Volume 24 Issue 01                                                                                                                        January 2021

Top Stories

A New Way of Training the Army’s Flight Paramedics

By Gina Cavallaro | U.S. Army Medical Center of Excellence Public Affairs | Aug 2020


The Army is changing the way it trains its flight paramedics to prepare for a future battlefield where swift medical evacuation won’t be assured. The Combat Paramedic Course, a 30-week pilot, marks the first step in ramping up medical expertise that could include ground paramedics and more advanced skills for the Army’s almost 34,000 combat medics. Jay Harmon III, deputy to the commander of the U.S. Army Medical Center of Excellence in San Antonio, Maj. Chris Gonzalez, pilot program director, and Master Sgt. Joey Hernandez, pilot NCO in charge, explain. Their answers have been condensed and edited for space.
1. How were paramedics trained until now? The Army was producing the paramedic certification through a contract here in San Antonio. Civilian paramedic programs are focused on pre-hospital emergency medical services, but the dynamics change in an operational context like combat. [Civilian paramedics] have protocols and standing guidance provided by their medical director; we teach our students how to think critically through a problem set in the event they have no doctor they can go back to.

2. Do you have an example of that critical thinking? Take something as simple as tourniquet application. We teach combat medics which wounds can be controlled with a tourniquet and then reinforce the accurate, adequate and timely delivery of that. With combat paramedics, we don’t just need them to be experts at that kind of basic skill, we need them to understand, “OK, I can’t evacuate this person for two hours. Can I convert this tourniquet to another kind of dressing that’s not going to cut off circulation to the entire limb?” “Now I’ve got them for 12 hours, and I have a new problem. How do I prepare for that?” That sort of thing.

3. When will the pilot end? The first course began in January; there were two more starts in March and June, so the pilot will end early in 2021. Our objective is to make it a program of record, build it into the [budget] and make it a recurring and permanent part of our curriculum. Graduates who go on to serve as flight paramedics will attend and eight-week critical care course in San Antonio] and a four-week air crew member training course at Fort Rucker, Alabama.

4. Any additional certifications? Graduates will receive 51 of 60 semester credit hours toward an associate degree in Health Sciences–Emergency Medical Services (Army Paramedic) from the Uniformed Services University, a National Registered Paramedic certificate and [several certifications from national emergency medical and trauma care organizations].

5. Why just flight paramedics? At this time, the only paramedic requirement is for flight paramedics. If you look at this thing as a pyramid, the critical-care flight paramedics are the very top level. They’re the cap, the most highly trained medic that we are going to put in the force. Army leadership may determine that there are additional requirements for this capability at the ground [level. If so,] we will already have a validated program in place that will simply require resourcing to scale.

6. What’s the next level down on the pyramid? An advanced medical NCO trained to a combat paramedic standard that we would try to employ on all evacuation platforms in certain scenarios, units and situations. We want to make our medics better at the base of the pyramid by giving them more knowledge and more skills that, quite frankly, before have only been seen in our nursing care specialists who receive training in how to take care of patients for longer periods of time. We want to take portions of that [training] to include in Advanced Individual Training for combat medics.

7. How significant is this? It’s the contract that we have with our soldiers that when they go into harm’s way, that we’re going to do everything medically, humanly possible to prevent loss of life. With this, we are just increasing the trust and confidence of the soldiers in us.

Army Medical Department Board test auto-injectors, gets feedback from Soldiers

By Jose E. Rodriguez | U.S. Army Medical Center of Excellence Public Affairs | Sep 2019

While training during a simulated Chemical, Biological, Radiological, and Nuclear, or CBRN, attack at Joint Base San Antonio-Camp Bullis, a Soldier checks a causality's Mission Oriented Protective Posture, or MOPP, mask. While training during a simulated Chemical, Biological, Radiological, and Nuclear, or CBRN, attack at Joint Base San Antonio-Camp Bullis, a Soldier checks a causality's Mission Oriented Protective Posture, or MOPP, mask. (Photo by Jose E. Rodriguez) Photo Details | Download | 0 RELATED MEDIA Army Medical Department Board test auto-injectors, gets feedback from Soldiers (Related Story) JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas —

The Chemical and Biological Defense Auto-Injector Device, or CBD auto-injector, is something no Soldier ever wants to use on the battlefield. The effects of chemical and biological weapons are horrific.

Nerve agents are the most toxic of the known chemical agents. They are hazards in both liquid and vapor states and can cause death within minutes after exposure. Nerve agents are the primary chemical warfare agent threat because of their high toxicity and effectiveness through multiple routes of entry. They are absorbed through the eyes, respiratory tract, and skin.

Ensuring CBD auto-injectors are functional and usable are critical in savings lives. The CBD Auto-Injector Device is designed to be used in a Chemical, Biological, Radiological, and Nuclear, or CBRN, environment. Recently the U.S. Army Medical Department Board, or USAMEDDBD, assigned to the U.S. Army Medical Center of Excellence at Joint Base San Antonio-Fort Sam Houston, conducted a test of these devices at JBSA-Camp Bullis.

The Joint Program Executive Office for Chemical and Biological Defense, Medical Countermeasure Systems, or JPEO-CBD MCS, at Fort Detrick, Maryland, requested the AMEDD Board conduct a customer test of the CBD auto-injector device within the operational environment. The data and test findings collected by the AMEDD Board will be will be provided to JPEO--CBD MCS.

The CBD Auto-Injector Device is a replacement for the currently fielded auto-injector for treatment against nerve agent and insecticide poisoning, adjunctive treatment, and management of agent-induced seizures. The United States military adopted the auto-injector as the drug delivery device because of ease of use, packaging durability, and drug product stability under varying storage conditions.

Soldiers donned Mission Oriented Protective Posture, more commonly known as MOPP protective gear, and tested the CBD auto-injectors in a simulated battlefield exercise complete with smoke grenades. MOPA masks can limit visibility, so the injectors have clear, easy to understand pictorial instructions. "A lot of these auto-injectors used to have wording, just written instructions," said Gary Cabigon, an operational tester with the AMEDD Board.

"What we learned over the years is that pictures are easier to comprehend, especially in a stressful environment." Cabigon said that when under a CBRN attack vital seconds saved in dispensing the injector matter. Sgt. First Class Elijah Williamson, an AMEDD Board test officer, talked about conducting the test in the field. "I think it's great having the training asset here at Fort Sam," Williamson said.

We have the austere environment where we can create the simulation of the battlefield. We do so much on slides and videos that you want to get hands-on and create that realism out at JBSA-Camp Bullis. You can't get that in the classroom."

The CBD auto-injectors are designed to deliver an intramuscular injection with a 22-gauge needle with a pressure-activated coil spring mechanism that triggers the needle after removal of the safety cap. When activated, the needle protrudes through the needle end.

The CBD auto-injector device is a replacement for the currently fielded auto-injector for treatment against nerve agent and insecticide poisoning, adjunctive treatment, and management of agent-induced seizures. The United States military adopted the auto-injector as the drug delivery device because of ease of use, packaging durability, and drug product stability under varying storage conditions.

To learn more about the Army Medical Department Board's mission, visit

About MEDCoE

The U.S. Army Medical Center of Excellence, or MEDCoE, is located at Fort Sam Houston, Texas. The Army Medicine proponent responsible to envision and design responsive Army Medicine capabilities and structure that support the fielded force and the future force.  We develop adaptive medical doctrine that supports Army and Joint Force operational requirements. As one of the U.S. Army Training and Doctrine Command’s 10 Centers of Excellence, MEDCoE is who the Army relies upon to train, educate and inspire all of its medical personnel. Army Medicine Starts Here! We ensure that Army Medicine is ready today “To Conserve Fighting Strength,” so that Soldiers are able to win our nation’s wars and then come home safely. MEDCoE creates the highest standards of achievement in medical expertise by generating synergy through effective and efficient combination and integration of functions while reinforcing the unique requirements and capabilities of the Army Medical Department.csm

Senior Leadership


MG Dennis P. LeMaster

Commanding General

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CSM Clark Charpentier

Command Sergeant Major

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Mr. J.M. Harmon

Deputy to the CG

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COL Daniel Bonnichsen

Chief of Staff

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We envision, design, train, educate and inspire the world`s premier military medical force to enable readiness and strengthen America`s Army.

Envision means looking at what the Army`s medical force should look like and what it should be able to accomplish given the missions it can be expected to receive.

Design means building the tactical medical units, approving their equipment sets and developing the medical doctrine needed to provide quality healthcare in the field: whether the battlefield or the humanitarian assistance field.

Train means providing the education and training to develop military and civilian students into proficient and ready members of the military healthcare team.

Educate means through state-of-the-art, hands-on, scenario driven training based on lessons learned from today`s battlefields and clinical settings, we create an environment  in which students can develop the educational and training capabilities they will need in order to provide the best casualty and patient care possible.

Inspire means the MEDCoE professional staff development and career life-cycle management assures us that students will continue to receive the benefits of the best education and training opportunities available from some of the world`s most capable and innovative instructors, training developers and professional staff members.



To be the foundation on which Army Medicine is built, sustained and transformed.

Our Customers

  • Army medical and non-medical personnel
  • Navy, Air Force and Coast Guard medical personnel
  • Military leaders, political representatives and other decision-makers
  • DOD Personnel (military and civilian)
  • General public


There are seven major organizations that comprise the U.S. Army Medical Center of Excellence:

The Directorate of Training and Academic Affairs (DoTAA). The MEDCoE is accredited by the Council of Occupational Education, and all programs of instruction are reviewed by the American Council on Education. Students attending courses at the MEDCoE can get undergraduate and graduate college credits. The Graduate School also conducts nine doctoral and five masters degree programs.

The 32d Medical Brigade is comprised of the 232nd Medical Battalion and the 264th Medical Battalion.

The Medical Professional Training Brigade is comprised of the 187th Medical Battalion and the 188th Medical Battalion.

The Directorate of Simulations (DOS) is the central focal point for Army Medical Modeling and Simulation initiatives with the responsibility for the development and execution of medical simulation training and the emerging medical simulated training environment, or STE.

The Fielded Force Integration Directorate (FFID) enables the delivery of solutions for the fielded force across the domains of doctrine, organization, training, materiel, leadership, personnel, facilities and policy (DOTmLPF-P) for the Army Health System.

The Medical Capability Development and Integration Directorate (CDID) develops future concepts and requirements and conducts experimentation, data collection and analysis to validate those concepts and capabilities.  Identifies capability gaps, and develops appropriate requirements to mitigate and close capability gaps for the future. As of 1 OCT 2019, CDID is a subordinate organization of the Futures and Concepts Center (FCC), Army Futures Command, though located at Fort Sam Houston with MEDCoE to ensure synchronization of effort.  (LINK:

The Noncommissioned Officers Academy (NCOA) is our center for NCO professional military leadership education. The Academy teaches courses at both the entry and advanced levels.

The Personnel Proponent Directorate (APPD) does force modeling. The Army Medical Department has over 130,000 military and civilian members who work in 200 different officer, warrant officer, enlisted, and civilian specialties.  This directorate ensures that the Army`s medical force is properly structured to accomplish the Army Medicine`s many missions.

The Army Medical Department Board provides independent operational test and evaluation of medical and medical related materiel and information technology products in support of the Army and Department of Defense acquisition process; provides assessments of emerging concepts, doctrine, and advanced technology applications applied to the delivery of healthcare, both on the battlefield and in fixed facilities.



The U.S. Army Medical Center of Excellence (MEDCoE) traces its origin to the Medical Field Service School (MFSS) established, nearly 100 years ago in 1920 at Carlisle Barracks, Pennsylvania. The mission of the MFSS was to train doctors, dentists and nurses in their duties as Army officers.

In 1924, the MFSS conducted the first professional courses for noncommissioned officers and privates first class.

The MFSS moved to Fort Sam Houston in 1946 and was located in the 9th Infantry Regiment quadrangle; where U.S Army North (5th Army) is now located.

In 1972 a reorganization of the MFSS resulted in the re-designation of the MFSS as the Academy of Health Sciences, making it one of the largest medical training institutions in the world.

In 1991, it was re-designated as the Army Medical Department Center and School (AMEDDC&S), with the Academy of Health Sciences becoming the school arm of the institution.

In 1993, AMEDD Center and School was realigned under the U.S. Army Medical Command (Provisional) and remained under the U.S. Army Medical Command (MEDCOM) as it became fully functional in 1994.

On 19 February 2015, to better align with the other education and training institutions across the Army, though still under MEDCOM, the Department of the Army added Health Readiness Center of Excellence to the school’s designation, becoming the U.S. Army Medical Department Center and School, Health Readiness Center of Excellence (AMEDDC&S HRCoE).

On 19 October 2018, AMEDDC&S HRCoE began realignment from the U.S. Army Medical Command (USAMEDCOM) to U.S. Army Training and Doctrine Command (TRADOC) with operational control by the U.S. Army Combined Arms Center, to be completed effective 2 October 2019.

Effective 15 September 2019, the CoE was finally redesignated as the U.S. Army Medical Center of Excellence (MEDCoE) to further solidify their abiding dedication to Army Medicine, reverence to their profound history, and their commitment towards Army modernization with the singular focus of training Soldiers who will win our nations wars and then come home safely.

The MEDCoE supports the Army to lead the design, integration, education, and training of new and innovative approaches to health and the Army Health System.

MEDCoE is postured to enable effective and efficient integration and synchronization of Army Medical Department Doctrine, Organization, Training, Material, Leadership, Personnel and Facility, and Policy (DOTMLPF-P) development to ensure the latest solutions to any perceived or predicted Army Medicine gaps are documented and incorporated into our doctrine and instruction.

MEDCoE is organized with two brigades to enhance mission command, improve functional alignment, and set the conditions for becoming a degree-granting institution. Each brigade has the responsibility for the execution of training and education, as well as quality of life and immersion into the Army Profession.

The CoE structure increases collaboration across TRADOC, other organizations, programs, and the generating force to improve support to the operating force. It embraces best practices and initiatives that improve efficiency and effectiveness of the Army and other Service partners overall. The common structure across all CoEs improves the ability of external agencies to communicate with CoE subordinate elements. Where integrated staffs are realized and common instruction shared, manpower requirements are decreased and greater synergy is gained between staffs and schools.

The MEDCoE is focused on the Army and improving the readiness of the force and training the Army’s Medical Professionals.   We ensure that Army Medicine is ready today “To Conserve Fighting Strength” by training, educating and inspiring Soldiers and Leaders who are capable of meeting the Army’s requirements for a ready medical force and a medically ready force.

Army Medicine Starts Here!


From the Top
Army Suicide Prevention Program and Awareness Training

Leadership Notes
A Janitor's 10 Lessons in Leadership

Past, Present and Future
History of the MEDCoE

The Call of Duty
(tribute to  a Medal of Honor Recipient...this month:
William R. D. Blackwood


(list of On-line Military Magazines).

Army News You Can Use
(On-line Military News).


Training Notes
(training notes, courses, updates).

(opinion, letters, quotations, humor...this month: "Collection of Quotes on The Army Values and "Mentoring Topic" quotations from General Colin Powell


Medical Medal of Honor Recipients
See What's Happening with Pick a Day
(Today in the Department of Defense).
Editor's Comments
The  concept of the newsletter is to provide training information to  military medical personnel and DoD firefighters.