Enlisted biomeds must work around their military demands while supporting our troops and maintaining equipment at the 800,000- square-foot DGMC

Every biomedical engineering department faces often- underappreciated challenges every minute of every day just keeping critical patient-care equipment functioning properly and making sure it is where it needs to be when it is needed most. Now add to that daily tension a key staffer who leaves just as he or she has completed training and gotten up to speed. Toss in a required on-the-job fitness regimen for workers that cannot be brushed off, taken care of later, or replaced with, say, a vigorous game of tennis on the weekend. And just for good measure, enhance that situation with the knowledge that the patients who will need the equipment you maintain next are your colleagues, coworkers, and family members.

Then, just to spice things up, populate your device inventory with the absolute latest in medical technology and, so no one gets too complacent, throw in a dental clinic, teleradiology operations management for a couple of dozen other facilities, and a comprehensive clinical research operation. And, of course, financial woes may be just around the corner, because budget cuts are an ongoing threat. Oh, and you might be called up at a moment’s notice to ship out to Iraq, Afghanistan, or some other global trouble spot.

That is the day-to-day reality of life in the biomedical engineering department at David Grant USAF Medical Center (DGMC) at Travis Air Force Base in California. “The big difference between us and a civilian biomedical engineering department,” says Fred Daniels, CBET, chief of the Medical Equipment Repair Center and member of the 60th Medical Support Squadron, “is the fact that everyone on active duty also has readiness or fighting responsibilities they have to stay trained for.”

That includes scheduling conflicts ranging from, for example, that daily fitness regimen all the way up to deployment overseas. “There are a lot of other demands on their time,” Daniels says, perhaps understating just a bit, “that don’t exist in a civilian facility.”

In fact, because Travis serves as the Air Force’s West Coast staging platform for expeditionary medical missions for both combat support and humanitarian missions, the biomed department “stocks and maintains a large quantity of expeditionary equipment for use in various theaters of operation across the nation and around the world,” Daniels reports. “DGMC’s military personnel are deployed in support of humanitarian efforts, like the recent tsunami or hurricane responses, as well as military actions, like those in Iraq. It is our responsibility to ensure that all of that equipment is received and accounted for, and that scheduled maintenance and/or calibration is current before it is deployed in support of our war fighters.

“Our technicians have maintained and deployed equipment ranging from battery-operated suction aspirators to fully self-contained air-transportable computed tomography (CT) scanners,” Daniels continues.

Technicians on Daniels’ team can set up deployable, expandable hospitals so mobile, surgical, and critical-care teams can manage the air transport of critically injured personnel. Home to nearly 2,000 men and women from the 60th Medical Group, DGMC also offers magnetic resonance imaging, nuclear medicine, and what the center calls “a world-class hyperbaric chamber,” which is the second largest in the United States. The three-chamber pressure vessel is used in a form of high-tech medicine involving forcing oxygen under atmospheric pressure—equivalent to being as much as 200 feet under water—into wounds to facilitate healing. Only the unit at Duke University is bigger—and that’s just by 6 inches. And that one, Daniels says, is used for research, while the one at his facility “is a 24/7, 365-day operation. We’re treating patients each and every day.”

The medical center also supports regional health care programs throughout Northern California through partnerships with the University of California, Davis (Davis, Calif), Touro Osteopathic College (Vallejo, Calif), the University of the Pacific (Stockton, Calif), and Pacific Union College (Angwin, Calif). Included are extensive postgraduate physician-officer training programs in diagnostic radiology, internal medicine, surgery, pediatrics, obstetrics and gynecology, family practice, dentistry, pharmacy, nursing, and health services administration, as well as clinical technician training for enlisted personnel. Indeed, the number of students in training at DGMC typically exceeds 200 per year.

Focus On Training
“All of our active-duty technicians complete a 10-month formal training course at the triservice training facility in Wichita Falls, Tex, before their first duty assignment,” Daniels explains. “Usually, they are sent to a larger facility like ours first, rather than a smaller two- or three-person shop. Within 1 year after arrival at their first assignment, they are required to complete a formal career-development course with written exams at the end of each of nine volumes.”

DGMC also maintains “an active ‘on-the-job’ training program for technicians on specific equipment used in the facility,” he adds, “along with Readiness Skills Verification to maintain proficiency on equipment encountered in deployed locations. There are also occasional opportunities for factory training at the facilities of various equipment manufacturers.”

If that sounds like a lot of training, that is because, well, it is. “One of the biggest differences between civilian and military training is they essentially pack into 10 months what someone would get in a 4-year degree program in college,” Daniels notes. And, he points out, “In that setting, it’s going to be based on books. Very often, biomeds who come through civilian training programs have rarely actually gotten their hands on a piece of equipment. In military training, they learn to troubleshoot problems and see equipment in operation, to really touch it and play with it rather than just see pictures of it and talk about it.”

Airman First Class Kevin Phone has been there and, as Daniels points out, done that. “I found a real difference in the training,” he comments. “After formal schooling, we have on-the-job training. It never stops. I really appreciate that.” Indeed, it never stops for the ones doing the training, either. Most assignments are for just 2 or 3 years, Daniels notes, so most of the airmen who arrive right out of biomed training are there specifically to learn in a large-facility setting before being shipped out to the much-more-common two- or three-person shop.

“We constantly train,” he states. “It’s part of our mission, to train people for the rest of the Air Force. We try to keep three or four civilian technicians for continuity and mentoring. They work side by side with a noncommissioned officer in charge of each section.”

“You really look forward to having people already in the shop to train you,” says Airman First Class Jitender Dinnius. “We have the opportunity to follow in their footsteps and then do the same for the newer people.” That kind of focus on training is essential when you work at a facility that recently opened a Warfighter Photorefractive Keratectomy Center, one of only five in the Air Force Medical Service.

Communication Is Key
Inside the larger-than-800,000-square-foot DGMC, the biomedical engineering department also supports the 52-treatment-room Arthur J. Sachsel Dental Clinic, which boasts a state-of-the-art centralized Dental Instrument Processing Center. The biomeds also service patient-care equipment of all kinds, from x-ray equipment to monitors and exam tables, as well as a multi-service Armed Forces whole-blood-processing laboratory—one of only two in the United States—and an active Clinical Investigative Facility research center.

And then there’s the facility’s teleradiology services operations. “We provide services to a growing number of other Department of Defense facilities—currently 19 and growing—where there is limited or no access to blue-suit radiologists,” Daniels notes. “We are responsible for the maintenance of the radiation-therapy section, including a linear accelerator and a CT simulator, but both are maintained by the original equipment manufacturer under contract.”

The campus’ footprint measures more than two football fields in width and almost four football fields in length. Not surprisingly, that vast scope presents what Staff Sgt Jason Kluttz, team chief of imaging maintenance for the 60th Medical Support Squadron, describes as the biomed department’s biggest challenge.

“It’s communication with coworkers and documentation of our computer system, DMLSS,” he says. “So much space and equipment make it imperative that we communicate statuses with each other. Our biggest problem is communication between the end-users and us as maintainers in both directions: from them to us, so we know when something is broken, and from us back to them, so they know its status and estimated completion date.” That’s accomplished, Daniels notes, through telephone contact and a lot of e-mails.

DGMC is covered by three teams in the biomedical engineering department, Daniels adds. “Each is responsible for a specialty clinic, so we really get to know the people and the equipment. And the clinic personnel know who to come to in the shop.”

The medical center can operate for up to a week using internal utility capabilities. “We have a Medical Readiness office at DGMC that’s responsible for disaster planning internally and for coordination with other on-base operations, such as fire and security, and with other local health care facilities in the event of an areawide mass-casualty event,” Daniels reports.

“We have a full-time operations and maintenance contractor that is responsible for the physical plant, utilities, and emergency power generation,” Daniels continues. “That allows us, in the event of an emergency situation, to concentrate on taking care of equipment concerns and making sure we have backup devices for things like central suction and medical gasses. We are also available as a manpower pool to respond as needed for things like moving patients to triage or material to where it is required.”

All told, the Travis biomed staff is responsible for about 10,000 line items of equipment in its maintenance plan, Daniels reports. There are about 30 people on staff, including the customer service clerk as administrative support, five civilian biomedical engineering technicians, and 23 active-duty military personnel.

Sanya Bird, a contracted biomedical equipment technician at DGMC, notes that 20% of the biomed workforce is female. “That’s a stark contrast to the industry norm of 1% or 2%,” she says.

The biomed team is diverse in other ways, Daniels adds. “We have an active-duty member in our unit who emigrated from one of the former Soviet republics and who was recently commissioned as an officer from the enlisted ranks,” he says. Indeed, he notes, in addition to a native Ukrainian, the shop boasts first-generation immigrants from Burma, India, China, and the Philippines.

Supporting Our War Fighters
“The challenges of keeping our Medical Equipment Management Plan vital and functional while competing with the realities of time demands are inherent in being a military organization,” Daniels comments. “There is constant competition for time to complete our ‘primary’ duties while still keeping up with fitness training, readiness training, deployments, MERC regional support trips, and permanent reassignment of personnel at just about the time they become most valuable. In short, we need to recognize and remember that our first duty—always—is supporting our war fighters, making sure equipment is in place and functional to care for them while in the field as well as when they get back.”

That duty, he also points out, takes on personal meaning in the insulated world of a military base. “One of the things I think makes our techs work a little differently and approach their jobs with perhaps a little different attitude is the realization that their kid might be the next patient in that pediatric department,” Daniels says. “Or their wife in that labor and delivery room. Or their wingman may be the next one on that portable defibrillator/monitor in a deployed location that’s surrounded by a lot of sand with no emergency room in sight. There is a camaraderie in military hospitals that I’m not sure exists anywhere else.” 24x7

Read about other biomed teams in past issues of 24x7 at www.24x7mag.com.

Russell A. Jackson is a contributing writer for 24x7.