have an opportunity to bring different funding and programs into the organization and have broader opportunities,” said Lt. Col. Olga Betancourt, deputy chief, Education Division, WBAMC. “In turn, these increased opportunities will affect patient care because residents will be able to practice more and conduct different research improving Army Medicine.”

Although the simulation program at WBAMC is vastly focused on supporting the GME mission at WBAMC, CME is also profiting from the Sim Center’s various programs designed to educate and refine nursing skills and training requirements, as well as honing the skills of Soldiers preparing for deployment. After documenting outcomes for two continuous years, the center will be eligible to reapply for full accreditation from the organization.

Col. Erik Rude, commander, William Beaumont Army Medical Center, and Command Sgt. Maj. Janelle Ray, command sergeant major, WBAMC, are presented a plaque representing WBAMC’s Central Simulation Committee Medical Simulation Center’s recent provisional accreditation from the Society for Simulation in Healthcare, an international medical simulation accrediting organization, at WBAMC, Jan. 26. (Photo Credit: Marcy Sanchez)

In preparing for the accreditation, staff members developed curriculum to evaluate detailed processes for each scenario presented to GME residents.

“Everything we do here is to assist in (GME residents’) training development and to provide medical simulation for their respective programs,” said Thomas Soto, Simulationist, WBAMC. “So when residents actually conduct a procedure for the first time, it isn’t on a patient. It’s training hands on with high-fidelity Manikins.”

According to Betancourt, a native of Philadelphia, one of the first steps toward accreditation was formulating a multidisciplinary strategic plan to welcome creativity and collaboration thus developing the center’s programs to benefit training.

“It’s not just about doing the training but providing the curriculum that backs that training up such as what are the objectives, who’s the target audience, and developing scenarios for different training events,” said Soto, the simulation center’s only dedicated simulationist. “Simulation isn’t just providing a simulation the technician wants to show. This is targeted to residents and providers that are going to (or already) working on real patients and going out in to the community and performing these skills. It’s very specific and really detailed.”

Simulation programs at the center range from endoscopic surgery to neonatal care, benefiting all new healthcare professionals training at WBAMC from general surgery residents to the Army’s junior enlisted medics.

“There’s a lot of programs that are currently using the simulation program,” said Betancourt, who also supervises operations in the simulation center. “One of the rooms we created within the sim center is a patient room, a lot of the students will actually come into the room and actually work with a (simulated) patient in the room.”

Future plans include expanding the center’s capabilities to include laparoscopic surgery, spinal fusions, and robot-assisted surgery simulations.

In addition to current capabilities, the center is also an approved Fundamentals of Endoscopic Surgery site, meaning residents may be evaluated on their fundamental knowledge, clinical judgement and technical skills at the center required in endoscopy, a requirement for most surgery residents in WBAMC’s GME programs.

“We have the equipment and the site for designation which they need before graduating,” said Soto, a native of Aransas Pass, Texas. “We’re saving the Army money, getting residents trained and what they need to be credentialed.”

Future developments with full accreditation will also provide the necessary training physicians may require, eliminating the need to travel to other medical centers or hospitals to conduct training.

Simulation center staff credits WBAMC’s chief of education, Col. Susana Argueta, with initiating the accrediting process and collaborating with WBAMC leaders to develop program curriculums. Full accreditation across all Army Medicine simulation centers is also a goal to improve overall Army readiness.

Author: Marcy Sanchez – WBAMC /US Army

William Beaumont AMC welcomes new Command Sergeant Major

William Beaumont Army Medical Center held an assumption of responsibility ceremony during which Command Sgt. Maj. Janell Ray assumed responsibility as WBAMC’s command sergeant major.

Ray, a native of Fort Hood, Texas, previously served as command sergeant major of U.S. Army Medical Department Activity (MEDDAC) and Ireland Army Health Clinic at Fort Knox, Kentucky.

“Welcome to a great command sergeant major,” said Col. Erik Rude, commander, WBAMC. “As soon as the (command sergeant major list) came out, my phone blew up. Not enough people could call me to tell me about how great (Ray) is.”

A unit’s command sergeant major is the top enlisted advisor to the commander and an advocate for enlisted Soldiers.

During the ceremony Rude performed the traditional passing of the unit colors to Ray, a symbolism of assumption of responsibility and authority of the incoming command sergeant major.

“I’m truly humbled and honored to serve as the command sergeant major for the Soldiers, civilians and families of WBAMC,” said Ray. “Over the past 25 years I’ve been fortunate enough to serve with some great outstanding leaders and soldiers. I’m forever grateful and appreciative for their mentorship and guidance because it’s them who prepared me to take on the responsibility of what I perceive as the most challenging but rewarding job in my entire career at this point.”

According to Rude, while Ray’s peers discussed her strengths and knowledge with medical operations, both in and out of Military Treatment Facilities, their biggest emphasis was her love and caring for Soldiers.

“The success of this organization lies with each and every one of you doing your part as a member of an outstanding winning team,” said Ray. “Continue striving to be better tomorrow than you are today, so we can take our organization to the next level.”

Since July, 18 2017, WBAMC’s top enlisted position was filled by interim Command Sgt. Maj. Michael Fetzer, previously serving as command sergeant major, Troop Command, WBAMC.

“(Fetzer is) outstanding,” said Ray. “I’ve always appreciated his candid leadership and guidance. Because of his leadership, WBAMC is better today.”

WBAMC is dedicated to increasing Army Readiness through patient-friendly access to high-quality healthcare.

“We’ll continue to guide this extraordinary organization into the future of Army Medicine,” said Ray.

The ceremony was held at the Fort Bliss and Old Ironsides Museum, on Fort Bliss, December 19, 2017.

Author & Photographer: Marcy Sanchez – WBAMC/US Army

Commission on Cancer Highlights WBAMC Cancer Guidelines, Treatment

In 2016, Sherita Kelly, despite being in the best shape of her life, was diagnosed with stage three breast cancer, an advanced stage of breast cancer extending beyond the immediate tumor region but not yet invading other organs.

After her 40th birthday, Kelly, a military spouse and native of Columbus, Georgia, was recommended and requested a mammogram through her Primary Care Manager (PCM) even though she regularly performed self-exams and never detected abnormalities. The American Cancer Society recommends annual mammograms for women ages 40-44.

Once her mammogram was completed and she was informed of the diagnosis, Kelly didn’t know what to do next.

“I had multiple tumors but I never felt them,” said Kelly. “I didn’t know where to go or who to see.”

William Beaumont Army Medical Center has operated a cancer program fully approved by the American College of Surgeons, Commission on Cancer since 1954. Recent reports from the Commission on Cancer highlight WBAMC’s adherence to standardized guidelines on cancer screening and treatments.

“We can treat most cancer patients, except those requiring inpatient chemotherapy which we can’t (logistically) support,” said Dr. Warren Alexander, staff physician, Hematology/ Oncology Clinic. “As part of the Commission on Cancer, we do make a concerted effort to participate in screenings, not just for malignancies but for other (issues) to make the quality of life of our patients a little bit better.”

Over the past few years, WBAMC’s cancer treatment has been above the national average for administration and reporting radiation and chemotherapy after diagnosis, according to the Commission on Cancer, a program dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research and education.

“We have evidenced-based information that proves we are consistently above other Commission on Cancer sites when you pull all the data,” said Alexander, a San Francisco native. “Quarterly reports look at data and administration of radiation (therapy) after breast cancer therapy as well as mastectomy, we’re almost across the board 100 percent.”

According to Alexander, other measures also includes recommended treatments following the Commission on Cancer’s standardized guidelines, of which WBAMC is reported at 100 percent compliance.

“Even as guidelines change, we adapt,” said Alexander, who was recently recognized as one of the top specialty-care doctors in the Army. “(WBAMC) is above the national average in surgical outcomes. When you adhere to the guidelines you have a tendency to have good outcomes.”

Because of WBAMC’s proactive approach to recommended screenings, which incorporates everyone in a patient’s line of care, Kelly’s persistent PCM’s recommendations for a mammogram led to detecting Kelly’s cancer before it metastasized to stage four breast cancer, considered to be incurable.

“I was diagnosed in July, had a right mastectomy in September and started chemotherapy on Oct. 6,” said Kelly. “From the very first time I walked into the office, the physician explained everything. (Treatment) was difficult but the staff here made it easier, compared to how it could have been.”

After 28 treatments of radiation therapy, Kelly’s cancer went into remission.

Because of her experience during her battle, Kelly, already a registered nurse specializing in emergency medicine, is hoping to pursuit an education to also specialize in oncology. With the assistance of outside organizations, Kelly began initiated and began volunteering in the hospital’s Survivorship Group, a group aimed at comforting and educating other patients diagnosed with cancers.

“Once you’re diagnosed, your life completely changes. It’s always in the back of your head, how do I live without constantly thinking about whether it’s going to come back again,” said Kelly.

In addition to a full-team approach, WBAMC’s access to care and the military’s comprehensive health care which covers retirees and family members, also played a vital role in Kelly’s treatments.

“Having a team effort is important to be able to push patients from one clinic to another to include primary care,” said Alexander. “If you need a colonoscopy, mammogram… you can get one versus in the private sector where there may be a cost that may prohibit you from doing so. (WBAMC screenings) are free, (patients) just have to get it.”

Through adherence to guidelines and proactive screenings, WBAMC’s cancer program continuously contributes to Army readiness through patient-friendly access to high-quality healthcare.

Author: Marcy Sanchez – WBAMC

WBAMC Doctors Perform First TAVR in El Paso

Earlier this year, William Beaumont Army Medical Center doctors performed the first Transcatheter Aortic-Valve Replacement (TAVR) in El Paso at WBAMC.

The procedure is a minimally-invasive alternative to open-heart surgery for patients with severe Aortic Stenosis (AS), a condition involving the narrowing of the heart’s aortic valve which minimizes or blocks blood delivered to the aorta resulting in limited blood flow throughout the body.

The TAVR procedure is revolutionary not only as an alternative to traditional means of treating AS but also as a solution for patients who may not have had an option two years ago.

“It (is) a feasible way to save patients who are not good candidates for surgery,” said Maj. Ryan McDonough, interventional cardiologist and chief of cardiology, WBAMC. “There are patients who are not good surgical candidates but are excellent candidates for a percutaneous approach due to comorbidities, illnesses and previous surgeries.”

Because blood flow is limited in patients with AS, it makes the heart work harder to pump blood through the body, resulting in symptoms such as chest pain, fatigue and difficulty breathing.

Similar to a stent placed in an artery, patients are implanted with self-expanding valves via a catheter usually entering the body through the femoral artery in the groin. The minimally-invasive procedure results in reduced operating and recovery time when compared to traditional open-heart surgery procedures which usually demand for a sternotomy (opening of the sternum) to treat AS.

According to McDonough, as new as the procedure is to medicine, there are two Food and Drug Administration-approved devices available to patients for the procedure: self-expanding and balloon-expanded valves. While both have similar functions, the WBAMC patients were implanted with the self-expanding to minimize risks.

“The valve is stented on a self-expanding metal that reacts to heat. When exposed to heat it expands to a predesigned form and the catheter slowly comes off the valve and expands,” said McDonough, a native of Port Jefferson, New York. “You don’t have to balloon expand or pace (regulate the heartbeat by means of an artificial pacemaker), (the valve) is recapturable and repositionable. The valve deploys to 80 percent first, allowing us to assess whether it’s position and functionality is correct before fully deploying.”

The self-expanding valve also conforms and seals to non-circular aortic valve annulus (passages) and may be safer to use than other TAVR devices due to decreased potential to rupture tissue, decreasing mortality risk.

For 75-year-old Daniel Mooneyhan, the second patient to be implanted with the valve in El Paso, the valve provided relief after suffering with AS for two years.

“I was walking one day and I had to stop and hold on to a tree at a park. I was having a lot of heaviness, a little chest pain here and there,” said Mooneyhan, a 75-year-old retired Army first sergeant.

After a series of tests and exams, Mooneyhan was informed that his aortic valve was failing. Due to previous ailments along with reluctance to open-heart surgery, Mooneyhan didn’t prove to be a good surgical candidate for a bioprosthetic valve, which must be sewn into place during open-heart surgery, occasionally taking hours to complete.

“I didn’t want to be cut open. If I had to be cut open just forget it,” said Mooneyhan.

While this was a first at WBAMC, it wasn’t new to Mooneyhan, who had been researching treatment options for his condition.

“I watched hundreds of videos (regarding the procedure) and talked to the specialists,” said Mooneyhan. “They (perform the procedure) in Tucson, Albuquerque, Lubbock, Dallas, Indianapolis, San Antonio, so why can’t we do this here in El Paso?”

After McDonough spent three years supporting and training for the use of the TAVR device, the device was approved for treatment at WBAMC.

“It’s awesome,” said McDonough, who along with an interdisciplinary team of surgical professionals performed both treatments. “I felt very comfortable with our team doing this procedure and it’s very much a collaborated team approach. It’s not the technical part of deploying the valve, it’s the process.”

On Nov. 15, Mooneyhan received a call to be admitted for treatment at WBAMC the following day. Less than a week later, Mooneyhan was back home, feeling relieved.

“I’m sleeping better, I’m getting a full breath, I’m feeling good and have no scars or anything,” said Mooneyhan, just 10 days past the TAVR procedure. “There’s people here in this city, in this county who probably need this procedure, I think this is the future.”

“Once the valve is in and it’s functional, their heart is fixed,” said McDonough. “The only reason we keep the patient is to make sure they don’t develop conduction abnormalities (electrical impulses which cause the heart to beat), a potential need for a pacemaker and to monitor the access site.”

While WBAMC has already scheduled another pair of TAVR procedures, the success and benefit of the treatment made an emotional impact on Mooneyhan.

“There’s people out there who need this, who are dying,” said Mooneyhan. “To those guys that are retired and any veteran who needs this, they need to come (to WBAMC). These doctors are awesome, they’re good doctors.”

Author –  Marcy Sanchez – WBAMC / U.S. Army

William Beaumont AMC Midwives Expand Women’s Options

From adolescence to beyond menopause, midwives offer a broad scope of practice tailored to women’s preference of care. To celebrate their holistic approach and contributions to the medical community, midwives are being recognized October 1 – 7 as part of National Midwifery Week.

At William Beaumont Army Medical Center, a team of Certified Nurse-Midwives (CNMs) provide around-the-clock care, the only medical center in El Paso to do so, ranging from well-woman exams to postpartum care.

“I love being a nurse and being a midwife,” said Maj. Noelle Dove, nurse midwife, Department of Women’s Health Services, WBAMC. “(Being a midwife) is about being able to offer more to the patient and increasing the opportunities that (CNMs) can be involved in.”

According to the American College of Nurse-Midwives (ACNM), in 2014, 8.3 percent of all U.S. births were delivered by CNMs. Furthermore, statistics show a steady rise in CNM-attended births in the U.S. since 1989.

The growth in opting for CNM-attended births may be attributed to CNMs’ commitment to evidence-based practices which continuously introduces options for women not just during labor but also within their primary care practice.

Valerie Miller (left), nurse midwife, Department of Women’s Health Services, William Beaumont Army Medical Center, conducts a group prenatal care session with parents of newborns to discuss concerns, expectations and answer any questions the couples may have regarding their birthing experience at WBAMC | Photo by Marcy Sanchez

“Women’s bodies are pretty amazing,” said Capt. Merry Fontenot, nurse midwife, WBAMC. “As midwives, which means ‘with women,’ we also provide our patients the tools to make decisions. We don’t make the decision for them on a regular basis; we empower them to make the best decision for themselves.”

While some patients may not be familiar with the profession, CNMs and Obstetrician-Gynecologists do have a shared goal of promoting safe women’s health through evidence-based models. Such evidence-based models are a staple at WBAMC’s Labor & Delivery Unit where CNMs have introduced a variety of modalities to broaden women’s options during labor such as hydrotherapy, wireless monitoring and are currently looking into other alternative pain management techniques such as Nitrous Oxide, better known as laughing gas.

“Labor can be a long process and sometimes women need all sorts of options to get them through it,” said Dove, a native of Woodbridge, Virginia. “We’re going to let women go on and have their babies in the way that their bodies and babies are dictating and sometimes that could take a couple of days. So offering (nitrous oxide) can get them through the pain of labor in the early and late stages and starts working in a few minutes and can stop working in a few minutes.”

In addition to providing clinical diagnosis during low-risk interventions, midwives also emphasize prenatal education and pain-mitigating techniques for moms during pregnancy, labor and birth.

“The actual practice of midwifery extends back to the beginning of time,” said Valerie Miller, nurse midwife, WBAMC. “It’s a practice that has an amazing culture of promoting women having their babies in a safe way and a way they want to do it.”

Nurse midwives’ roles also expand beyond the exam rooms to WBAMC’s group prenatal care sessions where they provide expecting and

Valerie Miller (lower right), nurse midwife, Department of Women’s Health Services, William Beaumont Army Medical Center, conducts a group prenatal care session with parents of newborns to discuss concerns, expectations and answer any questions the couples may have regarding their birthing experience at WBAMC
| Photo Credit: Marcy Sanchez

new moms a group setting to discuss concerns, pain management, expectations, birthing plans and a health check-up during two-hour-long sessions.

“We do a lot of education and provide good quality care to our patients while letting them own their own experience,” said Fontenot. “It’s really their choice how they want their care. If they do or don’t want a medicated labor, we’re there with them. We’ll be there while they’re breathing and laboring through the pain if that’s the experience they want. It’s their choice and we’re there to support them and allow them to make the best decision for themselves, it’s their time.”

WBAMC’s group prenatal care sessions are where first-time mom, Susan Molina, was introduced to the profession.

“This is my first experience with a midwife and I didn’t expect it to be so awesome,” said Molina, a military spouse whose daughter, Veronica, was delivered at WBAMC on Sept. 19. “The experience was definitely more personal and felt like a closer connection.”

According to Molina, a 28-year-old native of Westchester, New York, the midwife care she experienced made her pregnancy and labor easier. So much so, during labor Molina was nervous and anxious but felt relieved once Miller, the midwife on duty, came into the room before delivering her baby.

While WBAMC midwives focus on OB care, they are capable of providing well-women exams, gynecologic, family planning and menopausal care.

“Patients have a choice,” said Fontenot. “Our end goal is healthy mom, healthy baby.”

Author: Marcy Sanchez – WBAMC

William Beaumont Army Medical Center’s CNSs Recognized, Defined

In the United States there are approximately 72,000 Clinical Nurse Specialists (CNS) and approximately 2.7 million nurses. That’s one CNS to every 37.5 nurses.

What is a CNS you may ask?

Clinical Nurse Specialists are Advanced Practice Registered Nurses (APRNs) who not only provide patient care but specialize in mentoring, educating and progressing clinical practices in specific patient populations. Sept. 1 – 7 marks the annual National CNS Recognition Week.

“They’re not the same as other (APRNs),” said Col. Gayla Wilson, chief nursing officer, William Beaumont Army Medical Center. “They focus on their clinical areas. They’re spectacular in what they do. One of the key roles, as educators, is bringing the latest and greatest evidence-based practices to the fight.”

Clinical Nurse Specialists are one of four APRNs which include nurse anesthetists, nurse midwives and nurse practitioners. While CNSs in a civilian capacity are capable of diagnosing and prescribing medication, Army CNSs focus on progressing Army Medicine as a whole and employing best-practice in their respective specialties.

“I think the biggest difference (for Army CNSs) is shifting focus from single patient care to advancing the care of all patients,” said Lt. Col. Patrick Marlow, CNS, Emergency Department, WBAMC. “While others work full time with patient care, (being a CNS) gives us the education and time to implement programs and efforts (to advance their clinical areas).”

Recently, Marlow, a Milwaukee native, was instrumental in implementing an Emergency Department program which decreased wait times for beneficiaries while increasing primary care engagement with active-duty service members. Although CNSs do take an active role in patient care, their greatest impact is improving overall proficiency and efficiency of their units.

“(CNSs) create strong foundations for the staff,” said Wilson. “I don’t have to depend on the (officer in charge of a unit) to carve time out of their day to make sure all of their staff understand the latest practices.”

“We are considered expert clinicians at the bedside but one of our more significant roles is to help guide and mentor newer nurses,” said Maj. Maria Pescatore, CNS and officer in charge, Medical-Surgical Unit, WBAMC. “CNSs help improve new nurses’ skills and critical thinking while increasing their capabilities and development, breaking them out of a novice role to an advanced one.”

While CNSs continuously research for best practices in their fields, their expertise goes beyond clinical practices as they play a role in improving safety measures in their units as well. Wilson also points out this year’s CNS Week theme “Leading Changes to Healthier Living,” is embodied by WBAMC CNSs in their vigilant staff education including raising awareness of proper patient lifting techniques, increasing communication among staff and building resilience.

“My favorite part (about being a CNS) is being with the new nurses and mentoring and guiding them through their nursing practice,” said Pescatore, a native of Binghamton, New York. “The best part is to watch them grow; it reinvigorates why we do what we do.”

One unique challenge WBAMC CNSs face is preparing to transition to the Fort Bliss Replacement Hospital, which is slated to open in 2019, by providing input regarding development of clinical areas to maximize best practices by healthcare professionals. Additionally, Wilson states CNSs are active in mitigating costs by researching and endorsing more efficient equipment and supplies.

“(CNSs) improve efficiency, competency and throughput capabilities by going with the best product and educating staff on utilization of the best product,” said Wilson. “(CNSs) are definitely moving us in the right direction and moving us as a team.”

There are currently six CNS roles at WBAMC covering the hospital’s Critical Care Unit, Medical and Surgical Units, Perioperative Nursing Services, Maternal Child Health Services and Emergency Services. As WBAMC transitions from Level III Trauma Center designation to Level II, their roles are crucial as subject-matter experts to train and educate nursing staff on efficient practices to prepare for more comprehensive or definitive care.

Because of the continuous advancements CNSs provide to clinical practices, their actions sometimes require an interdisciplinary approach to formulate changes which improves overall patient care at WBAMC.

Over the course of this year’s CNS week WBAMC CNSs educated beneficiaries and fellow staff members as to how the role they have in the hospital impacts patient care and readiness for service members.

Author: Marcy Sanchez – WBAMC