TARA to the Rescue
"Today is a blur for me," says Terry Dover, Chief Warrant Officer 3, fresh from temporary duty. "I walked into my office over there, and I said, 'Where's all my stuff? Did I get fired while I was gone?'"
Thankfully, it was just another move. His papers and belongings lie boxed in a new office. A framed photo of his smiling family sits on the unfamiliar desk. A carved Polynesian mask from a trip to Hawaii glares from the wall with an open-mouthed scowl, bemoaning its latest excursion in cardboard.
Dover himself is used to being on the go. He and colleagues on the Technology Assessment and Requirements Analysis (TARA) team have experienced steady growth and inevitable changes over the past few years. Dover is Project Manager for Clinical Technologies and the TARA Team Lead, Integrated Clinical Systems PMO.
TARA falls under the U.S. Medical Materiel Agency (USAMMA), a key component of the U.S. Army Medical Research and Materiel Command. USAMMA manages strategic-level medical logistics and provides medical equipment for Active Component, Army Reserve and National Guard forces. Comprising a full-time team of 14 and drawing on a corps of expert consultants from the Office of the Surgeon General, the TARA team conducts thorough analyses of medical treatment facilities. It assesses clinical operations; workload requirements; technical operations; and equipment maintenance, use and life cycle. TARA translates those findings into recommended process improvements and equipment replacement plans. Since 1995 the program has a recognized cost savings or avoidance of $231 million for the Army Medical Department in service and maintenance contracts, equipment purchases, group buys and environmental hazard reduction.
No wonder TARA is in demand -- and on call around the clock.
"Because of the time zone difference," Dover says, "there is work 24/7. Now we're doing all the COCOM [Combatant Command], or trying to," he continues. "We just picked up SOUTHCOM [Southern Command] this last year. We've been working with CENTCOM [Central Command] since 2008. We expect AFRICOM [Africa Command] to come on board in the next few years based on what we see happening there."
Dover's team charts an ambitious schedule. It is slated to assess at least seven Army Medical Centers and Hospitals this year alone. By year's end the TARA team will have zigzagged across the country from Maryland to Kentucky, Texas, Georgia, Washington, Alaska and California. In past years the team has deployed to such far-flung locales as Korea, Kuwait, Afghanistan, Iraq and Honduras.
But TARA isn't just going in circles. The team has made vital changes to outdated doctrine at medical treatment facilities worldwide. Dover cites the increased use of and reliance on CT scans as a prime example.
"CTs were not the standard," he says. "But if you look at how and when that doctrine was written, it is very dated. We changed things dramatically when we went into the Gulf War, but even more so with our current conflicts. The CT became essential [toward assessing] the types of trauma we are seeing now."
"When you have a person who is unconscious or with a blast injury, you cannot really diagnose internally what is going on," Dover explains. "With a CT you can see everything to some degree, and you can perform a CT scan in a couple of minutes -- know what is broken, what is not broken, where things may be bleeding or not bleeding. That becomes critical when you go into surgery."
Dover and his team understand that CT's benefit extends beyond the operating room, as the resulting scans provide important feedback to field combat units.
"If we see certain head injuries on a CT," he says, "we know the armor is not doing the job. Or, maybe it's doing the job but missing this part of it. So people are going to go back and say, 'Look, we know blast injuries are doing this. We are protecting the skull, but we have all these other problems.'"
CT is just one tool in TARA's growing arsenal. Dover's overriding mission is to assemble joint teams to better understand how different forces' facilities might operate.
"The intent is to pool [experts] from different areas," Dover says, "so when we walk through the doors [of any] facility, that gives us instant credibility. There are some nuances how the Army does things, how the Air Force does things and how the Navy does things, but ultimately how they treat patients is really the same. It is just getting through the operational piece and figuring that out."
Col. Kelly Wolgast has worked in every capacity imaginable -- as a team member and TARA recipient, in addition to being Commander of Evans Army Community Hospital at Fort Carson, Colorado. She bears out the team's reliance on authoritative consultants.
"When you have a radiologist speaking to radiology people about radiology things," says Wolgast, "those conversations tend to go very quickly, because everybody understands each other. When I speak about clinical systems and nursing care, well, as the Senior Nurse Executive in the U.S. Army Medical Command, that's my role and responsibility, and I am perceived as an expert in that, so that's a good thing. You're already over the credibility hump."
For those facing new assignments, a TARA assessment can outline a facility's capabilities, enabling incoming personnel to quickly get up to speed. Last winter the team traveled to Soto Cano Air Base in Comayagua, Honduras, to evaluate the medical element at Joint Task Force-Bravo (JTF-B) in advance of a new logistics chief. What the team found was a facility in need of logistical guidance.
JTF-B is wholly dependent on generators for its power. The climate is hot and humid, with rain half the year -- conditions hard on equipment. In lieu of local support, base personnel must send the equipment stateside for maintenance. And if a crisis occurs, humanitarian or otherwise, staff must pull field equipment from the clinic.
In just one week Dover and 10 team members combed through JTF-B, evaluating the facility's nursing and operations, its equipment and laboratory, its diagnostic imaging, and its image archival and transferal system. The resulting report included an eight-page inventory of more than 150 items, from operating tables to defibrillators to battery chargers, listing manufacturers, model numbers, life expectancy and replacement dates for each piece of equipment. This list will serve as a replacement and acquisition plan. TARA also streamlined the cumbersome equipment replacement process and made specific recommendations in other areas, from training to staffing to record-keeping, all with an eye on improving safe operations and the quality of care.
U.S. Air Force Maj. Andrea Ryan, the incoming Logistics Chief, reported to JTF-B four months after the assessment but had plenty of praise for what Dover's team was able to achieve in its short time at the facility.
"Chief Dover has been nothing short of amazing," says Ryan. "The TARA team was able to assess the equipment and put together a replacement schedule, ensuring that critical medical equipment used in delivering health care to our deployed members is the best it can be and within safety and regulatory management controls."
"[That] support for field operations is more than any medical logistics officer could ask for."
TARA is working as fast as it can to meet the growing demand.
"The demand is pretty high," Wolgast admits, "but we can only do so many a year. So we look at the schedule and focus on places that emerge as high need -- for instance, a place that had a natural disaster [see sidebar, "Natural Disaster, Manmade Solutions"] or some sort of facility failure. We could do a visit like that."
Dover keeps his suitcase and rucksack handy, just in case.
For more information on the TARA program, visit http://www.usamma.army.mil/tara.cfm.