WEBVTT 00:00.390 --> 00:03.250 Thank you very much a Steve Alan Dr and 00:03.250 --> 00:05.361 all of you . And let me just start by 00:05.361 --> 00:08.410 saying thank you for the last three 00:08.410 --> 00:10.760 years . Let's find the clock back a 00:10.760 --> 00:12.760 little bit and just reflect on what 00:12.760 --> 00:14.316 we've done . So the largest 00:14.316 --> 00:17.750 noncombatant evacuation operation since 00:17.750 --> 00:20.960 the Second World War 120,000 people 00:20.970 --> 00:24.370 moved safely with great medical care 00:24.380 --> 00:27.290 under duress out of Afghanistan . 00:28.460 --> 00:30.238 That was an inter agency and an 00:30.240 --> 00:32.130 international effort which was a 00:32.140 --> 00:34.930 tremendous success . The worst pandemic 00:34.930 --> 00:38.600 in 100 years . And as you heard this 00:38.600 --> 00:41.480 morning the military health system 00:41.480 --> 00:44.410 became the pinch hitter that stepped in 00:44.470 --> 00:46.810 to help our civilian partners as we 00:46.810 --> 00:48.977 collectively struggled to work through 00:48.977 --> 00:51.480 that pandemic . And we helped with 00:51.480 --> 00:54.040 operation warp speed . One of the real 00:54.050 --> 00:57.140 successes of the entire health care 00:57.140 --> 00:59.390 system was how we work together between 00:59.390 --> 01:01.650 the Department of Defense , health and 01:01.650 --> 01:05.010 human services and many others To bring 01:05.010 --> 01:06.954 safe and effective vaccines to the 01:06.954 --> 01:09.150 American public in 10 months . 01:09.160 --> 01:11.370 Something that previously had taken 01:11.380 --> 01:13.790 years to do leveraging technology that 01:13.790 --> 01:15.846 in some cases have been developed by 01:15.846 --> 01:17.957 the Department of Defense and DARPA , 01:17.957 --> 01:20.590 tremendous accomplishment . And during 01:20.590 --> 01:22.930 that same period we're now supporting 01:22.930 --> 01:25.050 our Ukrainian colleagues as they deal 01:25.050 --> 01:27.360 with the unprovoked and precedent 01:27.360 --> 01:29.660 setting attack by the Russians . That 01:29.660 --> 01:31.910 is trying to change the world order . 01:32.640 --> 01:34.930 It has been a hell of a three years . 01:34.940 --> 01:38.350 Thank you to everyone in the room who 01:38.360 --> 01:41.860 has helped us to be as successful as 01:41.870 --> 01:44.580 we've been during those three years and 01:44.580 --> 01:46.747 I hope you should go out to your teams 01:46.747 --> 01:48.969 and we deal with all of the things that 01:48.969 --> 01:51.136 we've talked about for the last couple 01:51.136 --> 01:50.260 of hours here in the workforce 01:50.260 --> 01:52.371 challenges and the I . T . Challenges 01:52.371 --> 01:54.740 and everything else that we don't 01:54.750 --> 01:58.050 forget to stop and say thank you to the 01:58.060 --> 02:00.580 people who have actually done the 02:00.590 --> 02:03.840 extraordinary over and over and over 02:03.840 --> 02:06.620 again and made it look simple because 02:06.620 --> 02:08.787 that's what we do in military medicine 02:08.787 --> 02:10.842 with our partners across the force . 02:11.160 --> 02:13.327 Now as a speaker , I'm obliged to tell 02:13.327 --> 02:15.510 you if I have any conflict of interest 02:15.520 --> 02:18.010 and I will tell you for this talk . I 02:18.010 --> 02:21.090 do have a conflict of interest . So I'm 02:21.090 --> 02:23.312 the joint staff surgeon . That's not my 02:23.312 --> 02:25.423 conflict . My conflict is that my dad 02:25.423 --> 02:28.030 who just turned 96 is in was in the 02:28.030 --> 02:30.960 Navy at the end of World War II . He 02:30.970 --> 02:33.192 keeps hoping that I will make something 02:33.192 --> 02:36.820 of myself and join the Navy . And 02:36.830 --> 02:39.160 uh considering 02:40.690 --> 02:42.912 not yet , but he's continued to give me 02:42.912 --> 02:45.580 feedback about my poor choices in life . 02:46.250 --> 02:49.620 Um my mom was a freedom fighter born in 02:49.620 --> 02:51.620 a country called Hungary in Eastern 02:51.620 --> 02:54.360 Europe . Her parents were killed by the 02:54.370 --> 02:56.592 Russians at the end of the Second World 02:56.592 --> 02:59.020 War . She fought in the 56 revolution 02:59.020 --> 03:01.242 was imprisoned and eventually escaped , 03:01.250 --> 03:03.770 came to this country and married my dad . 03:03.780 --> 03:06.600 Uh she was a big believer that freedom 03:06.600 --> 03:09.930 is not free and that a bad day is not 03:09.940 --> 03:12.162 when you're working hard at work . It's 03:12.162 --> 03:15.540 when your family disappears . And 03:15.540 --> 03:17.707 sometimes we forget what that real bad 03:17.707 --> 03:20.160 day looks like and that's a conflict of 03:20.160 --> 03:22.216 interest . Fruity and that's the art 03:22.216 --> 03:24.810 state that I grew up with . I'm blessed 03:24.820 --> 03:27.500 to have met my wife when she was an 03:27.510 --> 03:29.566 army physician . Rita was working at 03:29.566 --> 03:31.621 Brooke Army medical center and I was 03:31.621 --> 03:34.020 doing my rotation there . First time I 03:34.020 --> 03:36.131 met her , I fell in love . She has no 03:36.131 --> 03:37.798 recollection of our meeting . 03:40.940 --> 03:43.710 Uh , but throughout our marriage , 27 03:43.710 --> 03:46.360 years now , she has ensured that I 03:46.360 --> 03:48.193 sleep on the sofa whenever I say 03:48.193 --> 03:50.360 anything that's not positive about the 03:50.360 --> 03:52.471 army . So I've got my dad on the navy 03:52.471 --> 03:54.693 side , my wife on the army side and now 03:54.693 --> 03:56.916 her younger son is in his third year at 03:56.916 --> 03:58.971 the Naval Academy and he wants to go 03:58.971 --> 03:58.420 marine option . 04:01.940 --> 04:05.020 I may have spent 37 years in the air 04:05.020 --> 04:07.320 force , but I've spent 37 years being 04:07.320 --> 04:09.970 told I made a poor choice and that 04:09.980 --> 04:13.800 really it's a joint fight And that's 04:13.800 --> 04:15.911 what I'm going to touch on throughout 04:15.911 --> 04:18.280 this entire next 25 minutes or so it 04:18.280 --> 04:20.830 will spend together if you look at 04:20.840 --> 04:22.840 every one of our organizations , we 04:22.840 --> 04:24.618 have exceptional people who are 04:24.618 --> 04:27.650 incredibly dedicated who chose early in 04:27.650 --> 04:30.390 their careers to help those in uniform 04:30.400 --> 04:32.400 to help those who raise their right 04:32.400 --> 04:34.122 hand to support and defend the 04:34.122 --> 04:36.289 constitution of the United States . We 04:36.289 --> 04:38.780 have the privilege and the pleasure of 04:38.790 --> 04:41.060 taking care of them as hard as that may 04:41.060 --> 04:44.640 be And it's getting harder . So we've 04:44.640 --> 04:46.751 talked about a tremendous amount this 04:46.751 --> 04:49.300 morning already all the challenges that 04:49.310 --> 04:51.421 the US health care system is facing . 04:51.421 --> 04:53.830 And I'll tell you I was at a uh event 04:53.840 --> 04:57.590 overseas about six months ago 35 of the 04:57.600 --> 04:59.711 ceo of the largest healthcare systems 04:59.711 --> 05:01.910 in the world . Nothing that we talked 05:01.910 --> 05:03.910 about this morning is unique to the 05:03.910 --> 05:06.021 United States . You're seeing exactly 05:06.021 --> 05:08.132 the same problems in europe and South 05:08.132 --> 05:10.400 Africa South America and in ASIA 05:10.410 --> 05:13.630 workforce challenges rapid pace of 05:13.640 --> 05:16.210 biological threats . You can go down 05:16.210 --> 05:19.430 the list I . T . Challenges . This is a 05:19.440 --> 05:21.607 global problem that we're facing right 05:21.607 --> 05:24.200 now and as General Crosson said we are 05:24.200 --> 05:26.256 not going to solve it . Doing things 05:26.256 --> 05:28.311 the way we've done in the past . But 05:28.311 --> 05:30.256 wait as the bronco commercial says 05:30.256 --> 05:33.320 there's more because we have countries 05:33.320 --> 05:36.290 now that are actively committed to 05:36.300 --> 05:39.090 trying to change the world order . So 05:39.090 --> 05:41.090 this is where I'm gonna spend a few 05:41.090 --> 05:43.257 minutes talking about the character of 05:43.257 --> 05:45.510 war . You know most of us in uniform 05:45.510 --> 05:47.677 and those of you who once wore a cloth 05:47.677 --> 05:49.960 understand what it is that we do in the 05:49.970 --> 05:52.026 military and how the military health 05:52.026 --> 05:54.440 system is a subset . But what we're 05:54.440 --> 05:57.860 discovering is that what we will do in 05:57.860 --> 06:01.620 the future is very different than what 06:01.630 --> 06:05.580 we have done up to this point . Some of 06:05.580 --> 06:08.380 it is self evident if there is another 06:08.380 --> 06:11.080 conflict between two great powers it 06:11.090 --> 06:14.330 will be a horrific event in which the 06:14.340 --> 06:18.210 casualties far exceed anything that 06:18.220 --> 06:20.331 we've seen since the end of World War 06:20.331 --> 06:22.590 Two . And so when we talk about a 06:22.590 --> 06:24.770 healthcare system that is able to do 06:24.780 --> 06:27.040 remarkable things on a daily basis , 06:27.050 --> 06:29.272 just as General Crosson said , it's got 06:29.272 --> 06:31.050 to be scalable , it's got to be 06:31.050 --> 06:33.161 something that can rapidly surge from 06:33.161 --> 06:36.460 steady state to a much greater capacity 06:36.670 --> 06:39.360 in order to receive those casualties . 06:39.370 --> 06:41.148 And if you look at our National 06:41.148 --> 06:43.092 Security strategy , the number one 06:43.092 --> 06:45.037 problem with the national Security 06:45.037 --> 06:47.148 describes is defending the homeland , 06:47.148 --> 06:49.092 because we now know that there are 06:49.092 --> 06:51.092 multiple countries who have weapons 06:51.092 --> 06:53.314 that are aimed at our homeland and with 06:53.314 --> 06:55.259 less kinetic threats . We face the 06:55.259 --> 06:57.990 cyber risk of folks seeking to disrupt 06:58.000 --> 07:00.700 our day to day life through attacks on 07:00.700 --> 07:03.230 a variety of aspects of our networks 07:03.230 --> 07:05.970 along the way . That's not something we 07:05.980 --> 07:08.258 really have to think about for a while . 07:08.580 --> 07:12.080 Starting in 2019 , the chairman of the 07:12.090 --> 07:14.730 Joint Chiefs said we need to think 07:14.740 --> 07:16.580 differently about what we in the 07:16.590 --> 07:19.020 military are going to do . And he 07:19.030 --> 07:21.141 directed the development of the joint 07:21.141 --> 07:23.650 warfighting concept . Now , this 07:23.650 --> 07:25.600 concept is really derived from the 07:25.610 --> 07:29.170 premise that we are a joint team , 07:29.180 --> 07:31.347 every fight that the United States has 07:31.347 --> 07:33.569 been in for 100 years . We have done it 07:33.569 --> 07:35.513 with our allies and partners , our 07:35.513 --> 07:37.736 international allies and partners first 07:37.736 --> 07:39.840 and foremost , those who have stood 07:39.840 --> 07:42.990 side by side with us in conflict . We 07:42.990 --> 07:45.046 don't see any scenario in which that 07:45.046 --> 07:47.370 won't still be the case , but there's 07:47.370 --> 07:49.480 also our industry partners and we're 07:49.480 --> 07:51.369 seeing this now in the war that's 07:51.369 --> 07:53.640 unfolding in Ukraine , our industry's 07:53.640 --> 07:55.780 ability to rapidly surge production 07:55.790 --> 07:58.220 capacity to produce what's needed when 07:58.220 --> 07:59.942 it's needed . It's going to be 07:59.942 --> 08:02.053 challenged . We fed them a little bit 08:02.053 --> 08:04.164 of money every year to keep pipelines 08:04.164 --> 08:06.164 open or in some cases not enough to 08:06.164 --> 08:08.276 keep them open . Great example is the 08:08.276 --> 08:10.331 multi channel infusion pump that has 08:10.331 --> 08:12.760 been integral to patient movement for 08:12.770 --> 08:14.960 nearly a decade . Nobody's making it , 08:17.050 --> 08:19.106 we are going to have to partner more 08:19.106 --> 08:21.360 closely with industry to figure out how 08:21.370 --> 08:23.037 to make that partnership more 08:23.037 --> 08:25.980 successful , more resilient and more 08:25.980 --> 08:28.460 scalable . So that if the next first 08:28.460 --> 08:30.910 day in american history happens , not 08:30.910 --> 08:33.021 only our international partners , but 08:33.021 --> 08:35.340 our industry partners also able to 08:35.340 --> 08:38.670 respond . And then there are inter 08:38.670 --> 08:40.892 agency partners that I talked about and 08:40.892 --> 08:43.330 you know , my comments earlier on . So 08:43.330 --> 08:45.552 if we look at an attack on the homeland 08:45.552 --> 08:47.719 and casualties from that , there is no 08:47.719 --> 08:50.060 system that demonstrated that they have 08:50.060 --> 08:52.630 the surge capacity to deal with the 08:52.640 --> 08:55.000 pandemic . There's no system that will 08:55.000 --> 08:57.222 have the capacity and we've worked with 08:57.222 --> 08:59.710 HHS and the V . A . On this analysis to 08:59.710 --> 09:01.766 deal with an attack or a large scale 09:01.766 --> 09:03.988 natural disaster in the United States . 09:03.988 --> 09:06.043 It will be a team sport that we must 09:06.043 --> 09:09.150 work on together within the Department 09:09.150 --> 09:11.310 of Defense . We had a plan for this . 09:11.310 --> 09:13.421 at one point we had worked on it very 09:13.421 --> 09:15.643 carefully with our Interagency partners 09:15.643 --> 09:18.270 and it was derived from the national 09:18.270 --> 09:21.140 disaster medical System . We're now in 09:21.140 --> 09:23.362 the process of updating that plan and I 09:23.362 --> 09:25.529 would ask those of you who are here in 09:25.529 --> 09:29.520 the audience own that plan , own your 09:29.520 --> 09:32.520 part of helping us develop the 09:32.530 --> 09:35.660 integrated capability across our nation 09:35.670 --> 09:38.610 so that no matter what the next large 09:38.610 --> 09:40.770 scale casualty of generating event 09:40.770 --> 09:44.160 since we have those commitments across 09:44.170 --> 09:47.130 the interagency cross industry partners 09:47.140 --> 09:49.710 so that we are ready for that . 09:51.490 --> 09:54.080 That interagency partnership is crucial . 09:54.210 --> 09:57.070 The V . A . Has a large number of beds 09:57.070 --> 10:00.730 which they can't staff civilian health 10:00.730 --> 10:03.063 care system is struggling with staffing . 10:03.063 --> 10:05.650 We're struggling with staffing . There 10:05.650 --> 10:08.740 is no that we found no covered full of 10:08.740 --> 10:10.962 staff that we're going to be able to go 10:10.962 --> 10:13.129 back to to solve this problem as we go 10:13.129 --> 10:15.296 forward , which means that we're going 10:15.296 --> 10:17.462 to have to collaborate more closely in 10:17.462 --> 10:20.790 order to do so in the joint warfighting 10:20.800 --> 10:23.370 concept , We also talk about something 10:23.370 --> 10:25.592 that was mentioned one of the questions 10:25.592 --> 10:27.680 this morning and that's how integral 10:27.690 --> 10:30.580 data will be to everything that we do . 10:30.590 --> 10:32.812 If you look at the practice of medicine 10:32.812 --> 10:34.923 today and I suspect Doctor Woodson is 10:34.923 --> 10:36.701 going to talk about this in his 10:36.701 --> 10:38.868 comments in just a moment . The volume 10:38.868 --> 10:41.090 of knowledge and medicine is increasing 10:41.090 --> 10:42.979 at a tremendous pace . You know , 10:42.979 --> 10:45.034 there's one study that says that the 10:45.034 --> 10:47.090 totality of medical knowledge is now 10:47.090 --> 10:49.810 doubling every two months . There is no 10:49.810 --> 10:51.866 human being in the world , no matter 10:51.866 --> 10:53.921 how well trained , how committed you 10:53.921 --> 10:55.866 are and how many journals you read 10:55.866 --> 10:55.720 every night that you keep up with that 10:55.730 --> 10:58.450 volume of growth in medical knowledge . 10:59.020 --> 11:01.131 And so there's going to be a need for 11:01.131 --> 11:03.020 us to partner more closely in the 11:03.020 --> 11:05.210 digital space , both to understand how 11:05.210 --> 11:07.321 we share that rapid growth in medical 11:07.321 --> 11:09.790 knowledge , but also how we leverage 11:09.790 --> 11:12.620 that and bring it to the far forward 11:12.620 --> 11:14.842 Medics so that they have that knowledge 11:14.842 --> 11:16.676 at their fingertips when they're 11:16.676 --> 11:18.342 operating in a cyber degraded 11:18.342 --> 11:20.750 environment and they no longer have the 11:20.760 --> 11:22.593 connectivity that reaches back , 11:22.593 --> 11:24.880 whether it's to dr google chat GPT or 11:24.880 --> 11:27.400 any other system that's out there , the 11:27.400 --> 11:29.511 technology exists to do that . And as 11:29.511 --> 11:31.567 we look at some of our international 11:31.567 --> 11:33.622 partners , Israel , for example , is 11:33.622 --> 11:35.733 doing a phenomenal job of getting far 11:35.733 --> 11:37.789 ahead and looking at how to leverage 11:37.789 --> 11:39.900 data and getting it as far forward as 11:39.900 --> 11:42.150 possible . We need to do the same . And 11:42.150 --> 11:44.261 then there are the lessons that we've 11:44.261 --> 11:46.428 learned over and over again , which we 11:46.428 --> 11:48.483 then promptly forget because they're 11:48.483 --> 11:51.200 painful and expensive the primacy of 11:51.200 --> 11:55.020 blood products every conflict , we've 11:55.020 --> 11:57.242 demonstrated time and time again , that 11:57.242 --> 12:00.060 whole blood is by far the best 12:00.070 --> 12:02.237 intervention that you can offer if you 12:02.237 --> 12:04.348 can get someone whole blood when they 12:04.348 --> 12:06.570 need it , the outcomes are tremendously 12:06.570 --> 12:09.100 better . But then after the war is over , 12:09.110 --> 12:10.888 we start having deep thoughtful 12:10.888 --> 12:13.110 discussions about how expensive that is 12:13.110 --> 12:15.277 to maintain that capability to collect 12:15.277 --> 12:17.388 and process all of that whole blood . 12:17.388 --> 12:19.499 And then we say , you know , let's do 12:19.499 --> 12:21.610 some studies on lactating Raiders and 12:21.610 --> 12:23.554 compare it to normal sailing . You 12:23.554 --> 12:25.554 don't have to do with whole blood , 12:25.554 --> 12:27.777 it's cheaper . And then we wind up at a 12:27.777 --> 12:29.666 point where we no longer have the 12:29.666 --> 12:31.832 capacity to produce the whole blood in 12:31.832 --> 12:33.721 the quantities that we need order 12:33.721 --> 12:35.832 transported to the locations where we 12:35.832 --> 12:37.443 need it . This is one of the 12:37.443 --> 12:39.610 fundamental problems that we will have 12:39.610 --> 12:41.666 to collectively work on and I'm very 12:41.666 --> 12:43.888 grateful for our international partners 12:43.888 --> 12:46.054 who are here in the room because we're 12:46.054 --> 12:48.221 approaching this as a global problem . 12:48.221 --> 12:50.443 Looking at what we can do , not just in 12:50.443 --> 12:50.230 the military , not just in the United 12:50.230 --> 12:52.280 States , but with our civilian and 12:52.280 --> 12:54.391 military partners across the NATO and 12:54.391 --> 12:56.690 five I and other alliances so that we 12:56.690 --> 12:58.900 can rebuild the capacity to search 12:58.910 --> 13:02.730 blood production going forward . So 13:02.730 --> 13:04.897 I've described a host of problems that 13:04.897 --> 13:07.230 we're struggling with right now and 13:07.240 --> 13:10.360 that may be daunting and in some ways , 13:10.370 --> 13:12.370 maybe a little dispiriting to think 13:12.370 --> 13:14.710 about that . I don't believe so 13:14.710 --> 13:16.877 actually , and I would agree with what 13:16.877 --> 13:18.543 General Crosson said that our 13:18.543 --> 13:21.860 opportunity and our obligation is to 13:21.860 --> 13:24.810 bring the how to this discussion 13:25.990 --> 13:28.101 and the house starts at meetings like 13:28.101 --> 13:30.212 this . It starts with having the real 13:30.212 --> 13:32.046 discussions , not only about the 13:32.046 --> 13:34.101 problems , but the solutions that we 13:34.101 --> 13:36.212 can bring forward . Now , there was a 13:36.212 --> 13:38.379 great discussion about the contracting 13:38.379 --> 13:40.490 system and how that works . The Joint 13:40.490 --> 13:44.380 Chiefs are responsible for oversight of 13:44.390 --> 13:46.446 our contracting requirements through 13:46.446 --> 13:48.446 what's called the Jason's process , 13:48.446 --> 13:50.557 joint capabilities , process and this 13:50.557 --> 13:50.360 is one of the things that they 13:50.370 --> 13:52.990 collectively identified not just as a 13:53.000 --> 13:55.100 medical problem , but as a problem 13:55.100 --> 13:57.433 across the entire Department of Defense . 13:58.350 --> 14:00.572 That's an opportunity for us because as 14:00.572 --> 14:02.683 we look at the military health system 14:02.683 --> 14:05.170 as a subset of the military as a whole , 14:05.180 --> 14:07.402 as they look forward with those changes 14:07.402 --> 14:09.740 to improve how we interact with our 14:09.740 --> 14:12.550 industry partners , we should benefit 14:12.560 --> 14:14.782 from that because we are tightly linked 14:14.782 --> 14:16.504 with similarly , we talk about 14:16.504 --> 14:18.616 communication and we look at what the 14:18.616 --> 14:20.282 entire department is doing to 14:20.282 --> 14:22.504 revolutionize how we're communicating , 14:22.504 --> 14:24.727 how we share data back and forth . We , 14:24.727 --> 14:26.893 the military medical system should not 14:26.893 --> 14:29.280 be creating some separate capability . 14:29.290 --> 14:31.850 We must be aligned with what the rest 14:31.850 --> 14:34.290 of the military is doing as we go forth , 14:34.300 --> 14:36.790 so that the military solutions are the 14:36.790 --> 14:39.012 ones that the military health system is 14:39.012 --> 14:41.123 leveraging . So that when we roll out 14:41.123 --> 14:43.234 the door , we're plugging and playing 14:43.234 --> 14:45.234 with whatever system the military , 14:45.234 --> 14:47.290 regardless of service brings forward 14:47.290 --> 14:48.957 and we're ready to be able to 14:48.957 --> 14:50.901 communicate and then logistics , a 14:50.901 --> 14:53.970 critical part of operating in this new 14:53.980 --> 14:56.580 combat environment is how well you can 14:56.580 --> 14:58.747 support that fight . And again , we're 14:58.747 --> 15:00.913 seeing that in the Ukraine right now , 15:00.913 --> 15:03.080 the tremendous pace and consumption of 15:03.080 --> 15:05.750 munitions as far outpacing what most 15:05.750 --> 15:07.930 countries industry is able to produce 15:07.940 --> 15:10.530 on the healthcare side have had the 15:10.540 --> 15:12.700 great privilege . And uh General 15:12.700 --> 15:14.589 Hodgins is here some of our other 15:14.589 --> 15:16.811 international colleagues to talk to the 15:16.811 --> 15:18.867 Ukrainian surgeon general talk about 15:18.867 --> 15:21.033 the tremendous challenges that they're 15:21.033 --> 15:22.867 facing just in getting access to 15:22.867 --> 15:24.922 medical supplies in a timely fashion 15:24.922 --> 15:27.144 because the health care industry is not 15:27.144 --> 15:29.367 designed right now . Nor is it scalable 15:29.367 --> 15:31.478 to produce the quantity and the types 15:31.478 --> 15:33.830 of health care supplies that are needed 15:33.840 --> 15:36.062 when you're in a high intensity kinetic 15:36.062 --> 15:38.070 conflict . Like we're seeing in the 15:38.080 --> 15:41.230 Ukraine right now . So as we step 15:41.230 --> 15:43.286 through all of these aspects of what 15:43.286 --> 15:45.830 the military is doing , both within the 15:45.830 --> 15:47.941 United States and with our key allies 15:47.941 --> 15:51.250 and partners . The opportunity then is 15:51.250 --> 15:53.780 for us in the military health system to 15:53.780 --> 15:56.030 leverage those changes that the entire 15:56.030 --> 15:58.040 U . S . Military and our allies and 15:58.040 --> 16:00.220 partners are implementing and bring 16:00.220 --> 16:02.164 them back into the military health 16:02.164 --> 16:04.580 system . General Cross had mentioned 16:04.580 --> 16:06.802 that senior leaders are concerned about 16:06.802 --> 16:08.913 this . I'll tell you , you know , for 16:08.913 --> 16:08.720 those of you who know , General Milley , 16:08.730 --> 16:12.360 very quiet , soft spoken guy . Uh not 16:12.360 --> 16:16.170 really uh he's expressed great concern 16:16.180 --> 16:18.290 about many things , but one of the 16:18.300 --> 16:20.560 things that he and I have talked about 16:20.570 --> 16:22.920 is whether our system has the 16:22.930 --> 16:25.800 capability and the capacity to do all 16:25.800 --> 16:28.550 the things that we are expected to do . 16:29.680 --> 16:31.902 And in the joint medical estimate , our 16:31.902 --> 16:34.013 answer is it's gonna be really hard , 16:35.610 --> 16:37.388 it's gonna be really hard to do 16:37.388 --> 16:39.499 everything that people think we'll be 16:39.499 --> 16:41.920 able to do . One of the things that's 16:41.920 --> 16:44.370 gonna be really hard is to get people 16:44.370 --> 16:46.530 out the door . You know , how we get 16:46.540 --> 16:48.762 people and keep them medically ready to 16:48.762 --> 16:51.280 deploy depends on all the system 16:51.280 --> 16:53.650 working well in peace time . And then 16:53.650 --> 16:56.660 as a conflict is beginning area of real 16:56.660 --> 17:00.120 concern , we touched on before Briefly , 17:00.130 --> 17:03.110 is how well we ensure that our medics 17:03.120 --> 17:05.570 are prepared to take care of combat 17:05.580 --> 17:07.960 casualties in an environment in which 17:07.960 --> 17:10.182 there's not a lot of trauma today . The 17:10.182 --> 17:12.349 way there was even 20 years ago in the 17:12.349 --> 17:13.960 United States or elsewhere , 17:13.960 --> 17:16.182 fortunately we're not seeing casualties 17:16.182 --> 17:18.293 coming back . But this is where these 17:18.293 --> 17:20.349 partnerships , both with the V . A . 17:20.349 --> 17:22.349 And the civilian trauma centers and 17:22.349 --> 17:24.293 with international partners should 17:24.293 --> 17:26.460 allow us to have that greater exposure 17:26.460 --> 17:29.880 to trauma care as well . And then as we 17:29.880 --> 17:32.750 step through another major area of 17:32.760 --> 17:34.927 concern , can we scale the health care 17:34.927 --> 17:37.920 system ? It can't be that we have a 17:37.920 --> 17:39.976 system that's designed for the worst 17:39.976 --> 17:41.976 day in american history and it just 17:41.976 --> 17:43.976 sits idle . It's got to be a system 17:43.976 --> 17:45.920 that's designed across the federal 17:45.920 --> 17:47.753 workforce and this is a personal 17:47.753 --> 17:49.920 opinion now , I'm not speaking for the 17:49.920 --> 17:52.031 department on this but we have got to 17:52.031 --> 17:54.087 get to a point where the D . O . D . 17:54.087 --> 17:56.253 The DEA and other federal partners are 17:56.253 --> 17:58.364 much more closely linked together and 17:58.364 --> 18:00.750 we are leveraging the incredible talent 18:00.750 --> 18:02.583 and capabilities of all of those 18:02.583 --> 18:04.417 systems . If you look across our 18:04.417 --> 18:06.472 country , we have federal healthcare 18:06.472 --> 18:08.472 locations in every state and almost 18:08.472 --> 18:10.870 every community . They all are 18:10.870 --> 18:12.900 struggling with not having enough 18:12.910 --> 18:15.020 workforce . And many of them are 18:15.020 --> 18:17.242 struggling with having too many complex 18:17.242 --> 18:19.520 cases for the workforce that they have . 18:19.520 --> 18:21.576 While we're struggling with having a 18:21.576 --> 18:23.520 workforce that doesn't have enough 18:23.520 --> 18:25.970 complex cases to take care of that . 18:25.980 --> 18:29.710 Integration among federal capabilities . 18:29.720 --> 18:32.130 Federal healthcare capabilities is what 18:32.130 --> 18:34.241 we do in crisis . It's what we did in 18:34.241 --> 18:36.241 Covid it's how we help the civilian 18:36.241 --> 18:38.297 healthcare system during code . It's 18:38.297 --> 18:40.297 what we did during Operation Allied 18:40.297 --> 18:41.963 welcome and how we helped our 18:41.963 --> 18:43.980 interagency partners bring 120,000 18:43.980 --> 18:47.950 displaced in uh refugees and 18:47.950 --> 18:50.061 asylum seekers in the United States . 18:50.061 --> 18:52.330 And it's what we do in every war for 18:52.330 --> 18:55.490 the last 100 years . We've got to make 18:55.490 --> 18:57.546 that part of our end state of how we 18:57.546 --> 18:59.434 integrate more closely across the 18:59.434 --> 19:03.180 federal system . I think there's , you 19:03.180 --> 19:06.070 know , there's a lot that the changing 19:06.070 --> 19:09.120 character of war gets into and it's 19:09.120 --> 19:11.120 hard to discuss in an unclassified 19:11.120 --> 19:13.270 level . So I'm gonna disappoint you 19:13.270 --> 19:15.720 profoundly . I haven't already and I'm 19:15.720 --> 19:17.609 going to talk about a fella named 19:17.609 --> 19:19.831 closets . Some of you may have heard of 19:19.831 --> 19:22.250 him in the military audience here fella 19:22.250 --> 19:25.670 named Carl clausewitz german strategist 19:26.910 --> 19:29.132 cosmetics talked about the character of 19:29.132 --> 19:31.132 war , but he talked about it in the 19:31.132 --> 19:33.590 context of the nature and he said the 19:33.590 --> 19:36.650 nature of war has some core elements . 19:36.710 --> 19:39.780 One is incredible violence 19:42.210 --> 19:44.510 and that's something that many of our 19:44.520 --> 19:46.131 countries will struggle with 19:46.131 --> 19:48.242 tremendously . We talked about mental 19:48.242 --> 19:50.464 health care but understanding what this 19:50.464 --> 19:52.576 worst day will look like is something 19:52.576 --> 19:54.742 that we collectively have to be candid 19:54.742 --> 19:56.909 about describing to our senior leaders 19:56.909 --> 19:59.760 and to our colleagues . I will tell you 19:59.760 --> 20:01.927 as military leaders . Military medical 20:01.927 --> 20:05.480 leaders . Part of our responsibility is 20:05.480 --> 20:08.100 ensuring that our senior leaders are 20:08.100 --> 20:10.390 well informed about the cost of war . 20:10.400 --> 20:12.400 Because the second thing cause it's 20:12.400 --> 20:14.622 talked about was the human dimension of 20:14.622 --> 20:16.567 war . We're really good at talking 20:16.567 --> 20:19.090 about how we maintain F 22 aircraft 20:19.100 --> 20:21.600 carriers and other things as a medical 20:21.600 --> 20:23.822 community . We must be equally adept at 20:23.822 --> 20:25.822 talking to our line leaders and our 20:25.822 --> 20:28.044 political leaders about how we care for 20:28.044 --> 20:30.156 the human weapons system . And before 20:30.156 --> 20:32.720 each conflict we must be able to tell 20:32.720 --> 20:35.110 them if this war happens with these 20:35.110 --> 20:37.510 planning factors , here's how many 20:37.520 --> 20:39.520 casualties should have , here's how 20:39.520 --> 20:41.464 many disease , non battle injury , 20:41.464 --> 20:43.409 here's how many traumatic injuries 20:43.409 --> 20:47.370 here's how many will die . That is our 20:47.370 --> 20:50.090 obligation . One of the great strengths 20:50.090 --> 20:52.312 of the D . A . J . And our joint trauma 20:52.312 --> 20:54.479 systems . We've now built the greatest 20:54.479 --> 20:56.646 collection of military medical data in 20:56.646 --> 20:58.950 the history of mankind that allows us 20:58.950 --> 21:01.600 to begin to understand and project 21:01.610 --> 21:04.210 given a variety of scenarios what our 21:04.220 --> 21:06.109 casualties will look like and how 21:06.109 --> 21:08.710 challenging it will be to care for . We 21:08.710 --> 21:10.877 must have the courage to say with that 21:10.877 --> 21:13.160 data . Here's what the cost of war will 21:13.170 --> 21:15.530 be so that our political leaders are 21:15.540 --> 21:17.762 able to make the most informed choice . 21:18.470 --> 21:20.470 But even more importantly than that 21:20.470 --> 21:23.230 political aspect , cosmetics talks 21:23.230 --> 21:25.397 about the will to fight and that's the 21:25.397 --> 21:28.470 will of a nation's people . Those who 21:28.470 --> 21:30.550 live at home . The moms and dads who 21:30.550 --> 21:32.439 send their sons and daughters off 21:32.980 --> 21:35.036 because they believe that we will be 21:35.036 --> 21:37.850 there . They have seen it for the last 21:37.860 --> 21:40.310 20 years . We've delivered the lowest 21:40.310 --> 21:42.199 item woods rate in the history of 21:42.199 --> 21:44.680 mankind . We delivered extraordinary 21:44.680 --> 21:46.700 saves people who should never have 21:46.700 --> 21:49.410 survived nine months after their injury 21:49.420 --> 21:51.642 or on the ski slopes of the Paralympics 21:51.642 --> 21:54.890 facility , snowboarding . We have made 21:54.890 --> 21:58.480 the impossible look routine And we've 21:58.480 --> 22:00.536 set that expectation that we will do 22:00.536 --> 22:02.702 that in every future conflict . And we 22:02.702 --> 22:04.480 collectively have to be able to 22:04.480 --> 22:07.420 describe what we will be able to do and 22:07.430 --> 22:10.080 what resources would be required to 22:10.080 --> 22:12.430 repeat the successes of the last 20 22:12.430 --> 22:13.970 years where they can be . 22:16.280 --> 22:20.220 That's a daunting challenge . And I 22:20.230 --> 22:22.220 was so excited to see how the last 22:22.220 --> 22:24.276 session ended because we've spent 10 22:24.276 --> 22:26.220 years arguing over who gets to run 22:26.220 --> 22:29.770 something . And my plea to you is that 22:29.770 --> 22:32.530 we spend the next years talking about 22:32.540 --> 22:36.430 how collectively ensure that we 22:36.430 --> 22:39.590 are as prepared as possible to care for 22:39.590 --> 22:41.534 someone's son or daughter when she 22:41.534 --> 22:43.646 walks through that tent and needs our 22:43.646 --> 22:47.140 help . We have all of the 22:47.140 --> 22:49.760 skills , all the talent , all the tools 22:49.760 --> 22:51.871 that we need to do that . If we think 22:51.871 --> 22:54.390 differently again , because we're a 22:54.400 --> 22:56.567 microcosm of the military as a whole , 22:56.567 --> 22:58.789 this is the perfect time to do it . Our 22:58.789 --> 23:00.900 National Security Strategy says we're 23:00.900 --> 23:04.210 at an inflection point in history . I 23:04.210 --> 23:06.377 actually went back and read the last I 23:06.377 --> 23:09.280 think 10 National Security Strategy and 23:09.280 --> 23:11.502 you won't find those words in any other 23:11.502 --> 23:13.669 national Security strategy besides the 23:13.669 --> 23:15.780 one that was published last year , An 23:15.780 --> 23:17.724 Inflection point in history that's 23:17.724 --> 23:19.970 causing tremendous discussions across 23:19.980 --> 23:22.147 our government and with our allies and 23:22.147 --> 23:24.202 partners about the need for change . 23:24.740 --> 23:26.970 And with that comes the opportunity for 23:26.970 --> 23:29.260 us to describe how we will change the 23:29.270 --> 23:31.780 practice of military medicine , data 23:31.780 --> 23:34.330 driven , evidence based practice to 23:34.330 --> 23:36.497 improve the mental health care that we 23:36.497 --> 23:38.608 provide through virtual means as well 23:38.608 --> 23:40.552 as in person , as well as personal 23:40.552 --> 23:42.886 means , how we improve patient movement , 23:42.886 --> 23:44.886 how we improve trauma care , how we 23:44.886 --> 23:46.886 improve disease , non battle injury 23:46.886 --> 23:48.497 care , how we deliver on the 23:48.497 --> 23:50.663 expectation and the promise that we've 23:50.663 --> 23:54.140 created that we will be there one more . 23:56.550 --> 23:59.060 It's a tremendous effort that faces us 23:59.440 --> 24:01.320 and I am absolutely confident 24:04.080 --> 24:06.590 now I'm gonna wrap this up by saying a 24:06.600 --> 24:08.850 couple of final thank you's here . 24:09.540 --> 24:11.596 Thank you again to our international 24:11.596 --> 24:13.880 partners . I'm so grateful to those of 24:13.880 --> 24:15.824 you who are here who made the long 24:15.824 --> 24:17.769 journey to be part of this again . 24:17.769 --> 24:19.824 There is no war that we will fight . 24:19.824 --> 24:21.769 There's no contingency conflict or 24:21.769 --> 24:23.880 natural disaster that will be engaged 24:23.880 --> 24:25.991 in where we don't go there with you . 24:25.991 --> 24:28.740 Thank you for being part . Thank you to 24:28.740 --> 24:30.907 our inter agency and industry partners 24:30.907 --> 24:33.018 who are here because there is nothing 24:33.018 --> 24:36.600 that we can do without you . I want to 24:36.600 --> 24:38.822 say a special thanks and I'd ask you in 24:38.822 --> 24:41.910 joining me for acting assistant 24:41.910 --> 24:44.132 Secretary of Defense mullin . So if you 24:44.132 --> 24:46.299 listen carefully to what she said this 24:46.299 --> 24:48.466 morning and want to unpack that just a 24:48.466 --> 24:50.466 little bit . So in february of last 24:50.466 --> 24:52.243 year , uh dr Martinez Lopez was 24:52.243 --> 24:54.410 nominated to be Assistant Secretary of 24:54.410 --> 24:56.410 Defense for health affairs and he's 24:56.410 --> 24:59.180 still waiting to be confirmed . Uh in 24:59.190 --> 25:01.700 april of last year , Miss mullen was 25:01.700 --> 25:04.220 hired to be the principal deputy to be 25:04.230 --> 25:06.452 his deputy and immediately stepped into 25:06.452 --> 25:08.510 his role . And I think you saw this 25:08.510 --> 25:11.750 morning . She has been a warm , 25:11.760 --> 25:14.510 challenging and demanding uh as the 25:14.520 --> 25:16.742 health affairs . But she's been a great 25:16.742 --> 25:18.853 partner to help us wrap up the end of 25:18.853 --> 25:20.909 the divorce and begin thinking about 25:20.909 --> 25:23.740 how we'll share custody . So I just ask 25:23.740 --> 25:26.270 you to join me as hopefully dr Martinez 25:26.270 --> 25:28.159 Lopez has confirmed in a round of 25:28.159 --> 25:29.159 applause for 25:39.000 --> 25:41.111 and last but not least I'll say thank 25:41.111 --> 25:43.111 you to you all for being here as we 25:43.111 --> 25:45.222 bring come back together as the House 25:45.222 --> 25:47.278 of Military medicine . Thank you for 25:47.278 --> 25:49.500 the collegial collaboration . Thank you 25:49.500 --> 25:51.500 for the professional partnerships . 25:51.500 --> 25:53.556 Thank you for that shared commitment 25:53.556 --> 25:55.611 that always puts the patient first . 25:55.611 --> 25:57.889 That's all I've got . Happy to take it . 25:58.170 --> 25:58.770 Mhm .