May 16, 2025 • 39 mins
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Description:
In this episode of At the Boundary, GNSI’s Jim Cardoso sits down with Dr. Tracey Pérez Koehlmoos—Director of the Center for Health Services Research and Doctoral Programs in Preventive Medicine & Biostatistics at the Uniformed Services University—to explore how lessons from the Ukraine war are reshaping U.S. battlefield medicine.
From the death of the "Golden Hour" to the rise of drone evacuations and mobile surgical units, this conversation examines how the U.S. military is preparing for medical realities in future conflicts—especially across vast, maritime regions like INDOPACOM.
Topics include:
• Why traditional evacuation timelines are no longer reliable
• Medical innovation in low-air-superiority environments
• Field surgeries, hospital trains, and rapid-deployment surgical ships
• Challenges of sustaining operating rooms at sea
• Digitizing battlefield medical records
• Impacts of aging fighting forces and declining youth health
Follow the GNSI Podcast At the Boundary for weekly conversations on global security, strategy, and defense innovation.
Links from the episode:
• “The Spy and the State: The History of American Intelligence” by Jeff Rogg
At the Boundary from the Global and National Security Institute at the University of South Florida, features global and national security issues we’ve found to be insightful, intriguing, fascinating, maybe controversial, but overall just worth talking about.
A "boundary" is a place, either literal or figurative, where two forces exist in close proximity to each other. Sometimes that boundary is in a state of harmony. More often than not, that boundary has a bit of chaos baked in. The Global and National Security Institute will live on the boundary of security policy and technology and that's where this podcast will focus.
The mission of GNSI is to provide actionable solutions to 21st-century security challenges for decision-makers at the local, state, national and global levels. We hope you enjoy At the Boundary.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jim Cardoso (00:00):
Jim, hello everyone. Welcome to this week's
(00:14):
episode of at the boundary, thepodcast from the global and
national security Institute atthe University of South Florida.
I'm Jim Cardoso, Senior Directorfor genocide, and your host for
at the boundary today on thepodcast, we're looking forward
to speaking with Dr Tracy Perezcolmus, she's a USF alumni who's
(00:37):
now director at the UniformedServices University of the
Health Sciences in Bethesda,Maryland. Before we talk to Dr
Perez ComuS, though, we wantedto remind you that our newest
research initiative here atGNSI, the Axis of Resistance,
will debut this week on ourYouTube channel. GNSI, Research
Fellow, Dr Armond mahmoudian,will tee things off with Dr
(00:59):
Mohsin Milani, ExecutiveDirector of the USF Center for
Strategic and diplomaticStudies, Dr Malani is one of the
world's foremost authorities onIran, and his latest book,
Iran's rise in rivalry with theUS in the Middle East was
published recently. Thisdiscussion will be the first of
a series of panels andinterviews that will explore the
(01:21):
Axis of Resistance. Be sure tosubscribe to our YouTube channel
while you're there, so you don'tmiss any of them. Also this
week, registration will open forour upcoming policy dialogs,
virtual event Trans Atlanticforum on cybersecurity on June
23 GNSI will partner withresearchers and experts from the
University of Paris Saclay todiscuss areas of national
(01:44):
security concern in cyberspace.
We'll drop a link forregistration in the show notes.
Finally, GNSI, Senior ResearchFellow, Dr Jeff rogs, newest
book, The Spy in the state, wasrecently cited in an article
appearing in the Atlantic. Thearticle is titled, How spying
helped erode American trust. Thearticle explain expands on an
(02:06):
idea Rob touches on in his bookthat the business of
intelligence, aka spying, is,quote, inherently un American,
unquote, and a practice illsuited to a country that values
honesty, transparency andforthrightness. It's a good
article and an even better book,and you should check them both
(02:26):
out. We'll have Jeff on futureepisodes of the podcast to talk
about his book. Okay, it's timeto bring on our guest for
today's episode, Dr Tracy Perezcolmus. She's currently director
of the Center for HealthServices Research and doctoral
programs in preventive medicineand biostatistics. That's the
center at the Uniformed ServicesUniversity of the Health
(02:48):
Sciences, commonly referred toas usues in Bethesda, Maryland.
She's also a professor at usues,and earned both her Master's and
PhD right here at the Universityof South Florida. We're excited
to have her on the podcasttoday. Tracy, welcome to at the
boundary.
Tracey Perez Koehlmoos, P (03:06):
Thank you so much, Jim, it is always a
pleasure to get my bull go Bullson and be amongst my people. Go
Bulls. And you know, just a joythat the toolkit that I got
doing public health and healthadministration at USF has been
able to carry me into atremendously meaningful career.
(03:26):
So thank you.
Jim Cardoso (03:27):
You started to talk a little bit about your
background, obviously, yourbulls background, but tell us a
little bit more about yourbackground and your current
research. Sure.
Tracey Perez Koehlmoos, PhD, (03:36):
So my PhD is in public health. I
was an Army officer back in theday, and people often think I
was some because I work inhealth and health care. Now,
people often assume that I wassomething soft, but I was an Air
Defense Artillery officer in theArmy. I was not soft. My War was
the first Golf War, Gulf War. Iwas an army wife, and that's
(03:58):
what I was doing when I wasworking on my degrees at the
University of South Florida, Iled big programs in
international health acrossSouth Asia, before repatriating
to the United States when webecame a Gold Star Family, and I
was working for the AssistantCommandant and Commandant of the
Marine Corps in my previous job,before joining and being The
(04:19):
sort of seduced to join theUniformed Services University to
stand up a robust portfolio ofhealth services research and
take their Dr Ph and convert itto a true PhD in public health
to help meet the needs of theMilitary Health System and the
Department of Defense. So I'm afed. I always think it's
(04:41):
important for me to share thatwith you all that I'm a federal
government employee. I will tryto be as relaxed and happy as a
Fed can be when talking, butwe'll see how this goes and we
are wrapping up, in addition toa robust portfolio, a sort of
more mundane, racial, ethnicdisparities, low value. Health
Service, utilization and accessstudies. The work that we're
(05:04):
going to talk about today, Ithink, has more to do with I
have a large portfolio of workcoming out of the current
Russian Ukraine crisis. We wereasked early on the invasion. Was
February of 2022 2022 Yeah, Iwas I was asked right at the end
of 2022 to design and implementsome research that could
(05:27):
illuminate what's going on inthe health and trauma system of
Ukraine. So I am rolled intoday, prepared to talk about
those things with you.
Excellent,
Jim Cardoso (05:36):
and we look forward to it. So before we get deep
into Ukraine, let's firstdiscuss, you know, America's
most recent major combatexperience, which would be G
wat, Iraq, Afghanistan, and whatwould characterize battlefield
medical operations during thattime, which were unique to that
(05:56):
conflict, or at least, whichpossibly are not representative
of future war,
Tracey Perez Koehlm (06:03):
absolutely.
So that was really anasymmetrical conflict. We had
air superiority so that we hadthe unlimited air bridge
wherever we went. We could bringpeople in, we could bring in
supplies and equipment. We couldexit when we wanted to exit,
people were injured, and wedeveloped a norm called the
golden hour with the idea, butactually we say golden hour, but
(06:24):
it's really more a platinum 10or 15 minutes, right there at
the at the point of injury. Butwe established, along with our
colleagues at NATO, and executedreally robust systems of role
one, Rule two, role three androll four and five, being
further back and away, far awayfrom from the battlefield for
more intense care, but we wereable to move the wounded as
(06:45):
quickly as we were able aspossible, ideally by air,
preferably within an hour,getting them to definitive
surgical care To help treattheir wounds before we would
move them to a higher level ofcare. So we had some really
great we had unlimitedcommunications. And so it was
(07:08):
really just a great place tosort of execute. And there was a
lot of learning that took place.
We stood up the joint traumasystem, for example, if you've
not heard about that previously,that was a great innovation,
where, and it still meets, itstill meets once a week. It's a
(07:28):
virtual meeting, and they wouldtake a case from the battlefield
and follow that case through thesystem, in addition to
collecting the data so that realtime lessons learned could be
translated across theenterprise. It is the Institute
of Medicine declared that thejoint trauma system that we
developed during OEF and OIF wasthe ideal learning health system
(07:54):
that you take and it could besomething as simple as, hey,
surgeons down range, if youleave an extra inch of skin for
a for an amputation, this is theimprovement we can make to the
outcome for that warrior goingforward, and what it does for
that warrior for the rest oftheir life. So they were able to
(08:15):
really look at was what wasgoing on, and bring everybody
together. And again, the jointtrauma system continues. And
when COVID broke out, we wereable that, not me, some of some
of the medical leaders of theMilitary Health System were able
to commandeer, at first, thejoint trauma system, or the JTS,
(08:40):
but then they developed theirown system where they were they
brought the same methodology oflearning health system to
quickly gather informationabout, you know, burden of
disease, challenges and care ofindividuals with COVID as well
as specialty items like what todo with pregnant women, What to
(09:00):
do with children with thisdisease. So it really is a
tremendous learning healthsystem, and it came to us
through some real innovation,and people who wanted to say,
yes, because you were in themilitary, also, you know that it
was very easy for people to say,This is my chain of command, and
(09:21):
that's a great idea, but you Idon't have the power to change.
And so it was visionary leaderslike Lieutenant General Doug Rob
or, at the time Colonel JohnHolcomb, really visionary
leaders who were able to do somemeta leadership and work across
different silos to bring thejoint trauma system and the data
(09:41):
that were collected that way tolife during OEF and OIS. So we
really it was a real highlightof military medicine over that,
that those 20 years of conflict,
Jim Cardoso (09:52):
oh yeah, there's unquestionably some incredible
advances that happen across theboard. And I mean, in well, not
just, I mean, obviously web.
Nearing and targeting and how toactually execute military
operations, but also the themedical side as well. And I
mean, and I think a lot of thatwould obviously be, you've
created lessons learned for thefuture, but now shifting a bit,
(10:13):
we're seeing the future ofwarfare is, is changing or and
in some ways. And we talkedabout a little bit yesterday, is
almost Some of it's going backto the past, almost, and how
warfare was fought a centuryago, in some ways. And so what
are some of the main lessonsthat you're seeing in Ukraine
that are different from G wattand may signal challenges to the
US in the future that the US maynot be prepared to face?
Tracey Perez Koehlmoos, PhD, (10:39):
I think that we I think just in
general, we are preparing toface a lot of the things that
they're facing in Ukraine thatare very different from from
where we were. So I do want togive a shout out to my
colleagues at the UniformedServices University and
industrious providers andresearchers across the
Department of Defense, and ourcolleagues at all, like the
(11:01):
applied physics labs and thatsort of thing, that there's a
lot of work going into ourunderstanding of the future of
warfare, including very from akey point, what we've learned
from from Ukraine as well. Sosome of the lessons that we're
seeing from Ukraine is, ofcourse, and I love to say this,
(11:22):
and I said this at a meeting,and the Surgeon General of
Ukraine walked up to meafterwards and hugged me.
Because, for those of you whocan't see me, because this is a
voice issue, I'm little, likeI'm little, and people hug me
right during the pandemic, I wasquite sure that I would die,
because people couldn't stoplike seeing me being happy and
giving me a big hug. Oh, they'regoing to kill me. I'm giving
(11:44):
them the elbow they're givingyou all but the Surgeon General
of Ukraine and some of the otherleaders of Ukraine, I was at a
meeting at NATO last May, and Imade you know I was talking
about, I lead a syndicate onmedical evacuation and
repatriation. And one of thethings that I said is the golden
hour is dead. And I would wewould be remiss to talk about
(12:05):
the golden hour in the presenceof Ukrainian war fighters,
leaders and military planners,because that was an idea, that
it is an ideal, and we were ableto make it work for almost,
Jim Cardoso (12:22):
you know, 2020, 20 years, yeah,
Tracey Perez Koehlmoos, (12:24):
right, or two decades of war. But in
Ukraine, they don't own theskies. They don't own
communications, right? It's sothey've had to work with what
they have. So we see peoplelingering longer at the point of
injury. We hear heroic storiesabout Ukrainian soldiers being
(12:47):
sent forward with a pain pilland a an antibiotic, and if
they're injured, they're to takethose two things and wait to be
saved. And you have stories ofsoldiers lingering in an injured
but controversial, you know, aconflicted geographic zone, and
(13:08):
having to stay there, sometimesfor days, and perhaps try to
low, crawl their way out tosafety. And so these are the
sorts of things that we werehearing about early on from the
Ukrainians that we hear thatthey don't own there's there's
jamming, so then they can'talways rely on communication
(13:30):
techniques that were known tothem. They don't own the skies.
They don't have air superiority,so they're unable to use
helicopters to move people. Soinstead some of the innovations
that have taken places, they'lltalk about drones. And I know
when I see you're a pilot, andwhen I say the word drone, and
this is what I thought at first,is that, you know, oh, it was a
(13:51):
drone, like, like an airbornehelicopter type drone that I
would like to deliver a pizza tome, or whatever, or like that
they're using to deliver bloodin different remote areas of
Africa, like in Malawi, but it'snot that a drone flies in and
picks up by air. It's the dronesthat go in to pick up the
injured, and these are still inthe test phase. They're more
(14:15):
like a remote controlled car. Sowhen you hear about using drones
to remove injured servicemembers from the battlefield in
Ukraine. It's not in the air,yeah, it's not there yet. It's
remote controlled car. But Ithink that we have the vision of
that, you know, and I've seenprototypes at conferences of the
(14:36):
drone that will be able to pickup the injured service member
and return them. So we've seenthat. We've also seen, and this
is the part that really blowsthe sort of the people who made
the rules, the role one, therole two, the role three,
hospitals, there's differentprocedures and services that are
available at each of thoseroles. And what we've seen out
(14:58):
of necessity, and you. Crane, wesee surgeries and resuscitative
services taking place closer tothe point of injury, so that we
have role two is really likerole two plus, and we see that
then they're even having to holdthe ill and injured the wounded
longer in those places than wewould ideally like. The other
(15:23):
thing, again, with the lack ofair superiority, they're moving.
Ukraine is a big geographicspace. It's connected by a rail
network, and so they're moving.
They're wounded, ill and injuredby train. And so then it's, how
do you equip a train to serve asan ambulance or as as a mobile
(15:47):
hospital? And so we're seeing alot of that. I feel, I boy, I
could really, actually talkabout this all day. And so in
that, one of the small changes,and we published an article on
this, there's a device calledmoves SLC. It's made by a
Canadian company, and is aportable ventilator. And it's
proprietary, right? It's not apiece of American equipment.
(16:10):
It's not a military piece ofequipment. They're a civilian
company. They were great to uswhen we were writing our paper.
But the reason we wrote a paperexclusively about the utility
and interest in moves. SLC wasbecause when we did our
interviews with the Ukrainianhealthcare workers, they I
didn't know what moves was, andit kept coming up. And I would,
(16:35):
you know, I'd probe a little,and they'd tell me the good and
the bad.
Jim Cardoso (16:40):
They were aware, but they were using it. Oh,
absolutely, they were
Tracey Perez Koehlmoos, Ph (16:43):
100% enamored with it, to the point
that my colleague and I, who didthe research, we got on the
plane to fly back to the States.
And I said, we need to get apaper out about moves, because
people need to know that this isa capability in military
medicine and Battlefieldmedicine that's now necessary.
It didn't exist before it doesexist. Now you know it needs to
(17:06):
be and I know that there'sAmerican units that are testing
and investing in moves, theMarine Corps, the 82nd airborne
and others, are interested inhaving this capability and and
again, because it's proprietary,there's challenges with if
you're in Ukraine towards thefront and a piece breaks, how do
(17:28):
you fix that? Yeah, if you needmore filters, because it's a
ventilator, how do you fix that?
And so there's a lot of workarounds that have been
happening, and actually movesSLC, my understanding is that
they've been helpful to theUkrainians with here. Maybe you
3d print this, right? So that,so that these newer technologies
(17:52):
are being used and they'remaking these tremendous
adaptions.
Jim Cardoso (17:58):
You know, one thing that you know, you talked about
the trains, and you talked aboutsome of the specifics to the
Ukraine Battlefield, and a lotof lessons learned coming from
that, you know, as the US looksto the future. I mean, you know,
I think we can all agree thatthe future conflict, it's not
going to look like G watt, it'sgoing to be something different,
(18:20):
and maybe something likeUkraine, Russia, maybe something
different from that, but we'renot sure where it's gonna be.
And really, I mean, probably themost likely places I think most
people would consider would beeither the Middle East,
Southwest Asia, or the Far East.
Even more likely China, the IndoPAYCOM. Okay, so now you're in
the Indo PAYCOM. You don't haverailways. Rail.
Tracey Perez Koehlmoos, P (18:46):
Don't think it's that the United
States is investing in railcars. I don't think that it's
something that we're seeing.
Yeah, now
Jim Cardoso (18:55):
I'm tracking that.
I guess I'm just saying, I'm I'mjust leaning into what. So what,
what? So what specific lessonsis the US looking at now to
structure how it does fight thatfuture fight? So it's taking
these lessons from Ukraine, andthen what are they doing now to
kind of
Tracey Perez Koehlmoos, (19:13):
right?
But there's additional thingsthat we're doing specifically
for indo, PAYCOM, right? Yeah,yeah, yeah, where it's water,
yeah. So I think it's fairlywell known. And again, if we
look back at COVID, you know themercy and the comfort, there was
a beautiful shot of, I think,the comfort sailing into New
York Harbor, right? They weregoing to sail in, save the day,
alleviate all sorts ofchallenges being faced in New
(19:38):
York at the early stage of thepandemic, when horrible,
horrible things were happeningthere, it didn't quite the
shipboard thing didn't work outquite as well as they thought it
would. Ships are actually a badenvironment for for viral
infections. So they ended upstanding at the Javits Center,
which was great, but theproblem. With the mercy and the
(19:59):
comfort as a hospital ships isthey are big and they're slow,
so the US Navy has ordered fouror six really rapid dual
surgical suite ships, again,with the tyranny of distance.
And there's a part of me thatdoesn't understand how you can
be on a ship. I've been on aship, maybe a cruise ship, but
(20:22):
it's, I don't know how yousustain an operating room going
over the seas at any amount ofspeed. So there's definitely,
you know that. So that'ssomething that we're working on.
We're working on other types ofair, back, to be done with more,
more air back over that more. Iknow that the army was testing,
(20:44):
almost like a mini Osprey aslike a replacement vehicle. And
I, I've been, you might knowmore about that.
Jim Cardoso (20:54):
That's moving forward. Yeah, the the flora,
basically, and that's going tobe, it's kind of, it's a tilt
rotor. It's the same, sameconcept that technology is a
little bit different, producedby the same company which made
the Osprey, but yet, hopefully,
Tracey Perez Koehlmoos, PhD, (21:07):
it doesn't suffer from like decades
of you know, real challenges indevelopment like the Osprey was
not only that the Osprey had,but that the Osprey sort of
continues. I love the I lovehaving to work for the Marine
Corps. Boy, do I love an Osprey.
And
Jim Cardoso (21:24):
you know, truth be told, I was an initial cadre
Osprey pilot for the Air Force,so I'm a big fan of the Osprey,
but, and I can also say that thethe new aircraft, the it's
called the v2 80, they've takenthe lessons learned from the
Osprey, and so they've made someadjustments, which are really
smart adjustments to thetechnology to address them. So I
(21:46):
think that that capability, andit's about Black Hawk size, so
it should make a really good,you know, medevac platform with
the speed of a turbopropaircraft. Well
Tracey Perez Koehlmoos, PhD (21:56):
and interesting. When I was in
Afghanistan, they were usuallyright at sort of in middle of
the war, they started usingOspreys as Cassie back medevac
requires you can do somethingtrue. Yeah, true. Back, you
could just kind of putcasualties in there. So there
(22:17):
really are efforts underway,because the Asprey is big, but
it's, you know, the fact thatyou can take off and that you
can go faster over greaterdistances again, makes it an
ideal if we're looking at war ininvacom. Additionally, the
United States has really plussedup, not just our hospital at
(22:38):
Tripler. Tripler is a majormedical center right in Hawaii,
right there in the middle of theocean, but it's the triple is
quite far from everywhere. ButGuam, where there's a brand new,
gorgeous hospital, is like,right there. Yeah, you know,
that's great location for us. Itis. I mean, capacity that way,
it's
Jim Cardoso (22:55):
right there. I mean, it's more right there, but
I mean, it's one of those thingsthat I wish they had globes
still. They we don't have globesanymore. Remember good old
globes they had that's,
Tracey Perez Koehlmoos, P (23:05):
well, I had a globe in my house.
Actually, I do have a globe inmy house, just I'm at my office
right now, so I don't have aglobe but, but it's, it's right
there, but it's still and Ilived, I used to live in South
Asia. You know, it's still afive hour flight. It's still a
seven hour flight. These arehuge distances. When
Jim Cardoso (23:23):
you look at a globe, just when the average
person, you know, they think,okay, the Pacific Ocean is kind
of big. Look at a globe, and youjust realize just how enormous
that space is. The specificocean, Right exactly. And so
when you say, I mean, you'reright, Guam is quote, it's
quote, unquote, relatively,you're right, right there. But
no, the distances are,especially in a, in a kazo vac
(23:45):
situation, the distances to, andso it does go back to, I think,
probably, you know, most likely,some of those lessons that are
learned in Ukraine that thepoint of, you know, the point of
injury, there's going to have tobe a lot more capability at the
point of injury just because ofthe distances involved, what you
think?
Tracey Perez Koehlmoos, Ph (24:02):
Yes, absolutely so. And that's where
we can do more now as well,because we have, well one we
have really brilliant andtalented medics and corpsmen
and, you know, people who arelike, right there, when things,
things happen, the
Jim Cardoso (24:20):
rest of them is going to be increased too,
because they're going to have tobe right there on a very lethal
Battlefield,
Tracey Perez Koehlm (24:27):
absolutely.
And so really, when we do talkabout moving injured people off
the battlefield with the drones,it's, do you have, like a drone
that folds over someone andgives them oxygen and blood, or
it apply some sort of pressure,and those are the sorts of
projects that are in testing anddevelopment in various stages
(24:48):
right now. Yeah, that's not thesort of research that I do, but
I do see a lot of that at adifferent conferences and events
that I go to.
Jim Cardoso (24:58):
What other innovations are you. And that'll
help prepare the US. You talkeda little bit about that, but
also some other innovation,maybe seeing that are helping
prepare the US for the for thenext fight. Either can be
technological or just, you know,just people expanding new uses
of current technology andcapability. What's being
innovative out there to prepareus?
Tracey Perez Koehlmoos, PhD, (25:18):
I think that we're doing a lot. So
we for medical records. And I'mjust going to say this, when we
transfer a patient on thebattlefield, it's a paper where
handing over paper, like afolder, is handed over. That is
unacceptable today,
Jim Cardoso (25:34):
today, that's still happening in
Tracey Perez Koehlmoos, Ph (25:37):
this moment. Wow, right now. And our
partners from Israel. Israel isa great partner to the United
States in terms of like,military medical innovations.
What they're doing is they had ahold. For those of you who can't
see because you're watching athome, that's, you know, we can
often transfer data from cellphone to cell phone. So they
(25:58):
quickly pioneered their theirsurgeon general rolled out the
he said, he's like, we're notdoing this anymore. We have to
be better than this, becausesome of the gaps are it's you
need to know the injuries in acase before that case arrives,
so that you can be prepared toreceive and operate on that
case. You also need that data sothat you can quickly assess the
(26:21):
types of injuries taking place,not just at the individual but
across your your fighting force.
So again, so you can prepare andadapt from from these systems.
But what he would the SurgeonGeneral of Israel said was,
we're not doing this paper thinganymore. So now it's, it's cell
phone touching cell phone at thepatient handoff point that they
(26:44):
just lay them on top of eachother, and they're, they're
done. They've moved on. And I, Iknow that we have to get to yes
to where we allow these sort oftechnological or AI and other
innovations into our data systemas a United States like we
really struggle as a DOD tostrike that balance between
(27:07):
protecting, particularly forhealth care, protecting the
health care data. But sometimes,if we protect too much, you
can't use that data to informprocess improvement and decision
making and improve care, whetherit's back in the United States
or on the battlefield. So thoseare some places where we are,
Jim Cardoso (27:33):
yeah, you know, I mean, and so you talked about
this earlier, but a lot oftimes, if people think about,
you know, challenges on thebattlefield, it's the lethality,
it's the weaponry. It's thedrones. We don't have air
superiority. We probably won'thave air superiority in future,
near peer, adversary conflict.
But you touched on it earlier,too, about like, kind of the
command and controlcapabilities, and then what
you're talking about now,transfer of data, the kind of
(27:54):
the data centric stuff, isequally challenging. And
sometimes when people thinkabout medicine, that's not what
they think about. They thinkabout. They think about the
tactical, you know, providingcare, operating, you know,
treating wounds and everythinglike that. But if you don't have
this, the command and controlcapability, which is going to be
compromised, and you don't havethe data transfer capability, I
mean, you could almost be doingmore harm than good in some
(28:16):
cases.
Tracey Perez Koehlmoos, PhD (28:19):
Now is with our Ukraine work. It
wasn't just that. We looked atlike injury, Injury Prevention,
disease, non battle injury. Wealso looked, I'm a health system
scientist. So we lookedholistically at the logistics,
how, how things came in,supplies came in, how people
came out. We looked at theorganization of services. We
(28:41):
looked at what telehealth reallymeant. We looked at blood
products and pharmaceuticalsafety and quality. How are we
getting what we need to thebattlefield? You know, do we
need TSA and medics kits andthat? So really looking at
what's needed in the future, andalso looking at the health and
(29:01):
wellness of your servicemembers, right? It's one of the
things that we took out ofUkraine, is they've been at war
for a long time. You know, thesort of the young people who
were enthusiastic and joined upit's to serve at first, there's
been a lot of injuries there,and so you have an older
fighting force that's less fit.
So you've got people withhypertension, on hypertension
(29:24):
meds, with lymphedema, on medsfor that, yeah, with diabetes.
So you've got, you've got thearmy of the willing out there
with and with enthusiasm, withwhatever medical challenges they
were facing prior to going intothe armies, into the front for
(29:44):
Ukraine. So it is, yeah, it's adifferent whereas we have the
luxury as a United States tosay, Listen, you know, your
blood pressure is not undercontrol. You're not deployable,
or you or you have diet. 80s,you can't join and they not that
that's a luxury, yeah,
Jim Cardoso (30:05):
and in a future, near, peer, adversary conflict,
we may not have that luxury,either we may need you know more
well able bodied or close toable bodied people.
Tracey Perez Koehlmoos, PhD (30:15):
I'm gonna cut you off. We are a
society right now. Today, we'refewer than 25% of people of
enlistment age are qualified toserve. Oh, that's you're
Jim Cardoso (30:28):
absolutely right.
I've heard that before, too.
Yeah, right.
Tracey Perez Koehlmoos, PhD, (30:31):
We I publish on that we don't have
the humans in this country tomeet our recruiting goals rather
routinely, with the exception ofthe Army, right? I know we're
going over time, with theexception of the army rolling
out the program where they canbring service members. Would be
service members in the soldierprep program, teach them how to
(30:54):
pass the asvab, give them someacademic help, and then also get
them physically fit enough toserve, because obesity is a huge
reason. Obesity in today's youthis a huge reason that people
can't serve,
Jim Cardoso (31:08):
but that soldier prep program is a band aid. I
mean, I mean that, you know,that can't be the long term
solution for I agree with, Imean, I finally agree with you
right now,
Tracey Perez Koehlmoos, PhD (31:17):
but we're doing what other countries
do, only in reverse. So when Ibelieve, when my husband was the
defense attache in Bangladesh,Bangladesh had a program where
they would bring inundernourished young men,
undernourished young men whowish to be soldiers, and they
would get them nourished and tofull fitness. Whereas we're
doing we're taking in those
Jim Cardoso (31:39):
we have to study.
We have to skinny them out. We Iand
Tracey Perez Koehlmoos, (31:44):
perhaps in our society, where dense
calories are cheap calories,right? Yeah, where we teach them
about nutrition, we teach themlike holistic fitness and health
in a way that they were nevertaught in school. And of course,
to prepare for that the Army,Navy, Air Force, Space Force and
Marine Corps. Can't do it alone.
It requires a whole nationalsecurity like that requires a
(32:07):
whole government approach. Bringback the Presidential physical
fitness test in every school inAmerica. Make those kids run the
mile once a year, right? Thosewho are fit, we stopped giving
kids awards for physicalfitness, yeah, grade school
because it made other childrenfeel badly. Well, awards do make
(32:27):
other people who don't wantawards feel badly. We need to
get back on the track of havingand this is my public health
part. There'll be no soldiers ifthere's no health in today's
youth, we've got to get back tofitness.
Jim Cardoso (32:46):
There's a researcher here at one of our
research here in GNSI. He does alot on on recruiting military
society. Is another researcherhere, USF at large, dr, Lisa
Rossiter. She you and her wouldhave a very, very good
conversation. Because, I mean,I'm almost talking to her right
now when I listen to you, she'sexactly the same way, and kind
of that holistic and whole of,not a whole government, whole of
(33:08):
society, approach to be able toenable us to feel the force that
we may need in the future,
Tracey Perez Koehlmoos, (33:14):
right?
You know, but it's also, it's aforce that we need right now.
Yes, yes. Let's be really clear.
We've published papers with someof my you may have heard, I
don't know, in April 2023,there's something about 10,000
more soldiers with obesitycoming out of COVID 19, well,
it's 20,000 more now, because wejust updated the paper, and
(33:35):
being obese, if you're on activeduty, is not benign.
Musculoskeletal injuries are theleading cause of lost duty days
and active duty service membersand when the and the bodies of
soldiers, bless them, are notdifferent from the bodies of
other humans. Because there'ssome belief that there's magic
in wearing the uniform, thatsomehow, anatomically and
(33:58):
biologically, you are nowdifferent. And it's true, the
blood cells in my body are armygreen, singing the Army song,
marching in formation. Singright now, but the reality is
Jim Cardoso (34:08):
minor Air Force blue, but continue. Okay,
Tracey Perez Koehlmoos, P (34:11):
there you go. Not sure I'm
understanding that, but it'swhen as body mass index and body
fat percentage creep up inservice members, their risk of
getting a musculoskeletalinjury, leading cost of lost
duty days skyrockets so that itis a real national security risk
(34:34):
to us, not just from those whowill serve in the future, but
from those for those who areserving with us right now, and
that doesn't make me the mostpopular girl at the working
group. I assure you, when I rollinto the DoD body composition
working group, they're like, Whydo you hate us? I'm like, I
don't hate you. I don't want youto get hurt.
Jim Cardoso (34:55):
I will. I will say for the people listening to
this, next time we do this with.
With her. We're gonna, we'regonna get a virtual because if
it's too bad you're not enjoyingthe visual flair of the emotions
that are coming through as I'mwatching her speak right now.
But it's really, it's great tohear. I mean, I like it. It's a,
it's a, it's a message that is,that is needed to be heard. And
I think it's a great point youmake. It's not just a future
(35:17):
problem. It's a now problem. Butbefore we we are a little over,
but I want to give you a chance,because we spoke yesterday, and
you talked about the importanceof the safety and quality of the
pharmaceutical supply chain. Issomething you're very passionate
about. You feel is veryimportant in the associated
national security challengesthat go with that. I want to
give you a chance to talk alittle bit about that before we
end the podcast. You
Tracey Perez Koehlmoos, P (35:37):
know, there's the part of me that
thinks you need to have me backin a couple months,
Jim Cardoso (35:41):
we may do that.
Yeah, that's not a bad idea. Theteaser I
Tracey Perez Koehlmoos, Ph (35:45):
will give all of you is we have
offshored the creation of theingredients because, because
when you make a pill, any pill,a brand name pill, a generic
pill, it's a recipe. Think of itas, like my I have a chocolate
chip cookie recipe, and when thedrug that is tested is the brand
(36:05):
name, original recipe, when mydrug comes off a patent, it
means that anybody else on theplanet can make that drug. But I
always believed, until I startedreally working in this space,
that I had a chocolate chipcookie recipe, and when I came
(36:26):
off patent, you and everyoneelse had my chocolate chip
cookie recipe, and you can makemy same chocolate chip cookies.
That is not what generic drugsare. It's it's that you take,
you eat my cookie, or you seewhat's going on, you dissect my
cookie and backwards engineer,so, you know, there's some sort
of chocolate chip, and then, youknow, there's some other
(36:46):
activating ingredients in there,and then you fill it up with
whatever you want. And a lot ofour generics come from
ingredients that are sourced inChina. We go to war. Is China
going to be selling us low costantibiotics and low cost
(37:09):
pharmaceutical products? And youjust, I'm going to leave you
with that I am happy to comeback with. This is work that
we're doing with the White Houseright now.
Jim Cardoso (37:19):
Yeah, I'm cogitating on what the future
podcast is going to look andsound like, and I have some
ideas already that are poppingin my head. So, yeah, that's a
good, good teaser, good teasertrailer that we can provide to
everybody any but as we do wrapup any final comments on what
we've been talking about today,before we wrap up the podcast,
no,
Tracey Perez Koehlmoos, PhD (37:39):
not at all. I want to thank you Jim
and USF for having me back. GoBulls, and have a great
afternoon, evening, morning,depending on wherever our
listeners. So thank you. Yeah,thank
Jim Cardoso (37:51):
you. Thank you for your time. And we'll add to
that, Go Bulls. Many thankstoday to Dr Tracy Perez colmus,
a director at the UniformedServices, University of the
Health Sciences, and proud USFalumni, we were fortunate to be
able to connect with her thisweek and really enjoy the
conversation today, next week,on at the boundary, we'll be
(38:13):
talking with Danish Colonel AlanPeterson, who holds a position
that many are likely unfamiliarWith, chairman of the coalition
at US Central Command, we'regoing to find out what it's like
for him to be posted at CENTCOMand chairing one of the largest
military coalitions in history.
The coalition formed followingthe 911 terrorist attacks with a
common purpose to fightterrorism, but has since grown
(38:35):
to 46 countries working withCENTCOM to promote peace and
stability in the Middle East,Southwest Asia and beyond. It's
going to be a great conversationyou don't want to miss. Thanks
for listening today. You likethe podcast, please subscribe
and let your friends andcolleagues know, and if you have
an idea for a future podcast,we'd love to hear from you.
(38:55):
There's a link in the show notesto get in touch with us. You can
follow GNSI on our LinkedIn andX accounts at USF, underscore
GNSI, and check out our websiteas well at usf.edu/gnsi, while
you're there, don't forget tosubscribe to our monthly
newsletter.
(39:21):
That's going to wrap up thisepisode of at the boundary. Each
new episode will feature globaland national security issues we
found to be insightful,intriguing, maybe controversial,
but overall, just worth talkingabout. I'm Jim Cardoso, and
we'll see you at the boundary.
Jim, hello everyone. Welcome to this week's
(00:14):
episode of at the boundary, thepodcast from the global and
national security Institute atthe University of South Florida.
I'm Jim Cardoso, Senior Directorfor genocide, and your host for
at the boundary today on thepodcast, we're looking forward
to speaking with Dr Tracy Perezcolmus, she's a USF alumni who's
(00:37):
now director at the UniformedServices University of the
Health Sciences in Bethesda,Maryland. Before we talk to Dr
Perez ComuS, though, we wantedto remind you that our newest
research initiative here atGNSI, the Axis of Resistance,
will debut this week on ourYouTube channel. GNSI, Research
Fellow, Dr Armond mahmoudian,will tee things off with Dr
(00:59):
Mohsin Milani, ExecutiveDirector of the USF Center for
Strategic and diplomaticStudies, Dr Malani is one of the
world's foremost authorities onIran, and his latest book,
Iran's rise in rivalry with theUS in the Middle East was
published recently. Thisdiscussion will be the first of
a series of panels andinterviews that will explore the
(01:21):
Axis of Resistance. Be sure tosubscribe to our YouTube channel
while you're there, so you don'tmiss any of them. Also this
week, registration will open forour upcoming policy dialogs,
virtual event Trans Atlanticforum on cybersecurity on June
23 GNSI will partner withresearchers and experts from the
University of Paris Saclay todiscuss areas of national
(01:44):
security concern in cyberspace.
We'll drop a link forregistration in the show notes.
Finally, GNSI, Senior ResearchFellow, Dr Jeff rogs, newest
book, The Spy in the state, wasrecently cited in an article
appearing in the Atlantic. Thearticle is titled, How spying
helped erode American trust. Thearticle explain expands on an
(02:06):
idea Rob touches on in his bookthat the business of
intelligence, aka spying, is,quote, inherently un American,
unquote, and a practice illsuited to a country that values
honesty, transparency andforthrightness. It's a good
article and an even better book,and you should check them both
(02:26):
out. We'll have Jeff on futureepisodes of the podcast to talk
about his book. Okay, it's timeto bring on our guest for
today's episode, Dr Tracy Perezcolmus. She's currently director
of the Center for HealthServices Research and doctoral
programs in preventive medicineand biostatistics. That's the
center at the Uniformed ServicesUniversity of the Health
(02:48):
Sciences, commonly referred toas usues in Bethesda, Maryland.
She's also a professor at usues,and earned both her Master's and
PhD right here at the Universityof South Florida. We're excited
to have her on the podcasttoday. Tracy, welcome to at the
boundary.
Tracey Perez Koehlmoos, P (03:06):
Thank you so much, Jim, it is always a
pleasure to get my bull go Bullson and be amongst my people. Go
Bulls. And you know, just a joythat the toolkit that I got
doing public health and healthadministration at USF has been
able to carry me into atremendously meaningful career.
(03:26):
So thank you.
Jim Cardoso (03:27):
You started to talk a little bit about your
background, obviously, yourbulls background, but tell us a
little bit more about yourbackground and your current
research. Sure.
Tracey Perez Koehlmoos, PhD, (03:36):
So my PhD is in public health. I
was an Army officer back in theday, and people often think I
was some because I work inhealth and health care. Now,
people often assume that I wassomething soft, but I was an Air
Defense Artillery officer in theArmy. I was not soft. My War was
the first Golf War, Gulf War. Iwas an army wife, and that's
(03:58):
what I was doing when I wasworking on my degrees at the
University of South Florida, Iled big programs in
international health acrossSouth Asia, before repatriating
to the United States when webecame a Gold Star Family, and I
was working for the AssistantCommandant and Commandant of the
Marine Corps in my previous job,before joining and being The
(04:19):
sort of seduced to join theUniformed Services University to
stand up a robust portfolio ofhealth services research and
take their Dr Ph and convert itto a true PhD in public health
to help meet the needs of theMilitary Health System and the
Department of Defense. So I'm afed. I always think it's
(04:41):
important for me to share thatwith you all that I'm a federal
government employee. I will tryto be as relaxed and happy as a
Fed can be when talking, butwe'll see how this goes and we
are wrapping up, in addition toa robust portfolio, a sort of
more mundane, racial, ethnicdisparities, low value. Health
Service, utilization and accessstudies. The work that we're
(05:04):
going to talk about today, Ithink, has more to do with I
have a large portfolio of workcoming out of the current
Russian Ukraine crisis. We wereasked early on the invasion. Was
February of 2022 2022 Yeah, Iwas I was asked right at the end
of 2022 to design and implementsome research that could
(05:27):
illuminate what's going on inthe health and trauma system of
Ukraine. So I am rolled intoday, prepared to talk about
those things with you.
Excellent,
Jim Cardoso (05:36):
and we look forward to it. So before we get deep
into Ukraine, let's firstdiscuss, you know, America's
most recent major combatexperience, which would be G
wat, Iraq, Afghanistan, and whatwould characterize battlefield
medical operations during thattime, which were unique to that
(05:56):
conflict, or at least, whichpossibly are not representative
of future war,
Tracey Perez Koehlm (06:03):
absolutely.
So that was really anasymmetrical conflict. We had
air superiority so that we hadthe unlimited air bridge
wherever we went. We could bringpeople in, we could bring in
supplies and equipment. We couldexit when we wanted to exit,
people were injured, and wedeveloped a norm called the
golden hour with the idea, butactually we say golden hour, but
(06:24):
it's really more a platinum 10or 15 minutes, right there at
the at the point of injury. Butwe established, along with our
colleagues at NATO, and executedreally robust systems of role
one, Rule two, role three androll four and five, being
further back and away, far awayfrom from the battlefield for
more intense care, but we wereable to move the wounded as
(06:45):
quickly as we were able aspossible, ideally by air,
preferably within an hour,getting them to definitive
surgical care To help treattheir wounds before we would
move them to a higher level ofcare. So we had some really
great we had unlimitedcommunications. And so it was
(07:08):
really just a great place tosort of execute. And there was a
lot of learning that took place.
We stood up the joint traumasystem, for example, if you've
not heard about that previously,that was a great innovation,
where, and it still meets, itstill meets once a week. It's a
(07:28):
virtual meeting, and they wouldtake a case from the battlefield
and follow that case through thesystem, in addition to
collecting the data so that realtime lessons learned could be
translated across theenterprise. It is the Institute
of Medicine declared that thejoint trauma system that we
developed during OEF and OIF wasthe ideal learning health system
(07:54):
that you take and it could besomething as simple as, hey,
surgeons down range, if youleave an extra inch of skin for
a for an amputation, this is theimprovement we can make to the
outcome for that warrior goingforward, and what it does for
that warrior for the rest oftheir life. So they were able to
(08:15):
really look at was what wasgoing on, and bring everybody
together. And again, the jointtrauma system continues. And
when COVID broke out, we wereable that, not me, some of some
of the medical leaders of theMilitary Health System were able
to commandeer, at first, thejoint trauma system, or the JTS,
(08:40):
but then they developed theirown system where they were they
brought the same methodology oflearning health system to
quickly gather informationabout, you know, burden of
disease, challenges and care ofindividuals with COVID as well
as specialty items like what todo with pregnant women, What to
(09:00):
do with children with thisdisease. So it really is a
tremendous learning healthsystem, and it came to us
through some real innovation,and people who wanted to say,
yes, because you were in themilitary, also, you know that it
was very easy for people to say,This is my chain of command, and
(09:21):
that's a great idea, but you Idon't have the power to change.
And so it was visionary leaderslike Lieutenant General Doug Rob
or, at the time Colonel JohnHolcomb, really visionary
leaders who were able to do somemeta leadership and work across
different silos to bring thejoint trauma system and the data
(09:41):
that were collected that way tolife during OEF and OIS. So we
really it was a real highlightof military medicine over that,
that those 20 years of conflict,
Jim Cardoso (09:52):
oh yeah, there's unquestionably some incredible
advances that happen across theboard. And I mean, in well, not
just, I mean, obviously web.
Nearing and targeting and how toactually execute military
operations, but also the themedical side as well. And I
mean, and I think a lot of thatwould obviously be, you've
created lessons learned for thefuture, but now shifting a bit,
(10:13):
we're seeing the future ofwarfare is, is changing or and
in some ways. And we talkedabout a little bit yesterday, is
almost Some of it's going backto the past, almost, and how
warfare was fought a centuryago, in some ways. And so what
are some of the main lessonsthat you're seeing in Ukraine
that are different from G wattand may signal challenges to the
US in the future that the US maynot be prepared to face?
Tracey Perez Koehlmoos, PhD, (10:39):
I think that we I think just in
general, we are preparing toface a lot of the things that
they're facing in Ukraine thatare very different from from
where we were. So I do want togive a shout out to my
colleagues at the UniformedServices University and
industrious providers andresearchers across the
Department of Defense, and ourcolleagues at all, like the
(11:01):
applied physics labs and thatsort of thing, that there's a
lot of work going into ourunderstanding of the future of
warfare, including very from akey point, what we've learned
from from Ukraine as well. Sosome of the lessons that we're
seeing from Ukraine is, ofcourse, and I love to say this,
(11:22):
and I said this at a meeting,and the Surgeon General of
Ukraine walked up to meafterwards and hugged me.
Because, for those of you whocan't see me, because this is a
voice issue, I'm little, likeI'm little, and people hug me
right during the pandemic, I wasquite sure that I would die,
because people couldn't stoplike seeing me being happy and
giving me a big hug. Oh, they'regoing to kill me. I'm giving
(11:44):
them the elbow they're givingyou all but the Surgeon General
of Ukraine and some of the otherleaders of Ukraine, I was at a
meeting at NATO last May, and Imade you know I was talking
about, I lead a syndicate onmedical evacuation and
repatriation. And one of thethings that I said is the golden
hour is dead. And I would wewould be remiss to talk about
(12:05):
the golden hour in the presenceof Ukrainian war fighters,
leaders and military planners,because that was an idea, that
it is an ideal, and we were ableto make it work for almost,
Jim Cardoso (12:22):
you know, 2020, 20 years, yeah,
Tracey Perez Koehlmoos, (12:24):
right, or two decades of war. But in
Ukraine, they don't own theskies. They don't own
communications, right? It's sothey've had to work with what
they have. So we see peoplelingering longer at the point of
injury. We hear heroic storiesabout Ukrainian soldiers being
(12:47):
sent forward with a pain pilland a an antibiotic, and if
they're injured, they're to takethose two things and wait to be
saved. And you have stories ofsoldiers lingering in an injured
but controversial, you know, aconflicted geographic zone, and
(13:08):
having to stay there, sometimesfor days, and perhaps try to
low, crawl their way out tosafety. And so these are the
sorts of things that we werehearing about early on from the
Ukrainians that we hear thatthey don't own there's there's
jamming, so then they can'talways rely on communication
(13:30):
techniques that were known tothem. They don't own the skies.
They don't have air superiority,so they're unable to use
helicopters to move people. Soinstead some of the innovations
that have taken places, they'lltalk about drones. And I know
when I see you're a pilot, andwhen I say the word drone, and
this is what I thought at first,is that, you know, oh, it was a
(13:51):
drone, like, like an airbornehelicopter type drone that I
would like to deliver a pizza tome, or whatever, or like that
they're using to deliver bloodin different remote areas of
Africa, like in Malawi, but it'snot that a drone flies in and
picks up by air. It's the dronesthat go in to pick up the
injured, and these are still inthe test phase. They're more
(14:15):
like a remote controlled car. Sowhen you hear about using drones
to remove injured servicemembers from the battlefield in
Ukraine. It's not in the air,yeah, it's not there yet. It's
remote controlled car. But Ithink that we have the vision of
that, you know, and I've seenprototypes at conferences of the
(14:36):
drone that will be able to pickup the injured service member
and return them. So we've seenthat. We've also seen, and this
is the part that really blowsthe sort of the people who made
the rules, the role one, therole two, the role three,
hospitals, there's differentprocedures and services that are
available at each of thoseroles. And what we've seen out
(14:58):
of necessity, and you. Crane, wesee surgeries and resuscitative
services taking place closer tothe point of injury, so that we
have role two is really likerole two plus, and we see that
then they're even having to holdthe ill and injured the wounded
longer in those places than wewould ideally like. The other
(15:23):
thing, again, with the lack ofair superiority, they're moving.
Ukraine is a big geographicspace. It's connected by a rail
network, and so they're moving.
They're wounded, ill and injuredby train. And so then it's, how
do you equip a train to serve asan ambulance or as as a mobile
(15:47):
hospital? And so we're seeing alot of that. I feel, I boy, I
could really, actually talkabout this all day. And so in
that, one of the small changes,and we published an article on
this, there's a device calledmoves SLC. It's made by a
Canadian company, and is aportable ventilator. And it's
proprietary, right? It's not apiece of American equipment.
(16:10):
It's not a military piece ofequipment. They're a civilian
company. They were great to uswhen we were writing our paper.
But the reason we wrote a paperexclusively about the utility
and interest in moves. SLC wasbecause when we did our
interviews with the Ukrainianhealthcare workers, they I
didn't know what moves was, andit kept coming up. And I would,
(16:35):
you know, I'd probe a little,and they'd tell me the good and
the bad.
Jim Cardoso (16:40):
They were aware, but they were using it. Oh,
absolutely, they were
Tracey Perez Koehlmoos, Ph (16:43):
100% enamored with it, to the point
that my colleague and I, who didthe research, we got on the
plane to fly back to the States.
And I said, we need to get apaper out about moves, because
people need to know that this isa capability in military
medicine and Battlefieldmedicine that's now necessary.
It didn't exist before it doesexist. Now you know it needs to
(17:06):
be and I know that there'sAmerican units that are testing
and investing in moves, theMarine Corps, the 82nd airborne
and others, are interested inhaving this capability and and
again, because it's proprietary,there's challenges with if
you're in Ukraine towards thefront and a piece breaks, how do
(17:28):
you fix that? Yeah, if you needmore filters, because it's a
ventilator, how do you fix that?
And so there's a lot of workarounds that have been
happening, and actually movesSLC, my understanding is that
they've been helpful to theUkrainians with here. Maybe you
3d print this, right? So that,so that these newer technologies
(17:52):
are being used and they'remaking these tremendous
adaptions.
Jim Cardoso (17:58):
You know, one thing that you know, you talked about
the trains, and you talked aboutsome of the specifics to the
Ukraine Battlefield, and a lotof lessons learned coming from
that, you know, as the US looksto the future. I mean, you know,
I think we can all agree thatthe future conflict, it's not
going to look like G watt, it'sgoing to be something different,
(18:20):
and maybe something likeUkraine, Russia, maybe something
different from that, but we'renot sure where it's gonna be.
And really, I mean, probably themost likely places I think most
people would consider would beeither the Middle East,
Southwest Asia, or the Far East.
Even more likely China, the IndoPAYCOM. Okay, so now you're in
the Indo PAYCOM. You don't haverailways. Rail.
Tracey Perez Koehlmoos, P (18:46):
Don't think it's that the United
States is investing in railcars. I don't think that it's
something that we're seeing.
Yeah, now
Jim Cardoso (18:55):
I'm tracking that.
I guess I'm just saying, I'm I'mjust leaning into what. So what,
what? So what specific lessonsis the US looking at now to
structure how it does fight thatfuture fight? So it's taking
these lessons from Ukraine, andthen what are they doing now to
kind of
Tracey Perez Koehlmoos, (19:13):
right?
But there's additional thingsthat we're doing specifically
for indo, PAYCOM, right? Yeah,yeah, yeah, where it's water,
yeah. So I think it's fairlywell known. And again, if we
look back at COVID, you know themercy and the comfort, there was
a beautiful shot of, I think,the comfort sailing into New
York Harbor, right? They weregoing to sail in, save the day,
alleviate all sorts ofchallenges being faced in New
(19:38):
York at the early stage of thepandemic, when horrible,
horrible things were happeningthere, it didn't quite the
shipboard thing didn't work outquite as well as they thought it
would. Ships are actually a badenvironment for for viral
infections. So they ended upstanding at the Javits Center,
which was great, but theproblem. With the mercy and the
(19:59):
comfort as a hospital ships isthey are big and they're slow,
so the US Navy has ordered fouror six really rapid dual
surgical suite ships, again,with the tyranny of distance.
And there's a part of me thatdoesn't understand how you can
be on a ship. I've been on aship, maybe a cruise ship, but
(20:22):
it's, I don't know how yousustain an operating room going
over the seas at any amount ofspeed. So there's definitely,
you know that. So that'ssomething that we're working on.
We're working on other types ofair, back, to be done with more,
more air back over that more. Iknow that the army was testing,
(20:44):
almost like a mini Osprey aslike a replacement vehicle. And
I, I've been, you might knowmore about that.
Jim Cardoso (20:54):
That's moving forward. Yeah, the the flora,
basically, and that's going tobe, it's kind of, it's a tilt
rotor. It's the same, sameconcept that technology is a
little bit different, producedby the same company which made
the Osprey, but yet, hopefully,
Tracey Perez Koehlmoos, PhD, (21:07):
it doesn't suffer from like decades
of you know, real challenges indevelopment like the Osprey was
not only that the Osprey had,but that the Osprey sort of
continues. I love the I lovehaving to work for the Marine
Corps. Boy, do I love an Osprey.
And
Jim Cardoso (21:24):
you know, truth be told, I was an initial cadre
Osprey pilot for the Air Force,so I'm a big fan of the Osprey,
but, and I can also say that thethe new aircraft, the it's
called the v2 80, they've takenthe lessons learned from the
Osprey, and so they've made someadjustments, which are really
smart adjustments to thetechnology to address them. So I
(21:46):
think that that capability, andit's about Black Hawk size, so
it should make a really good,you know, medevac platform with
the speed of a turbopropaircraft. Well
Tracey Perez Koehlmoos, PhD (21:56):
and interesting. When I was in
Afghanistan, they were usuallyright at sort of in middle of
the war, they started usingOspreys as Cassie back medevac
requires you can do somethingtrue. Yeah, true. Back, you
could just kind of putcasualties in there. So there
(22:17):
really are efforts underway,because the Asprey is big, but
it's, you know, the fact thatyou can take off and that you
can go faster over greaterdistances again, makes it an
ideal if we're looking at war ininvacom. Additionally, the
United States has really plussedup, not just our hospital at
(22:38):
Tripler. Tripler is a majormedical center right in Hawaii,
right there in the middle of theocean, but it's the triple is
quite far from everywhere. ButGuam, where there's a brand new,
gorgeous hospital, is like,right there. Yeah, you know,
that's great location for us. Itis. I mean, capacity that way,
it's
Jim Cardoso (22:55):
right there. I mean, it's more right there, but
I mean, it's one of those thingsthat I wish they had globes
still. They we don't have globesanymore. Remember good old
globes they had that's,
Tracey Perez Koehlmoos, P (23:05):
well, I had a globe in my house.
Actually, I do have a globe inmy house, just I'm at my office
right now, so I don't have aglobe but, but it's, it's right
there, but it's still and Ilived, I used to live in South
Asia. You know, it's still afive hour flight. It's still a
seven hour flight. These arehuge distances. When
Jim Cardoso (23:23):
you look at a globe, just when the average
person, you know, they think,okay, the Pacific Ocean is kind
of big. Look at a globe, and youjust realize just how enormous
that space is. The specificocean, Right exactly. And so
when you say, I mean, you'reright, Guam is quote, it's
quote, unquote, relatively,you're right, right there. But
no, the distances are,especially in a, in a kazo vac
(23:45):
situation, the distances to, andso it does go back to, I think,
probably, you know, most likely,some of those lessons that are
learned in Ukraine that thepoint of, you know, the point of
injury, there's going to have tobe a lot more capability at the
point of injury just because ofthe distances involved, what you
think?
Tracey Perez Koehlmoos, Ph (24:02):
Yes, absolutely so. And that's where
we can do more now as well,because we have, well one we
have really brilliant andtalented medics and corpsmen
and, you know, people who arelike, right there, when things,
things happen, the
Jim Cardoso (24:20):
rest of them is going to be increased too,
because they're going to have tobe right there on a very lethal
Battlefield,
Tracey Perez Koehlm (24:27):
absolutely.
And so really, when we do talkabout moving injured people off
the battlefield with the drones,it's, do you have, like a drone
that folds over someone andgives them oxygen and blood, or
it apply some sort of pressure,and those are the sorts of
projects that are in testing anddevelopment in various stages
(24:48):
right now. Yeah, that's not thesort of research that I do, but
I do see a lot of that at adifferent conferences and events
that I go to.
Jim Cardoso (24:58):
What other innovations are you. And that'll
help prepare the US. You talkeda little bit about that, but
also some other innovation,maybe seeing that are helping
prepare the US for the for thenext fight. Either can be
technological or just, you know,just people expanding new uses
of current technology andcapability. What's being
innovative out there to prepareus?
Tracey Perez Koehlmoos, PhD, (25:18):
I think that we're doing a lot. So
we for medical records. And I'mjust going to say this, when we
transfer a patient on thebattlefield, it's a paper where
handing over paper, like afolder, is handed over. That is
unacceptable today,
Jim Cardoso (25:34):
today, that's still happening in
Tracey Perez Koehlmoos, Ph (25:37):
this moment. Wow, right now. And our
partners from Israel. Israel isa great partner to the United
States in terms of like,military medical innovations.
What they're doing is they had ahold. For those of you who can't
see because you're watching athome, that's, you know, we can
often transfer data from cellphone to cell phone. So they
(25:58):
quickly pioneered their theirsurgeon general rolled out the
he said, he's like, we're notdoing this anymore. We have to
be better than this, becausesome of the gaps are it's you
need to know the injuries in acase before that case arrives,
so that you can be prepared toreceive and operate on that
case. You also need that data sothat you can quickly assess the
(26:21):
types of injuries taking place,not just at the individual but
across your your fighting force.
So again, so you can prepare andadapt from from these systems.
But what he would the SurgeonGeneral of Israel said was,
we're not doing this paper thinganymore. So now it's, it's cell
phone touching cell phone at thepatient handoff point that they
(26:44):
just lay them on top of eachother, and they're, they're
done. They've moved on. And I, Iknow that we have to get to yes
to where we allow these sort oftechnological or AI and other
innovations into our data systemas a United States like we
really struggle as a DOD tostrike that balance between
(27:07):
protecting, particularly forhealth care, protecting the
health care data. But sometimes,if we protect too much, you
can't use that data to informprocess improvement and decision
making and improve care, whetherit's back in the United States
or on the battlefield. So thoseare some places where we are,
Jim Cardoso (27:33):
yeah, you know, I mean, and so you talked about
this earlier, but a lot oftimes, if people think about,
you know, challenges on thebattlefield, it's the lethality,
it's the weaponry. It's thedrones. We don't have air
superiority. We probably won'thave air superiority in future,
near peer, adversary conflict.
But you touched on it earlier,too, about like, kind of the
command and controlcapabilities, and then what
you're talking about now,transfer of data, the kind of
(27:54):
the data centric stuff, isequally challenging. And
sometimes when people thinkabout medicine, that's not what
they think about. They thinkabout. They think about the
tactical, you know, providingcare, operating, you know,
treating wounds and everythinglike that. But if you don't have
this, the command and controlcapability, which is going to be
compromised, and you don't havethe data transfer capability, I
mean, you could almost be doingmore harm than good in some
(28:16):
cases.
Tracey Perez Koehlmoos, PhD (28:19):
Now is with our Ukraine work. It
wasn't just that. We looked atlike injury, Injury Prevention,
disease, non battle injury. Wealso looked, I'm a health system
scientist. So we lookedholistically at the logistics,
how, how things came in,supplies came in, how people
came out. We looked at theorganization of services. We
(28:41):
looked at what telehealth reallymeant. We looked at blood
products and pharmaceuticalsafety and quality. How are we
getting what we need to thebattlefield? You know, do we
need TSA and medics kits andthat? So really looking at
what's needed in the future, andalso looking at the health and
(29:01):
wellness of your servicemembers, right? It's one of the
things that we took out ofUkraine, is they've been at war
for a long time. You know, thesort of the young people who
were enthusiastic and joined upit's to serve at first, there's
been a lot of injuries there,and so you have an older
fighting force that's less fit.
So you've got people withhypertension, on hypertension
(29:24):
meds, with lymphedema, on medsfor that, yeah, with diabetes.
So you've got, you've got thearmy of the willing out there
with and with enthusiasm, withwhatever medical challenges they
were facing prior to going intothe armies, into the front for
(29:44):
Ukraine. So it is, yeah, it's adifferent whereas we have the
luxury as a United States tosay, Listen, you know, your
blood pressure is not undercontrol. You're not deployable,
or you or you have diet. 80s,you can't join and they not that
that's a luxury, yeah,
Jim Cardoso (30:05):
and in a future, near, peer, adversary conflict,
we may not have that luxury,either we may need you know more
well able bodied or close toable bodied people.
Tracey Perez Koehlmoos, PhD (30:15):
I'm gonna cut you off. We are a
society right now. Today, we'refewer than 25% of people of
enlistment age are qualified toserve. Oh, that's you're
Jim Cardoso (30:28):
absolutely right.
I've heard that before, too.
Yeah, right.
Tracey Perez Koehlmoos, PhD, (30:31):
We I publish on that we don't have
the humans in this country tomeet our recruiting goals rather
routinely, with the exception ofthe Army, right? I know we're
going over time, with theexception of the army rolling
out the program where they canbring service members. Would be
service members in the soldierprep program, teach them how to
(30:54):
pass the asvab, give them someacademic help, and then also get
them physically fit enough toserve, because obesity is a huge
reason. Obesity in today's youthis a huge reason that people
can't serve,
Jim Cardoso (31:08):
but that soldier prep program is a band aid. I
mean, I mean that, you know,that can't be the long term
solution for I agree with, Imean, I finally agree with you
right now,
Tracey Perez Koehlmoos, PhD (31:17):
but we're doing what other countries
do, only in reverse. So when Ibelieve, when my husband was the
defense attache in Bangladesh,Bangladesh had a program where
they would bring inundernourished young men,
undernourished young men whowish to be soldiers, and they
would get them nourished and tofull fitness. Whereas we're
doing we're taking in those
Jim Cardoso (31:39):
we have to study.
We have to skinny them out. We Iand
Tracey Perez Koehlmoos, (31:44):
perhaps in our society, where dense
calories are cheap calories,right? Yeah, where we teach them
about nutrition, we teach themlike holistic fitness and health
in a way that they were nevertaught in school. And of course,
to prepare for that the Army,Navy, Air Force, Space Force and
Marine Corps. Can't do it alone.
It requires a whole nationalsecurity like that requires a
(32:07):
whole government approach. Bringback the Presidential physical
fitness test in every school inAmerica. Make those kids run the
mile once a year, right? Thosewho are fit, we stopped giving
kids awards for physicalfitness, yeah, grade school
because it made other childrenfeel badly. Well, awards do make
(32:27):
other people who don't wantawards feel badly. We need to
get back on the track of havingand this is my public health
part. There'll be no soldiers ifthere's no health in today's
youth, we've got to get back tofitness.
Jim Cardoso (32:46):
There's a researcher here at one of our
research here in GNSI. He does alot on on recruiting military
society. Is another researcherhere, USF at large, dr, Lisa
Rossiter. She you and her wouldhave a very, very good
conversation. Because, I mean,I'm almost talking to her right
now when I listen to you, she'sexactly the same way, and kind
of that holistic and whole of,not a whole government, whole of
(33:08):
society, approach to be able toenable us to feel the force that
we may need in the future,
Tracey Perez Koehlmoos, (33:14):
right?
You know, but it's also, it's aforce that we need right now.
Yes, yes. Let's be really clear.
We've published papers with someof my you may have heard, I
don't know, in April 2023,there's something about 10,000
more soldiers with obesitycoming out of COVID 19, well,
it's 20,000 more now, because wejust updated the paper, and
(33:35):
being obese, if you're on activeduty, is not benign.
Musculoskeletal injuries are theleading cause of lost duty days
and active duty service membersand when the and the bodies of
soldiers, bless them, are notdifferent from the bodies of
other humans. Because there'ssome belief that there's magic
in wearing the uniform, thatsomehow, anatomically and
(33:58):
biologically, you are nowdifferent. And it's true, the
blood cells in my body are armygreen, singing the Army song,
marching in formation. Singright now, but the reality is
Jim Cardoso (34:08):
minor Air Force blue, but continue. Okay,
Tracey Perez Koehlmoos, P (34:11):
there you go. Not sure I'm
understanding that, but it'swhen as body mass index and body
fat percentage creep up inservice members, their risk of
getting a musculoskeletalinjury, leading cost of lost
duty days skyrockets so that itis a real national security risk
(34:34):
to us, not just from those whowill serve in the future, but
from those for those who areserving with us right now, and
that doesn't make me the mostpopular girl at the working
group. I assure you, when I rollinto the DoD body composition
working group, they're like, Whydo you hate us? I'm like, I
don't hate you. I don't want youto get hurt.
Jim Cardoso (34:55):
I will. I will say for the people listening to
this, next time we do this with.
With her. We're gonna, we'regonna get a virtual because if
it's too bad you're not enjoyingthe visual flair of the emotions
that are coming through as I'mwatching her speak right now.
But it's really, it's great tohear. I mean, I like it. It's a,
it's a, it's a message that is,that is needed to be heard. And
I think it's a great point youmake. It's not just a future
(35:17):
problem. It's a now problem. Butbefore we we are a little over,
but I want to give you a chance,because we spoke yesterday, and
you talked about the importanceof the safety and quality of the
pharmaceutical supply chain. Issomething you're very passionate
about. You feel is veryimportant in the associated
national security challengesthat go with that. I want to
give you a chance to talk alittle bit about that before we
end the podcast. You
Tracey Perez Koehlmoos, P (35:37):
know, there's the part of me that
thinks you need to have me backin a couple months,
Jim Cardoso (35:41):
we may do that.
Yeah, that's not a bad idea. Theteaser I
Tracey Perez Koehlmoos, Ph (35:45):
will give all of you is we have
offshored the creation of theingredients because, because
when you make a pill, any pill,a brand name pill, a generic
pill, it's a recipe. Think of itas, like my I have a chocolate
chip cookie recipe, and when thedrug that is tested is the brand
(36:05):
name, original recipe, when mydrug comes off a patent, it
means that anybody else on theplanet can make that drug. But I
always believed, until I startedreally working in this space,
that I had a chocolate chipcookie recipe, and when I came
(36:26):
off patent, you and everyoneelse had my chocolate chip
cookie recipe, and you can makemy same chocolate chip cookies.
That is not what generic drugsare. It's it's that you take,
you eat my cookie, or you seewhat's going on, you dissect my
cookie and backwards engineer,so, you know, there's some sort
of chocolate chip, and then, youknow, there's some other
(36:46):
activating ingredients in there,and then you fill it up with
whatever you want. And a lot ofour generics come from
ingredients that are sourced inChina. We go to war. Is China
going to be selling us low costantibiotics and low cost
(37:09):
pharmaceutical products? And youjust, I'm going to leave you
with that I am happy to comeback with. This is work that
we're doing with the White Houseright now.
Jim Cardoso (37:19):
Yeah, I'm cogitating on what the future
podcast is going to look andsound like, and I have some
ideas already that are poppingin my head. So, yeah, that's a
good, good teaser, good teasertrailer that we can provide to
everybody any but as we do wrapup any final comments on what
we've been talking about today,before we wrap up the podcast,
no,
Tracey Perez Koehlmoos, PhD (37:39):
not at all. I want to thank you Jim
and USF for having me back. GoBulls, and have a great
afternoon, evening, morning,depending on wherever our
listeners. So thank you. Yeah,thank
Jim Cardoso (37:51):
you. Thank you for your time. And we'll add to
that, Go Bulls. Many thankstoday to Dr Tracy Perez colmus,
a director at the UniformedServices, University of the
Health Sciences, and proud USFalumni, we were fortunate to be
able to connect with her thisweek and really enjoy the
conversation today, next week,on at the boundary, we'll be
(38:13):
talking with Danish Colonel AlanPeterson, who holds a position
that many are likely unfamiliarWith, chairman of the coalition
at US Central Command, we'regoing to find out what it's like
for him to be posted at CENTCOMand chairing one of the largest
military coalitions in history.
The coalition formed followingthe 911 terrorist attacks with a
common purpose to fightterrorism, but has since grown
(38:35):
to 46 countries working withCENTCOM to promote peace and
stability in the Middle East,Southwest Asia and beyond. It's
going to be a great conversationyou don't want to miss. Thanks
for listening today. You likethe podcast, please subscribe
and let your friends andcolleagues know, and if you have
an idea for a future podcast,we'd love to hear from you.
(38:55):
There's a link in the show notesto get in touch with us. You can
follow GNSI on our LinkedIn andX accounts at USF, underscore
GNSI, and check out our websiteas well at usf.edu/gnsi, while
you're there, don't forget tosubscribe to our monthly
newsletter.
(39:21):
That's going to wrap up thisepisode of at the boundary. Each
new episode will feature globaland national security issues we
found to be insightful,intriguing, maybe controversial,
but overall, just worth talkingabout. I'm Jim Cardoso, and
we'll see you at the boundary.
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